Abstract
This prospective study included 236 open tibial fractures treated by unreamed AO nailing at three to four days after injury. Ten patients were lost to follow-up and 24 were excluded. We reviewed 202 consecutive open tibial fractures treated between January 1994 and December 2000. The mean age was 31 years (18 to 66) and 152 patients were men. There were 74 Gustilo grade-I, 66 grade-II, 32 grade-IIIA and 30 grade-IIIB fractures. The soft tissue injuries were managed by delayed primary closure, split skin graft or local flap. Most fractures were stabilised by unreamed nailing and statically locked.
Below-knee casts were applied routinely for six weeks. Full weight-bearing was permitted and maintained 6 to 12 weeks after the operation. In 16 patients (8%), union was delayed, but union occurred within 12 to 30 weeks in 194 patients (96%). Nonunion was observed in eight fractures (4%). Functional union occurred in all patients. Ten (5%) had mild knee pain. Acceptable shortening was noted in seven cases (3.5%) and varus/valgus angulations in 12 (6%). In two patients the nail was too long and required exchange. Eight locking screws bent or broke. There was no sepsis but three wounds were superficially infected. Compartment syndrome developed in one patient. Twelve additional operations (exchange nailing, bone grafting, fibular osteotomy and dynamisation) were performed for delayed unions and nonunions. Seven additional operations were undertaken for surgical errors where the nail was too long, there was early excessive rotation, or there were missed locking screws.
The delay in final treatment of open tibial fractures allows safe selection of patients for secure and cost-effective unreamed intramedullary nailing, with minor complications.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at PO Box 47363, Parklands, Johannesburg 2121, South Africa.
