Management of Gustilo and Anderson Type I and II Open Tibial Fracture Using Delayed Primary Nailing
An Assessment of Clinical and Radiological Outcome
Keywords:
Clinical and radiological outcome, delayed primary nailing, open tibial diaphyseal fractureAbstract
Background: Open tibial fracture is one of the most common trauma emergencies. Marked delay in presentation is noticed in developing countries, especially sub‑Saharan Africa due to poor pre‑hospital care, presentation to traditional bone setters and out‑of‑pocket payment of services. Primary nailing at the time of initial debridement was noticed to have a high prevalence of infection in some series. Delayed primary nailing after a period of debridement and wound care was found to be safe with less complication rate in this study. Objective: The objective of this study is to determine the clinical and radiological outcome of management of Gustilo and Anderson (GA) Type I and II open tibial fracture using delayed primary nailing, especially in patient with delayed presentation. Methodology: Twenty‑one (21) patients with open (GA I and II) tibial diaphyseal fracture were recruited into this study. They had initial debridement and a period of wound care before subsequent nailing. All patients had tibial interlocking nailing 5–9 days post‑injury using open technique with aid of the external jig system. The patients were followed up for 9 months. Clinical outcome was assessed using Johner and Wruh’s criteria at 6 months. The radiologic outcome was assessed using Radiologic union scale for tibia fracture (RUST). Results: The M: F was 4:1 with a mean age of 37.24 ± 13.8 years. Road traffic accident accounted for 85.7% (n = 18). Marked delayed presentation was noted, only four patients (19.1%) presented within 6 h from injury. GA Type II open fracture was the most prevalent fracture type accounting for 81.9% (n = 17). The clinical outcome using Johner and Wuh’s criteria at 6 months post‑nailing showed 18 patients (86%) had excellent and good outcome. Only one patient (4.8%) had poor outcome. RUST was used to assess the rate of union following the tibial nailing. Fractures were scored at 6 weeks, 12 weeks, 6 months and 9 months. Ten patients (47.6%) were united at 6 weeks, whereas 21 (100%) had achieved union at 9 months. The average time to radiologic union was 17.3 weeks. Seven patients (33.3% n = 7) had complications. Anterior knee pain, superficial surgical site infection (SSI) and delayed union were the complication recorded. Conclusion: Delayed primary nailing of open tibial fracture produces good to excellent outcome with acceptable complication rate, especially SSI.
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