Abstract: Background: Open fractures of the tibia pose complex challenges in orthopaedic treatment. Primary intramedullary nailing with simultaneous soft tissue reconstruction has gained recognition as an aggressive approach to achieve faster bone healing and lower infection rates. However, there is a need to evaluate its effectiveness and impact on outcomes.
Aim: This prospective study to assess the functional and radiological outcomes of locking intramedullary nailing and primary soft tissue reconstruction in open fractures of both bones of the leg.
Materials and Methods: The study included 30 patients with high-grade open tibial diaphyseal fractures who underwent primary intramedullary interlocking nailing with soft tissue reconstruction. The study included patients who were aged 20 years or older, presented within 24 hours of the injury, had high-grade open tibial diaphyseal fractures (Gustilo Anderson Grade I, II IIIA, III B), had primarily reconstruct able soft tissue injuries, and were willing to undergo treatment and follow-up. Patients with an immature skeleton, fractures with intra-articular extension, Gustilo Anderson Grade III C fractures, grossly contaminated and damaged wounds, or those who refused to participate were excluded from the study. Standardized management protocols were followed, including thorough wound irrigation and debridement, skeletal stabilization, and soft tissue reconstruction. Patients were followed up at regular intervals to assess outcomes such as fracture union, infection rates, and functional parameters.
Results: This prospective study evaluated 30 cases of open tibial fractures treated with primary intramedullary interlocking (IMIL) nails. The patients had a mean age of 43.8 years, with 19 males and 11 females. Road traffic accidents were the most common cause of injury. Fractures were classified according to the Gustilo and Anderson grading system, out of the thirty cases, thirteen were grade I, nine were grade II, four were grade IIIA, and seven were grade IIIB. Primary closure, secondary closure with various techniques, and flap reconstruction were used for wound closure. No perioperative complications were observed, and the average surgery duration was 118 minutes. The average time to bone union varied based on fracture grade, with an overall average of 20.7 weeks. Dynamization was performed in cases with delayed union. Infection occurred in four cases, all of which were successfully managed with debridement and antibiotics. One case developed deep infection and osteomyelitis. The functional outcomes were assessed using modified Ketenjian, et al. criteria, with 25 patients achieving excellent or good results. Satisfactory outcomes were observed for type I and II fractures, while severe type III injuries showed mostly excellent or good results. Some patients experienced reduced range of motion, anterior knee pain, and limb length discrepancy, but overall, the results were favourable.
Conclusion: In conclusion, un-reamed intramedullary nailing with early soft tissue coverage for open fractures of the tibia results in faster healing of both soft tissues and bone, easier soft tissue coverage, improved biomechanical stability, early rehabilitation, and infection rates comparable to other methods.
