Unreamed intramedullary nail versus external fixation in grade III open tibial fractures.

BACKGROUND: The optimum method for skeletal stabilization of severe open fractures of the tibial shaft remains controversial. METHODS: We compared the results of the AO unreamed tibial nail (URTN) with external fixation (Ex-Fix) in the treatment of patients with a grade III injury of the tibial diaphysis. Thirty patients were retrospectively reviewed, with a mean follow-up of 25 months (range, 12-56 months). Seventeen patients were treated with external fixation (grade IIIA, 12 patients; grade IIIB, 4 patients; and grade IIIC, 1 patient) and 13 with a URTN (grade IIIA, 6 patients; grade IIIB, 6 patients; and grade IIIC, 1 patient). Both groups were comparable with respect to age, gender, fracture severity, and Injury Severity Score. RESULTS: Mean time to full weight bearing was 37.4 weeks in the Ex-Fix group versus 22.2 weeks in the URTN group (p = 0.0069, t test). Seven patients in the Ex-Fix group required further surgery for nonunion versus two in the URTN group. There were four significant pin track infections. Removal of URTN was required in one case of deep infection. CONCLUSION: This study supports the use of the URTN over external fixation in the treatment of severe open tibial fractures.