Abstract
Purpose: The evaluation of the results of intramedullary nailing of open fractures of tibial shaft, which have been initially treated with external fixation.
Material & Method: Between 1997–2003, in 58 open fractures of tibial shaft (Gustillo type II & IIIa), the initially applied external fixation was replaced by an intramedullary nail type Russell-Taylor or Grosse-Kempf, either due to delay in union progress or due to frame‘s loosening. The conversion of external fixation to intramedullary nail was performed between 12th–15th week (average: 14th week), in two stages (1st stage: removal of EX.FIX, 2nd stage: insertion of I..N); with 13–22 days interval between the stages. In all cases, no elements of infection were noticed. In 45% of the patients bone grafting was performed at the time of nail‘s insertion. 37 patients were men and 21 were women, aged 19–52 years old (average: 31,7yrs). All patients were treated by the same surgical team and followed-up routinely.
Results: Union was achieved in 85% of the fractures, usually between 16–23 weeks (average: 18,7 weeks) from nail‘s insertion. In 7 cases, another operation was needed. Bone grafting in five, exchange of nail in two. Neither infection nor DVT was noticed. 82% of patients started sociallizing within 4 weeks, while 79% returned to pre-injury activities.
Conclusions: In cases that the union progress of the externally fixed open fractures of tibial shaft is not satisfactory; the conversion of external fixation to intramedullary nail seems to be a reliable option. The key points for the success of the method are timing and conditions of that conversion.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
