HOW SHOULD THE OPEN TIBIA FRACTURES BE TREATED? A RETROSPECTIVE COMPARATIVE STUDY BETWEEN INTRAMEDULLARY NAILING AND BIOLOGIC PLATING

Abstract

Background: In this retrospective study our purpose was to compare two treatment alternatives clinically.

Methods: Forty-five patients having grade I or II open tibia fractures were consisted in this study. Twenty-five of them, treated via minimal invasive plate osteosynthesis (MIPO), comprised group I. The latter 20 cases, treated via partial reamed intramedullary nailing (PR-IMN), called as group II. Aggressive debridement of all necrotic soft tissue and bone was performed primarily for all cases in the emergency room at admission to hospital. Definitive fixation was performed on average 3rd days (0 – 5) for group I and 2.5th days (0 – 4) for group II. Clinical evaluation was made on the basis of modified Ketenjian’s criteria.

Results: There were no significant differences between groups for demographic data (age, gender) and fracture type (p> 0.05). Full weight bearing periods of the group I and II were 21 and 22.4 weeks respectively. Non-union in one case of group I was revised by using circular external fixator. In another case implant removal was performed due to chronic osteomyelitis. Mal-union was detected in another case.

In group II, two cases needed implant revision with intramedullary nail in one and circular external fixator in another for non-union. Mal-union in one case and chronic osteomyelitis in another were late complications of group II. At the last follow up satisfaction rates were as; 21/25 in group I and 18/20 in group II clinically. There was no significant difference between both groups with regard to clinical evaluation (p> 0.05).

Conclusion: The clinical results of both groups were similar to each other. Although intramedullary nailing is the first choice, MIPO can be an alternative method for open tibia fractures.