Reoperation rates following intramedullary nailing versus external fixation of Gustilo Type 3A open tibia shaft fractures

Abstract

Background: Open tibia fractures are among the most difficult to manage due to the lack of soft tissue coverage and poor blood supply. This is especially true in developing settings primarily due to a lack of resources. Both locked Intramedullary Nailing (IM) and External Fixation (EF) are two possible modalities for surgical treatment of open tibia fractures. However, it is unknown at this time which one is most suitable in low resource regions especially with regards to the risk of serious complications requiring reoperation. This study was conducted to identify which method is safest and minimizes this risk in patients with open tibia fractures.

Methodology: A prospective cohort study of Gustilo 3A open tibia shaft factures treated either by intramedullary nailing or external fixation was conducted from March 2013 to February 2014 at Muhimbili Orthopaedic Institute (Dar es Salaam, Tanzania). Follow-up was conducted at 2, 6 10, 14, and 18 weeks postoperatively. The primary outcome assessed was all-cause reoperation.

Results: Fifty patients were enrolled and completed follow-up at all-time points; twenty-six were treated with IM nail and twenty-four were treated by EF. There were 9 (37.5%) EF patients who required reoperation compared to 1(3.8%) IM nail patient (p=0.004). Reasons for reoperation among EF patients were infection (2 patients), malalignment (3 patients), and delayed union (4 patients). The one IM nail patient presented with signs of infection and wound dehiscence at 14 weeks postoperatively. No patients presented with hardware failure or malrotation.

Conclusion: Treatment of Gustilo Type 3A open tibia shaft fractures with interlocking intramedullary nailing results in lower reoperation rate in the early stages of treatment compared to uniplanar external fixation.

Keywords: Orthopaedic surgery, Tanzania, Intramedullary nail, External fixation, Open tibia fracture