This paper reports on the results of intramedullary nailing in open tibial fractures. We studied 20 patients (18 men, 2 women) with open fractures of the tibia diaphysis treated with intramedullary nailing between 1998–2002. The mean age at surgery was 29 years (range 18–57 years). Fractures were the result of motor vehicle accidents (12 cases), car accidents (4 cases), or falling from a height (4 cases). We treated 5 type É, 11 type ÉÉ and 4 type ÉÉÉÁ fractures (Gustilo classification). Patients were operated within the first 8 hours after injury. The mean follow-up was 22 months. The treatment protocol included extensive and thorough cleansing of the wound and aggressive debridement, intramedullary nailing and wound closed primarily, when possible, and somministration of parenteral prophylactic antibiotics. The mean hospital stay was 6 days, and the mean time of healing was 25 weeks. The protocol management included also early postoperative mobilization of the knee and of the ankle joint and toe touch weight bearing till the second post-op day. Complications in this group included 3 infections, in one case we had to perform an osteotomy of the fibula and bone grafting because of delated healing and in 2 cases we had to remove failed screws. In the last follow-up examination, the range of motion of the knee and ankle joints was quite normal in the majority of the patients. Success rate in this study compares favourably with other groups of patients treated with “less aggressive” methods. The overall complication rate (including infection) was not higher in the open fractures treated with nailing compared with other operative methods. This technique allowed early mobilization on a partial weight-bearing regimen and rapid recovery. There were few re-operations only. These results suggested that intramedullary-nailing technique is at least as effective, if not more so, than external fixation for the treatment of open fractures of the tibia, since the method has been found to be safe, and complication rate is acceptable.
