Outcomes of Early Intramedullary Nail Fixation for Open Tibial Shaft Fracture

Abstract

Background: Open tibial shaft fractures necessitate immediate treatment. Because of the potential of infection, treatment of open tibial shaft fractures is debatable. It is suggested that intravenous antibiotics and fracture debridement be administered within 6 to 24 hours. Few studies have looked at outcomes when surgical therapy is given more than 24 hours after the fracture occurs. Aim of the study: The purpose of this study is to identify the risk factors for nonunion and infection after early intramedullary nailing in an open tibial shaft fracture. Methods: This study was conducted in TMSS Medical College, Bogura, Bangladesh. A retrospective study looked at open tibial shaft fractures treated with primary intramedullary nailing, from January 2021 to January 2022. The study included 42 patients who were admitted to the study institution. All collected data was entered into a Microsoft Excel Work Sheet and analyzed in SPSS 11.5 using descriptive statistics. Results: Forty-two patients (42 fractures) were included: 7 Gustilo type I, 18 type II, 12 type III-A, and 5 type III-B. Infection occurred in eight patients (19%). At the latest follow-up, one patient showed signs of non-union. Infection risk did not linked with Gustilo (p = 0.53) or AO type (p = 0.66). The time between trauma and wound debridement was substantially greater in infected patients (p = 0.049). Forty fractures (95.2%) healed in a mean of 6.9 6.1 months (range, 2-40). Non-union was associated with AO type (p = 0.05) but not with Gustilo type (p = 0.07). Conclusion: The only factor impacting infection risk was the length of time between treatments. Non-union status was tied to AO comminution grade. Primary intramedullary nailing appeared to be reliable if treated early and with thorough debridement. The benefits are early restoration of weight-bearing and a reduced patient load.

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