Comparison of Early Management of Compound Grade 2 and 3A (Gustilo-Anderson) Fractures of Tibia Shaft using Primary Intramedullary Nailing and Placement of Antibiotic Bone-Cement Beads, with that of External Fixator Application

摘要

Introduction: Compound fractures of tibia have been conventionally managed by debridement and external fixation, followed by intra medullary nailing or Ilizarov technique after few months. Definitive surgery is delayed in the early stages, as it may cause infections and additional soft tissue damage. But external fixators have their own set of complications. Hence a technique of antibiotic coated intramedullary nail (locked or unlocked) has been advocated. Methodology: Total 30 patients with grade 2 & 3 A (Gustilo-Anderson) compound tibia fractures were selected for the study. Group 1 was operated with antibiotic coated intramedullary nails. Group 2 was operated with external fixators application and later with intra medullary nailing. Results: The infection rate after nailing was 6.67% in group 1 (1out of 15) and 40% (6 out of 15) in group 2 (p=0.02 i.e. statistically significant).The timing to healing (cortical bridging) was 4.5 months (2 - 8.5months) in group 1 and 7.5 (3-18) months in group 2. (p=0.02i.e. statistically significant).The overall complication rate was 60% (9/15 cases) for group 2 and 26.67% (4/15 cases) for group 1 (p=0.03 i.e. statistically significant).Results of primary nailing with antibiotic impregnated cement are superior to delayed nailing after initial external fixation. Conclusion: Primary nailing with antibiotic impregnated cement method is biologically active with greater advantages compared with existing methods of treatment in grade 2 & 3A compound tibia fractures. Clinical results are better with a lower infection rate and a less hospital stay.