Incidence Of Early Infection In Open Tibial Shaft Fractures Treated With Internal And External Fixation

AIM - The aim of the present study was to analyse early infection rates following internal and external fixation in open tibial shaft fractures. OBJECTIVES The objectives of our study are 1.To Evaluate early infection rates in open tibial shaft fractures following debridement and skeletal stabilisation.2.To compare early infection rates among internal and external fixation in open tibial shaft fractures.3.To compare infection rates among the different sub-types of open tibial shaft fractures after internal or external fixation. 4.To find out if any correlation between time to surgery and early infection rate exists. METHODOLOGY For this purpose 82 open tibial shaft fractures were chosen from January 2011 to December 2013 that presented to us in the emergency department attended by one of our orthopaedic units. Seventy -two fractures were included in the study as per the inclusion criteria. Nine fractures were excluded, as they were treated with amputation. One patient expired in the intensive care unit and hence not included in analysis. RESULTS The infection rate following internal fixation in severe grade (Type 3B) fractures were 50. The similar rates in smaller wounds (Type 1 to 3A) ranged from 0 -11. This association was significant as the p-value was 0.05 as per the Fishers exact test. The overall early and late infection rates in open tibial shaft fractures treated with any form of stabilisation were high in the grade 3B group (28 and 22). The infection rates after internal fixation in 3A wounds were only 11 and Type 2 wounds were 0.CONCLUSIONInternal fixation can be chosen as a definitive form of fixation following debridement in types 1 to 3A fractures. We did not find any correlation with time to surgery and early infection rates as most of the patients were operated before 24 hours. In type 3B fractures, as the infection rates following internal fixation is high (50), we concluded that external fixation is a better option in these fractures as internal fixation tends to compromise endosteal blood supply as in the case of an intra-medullary nail or periosteal vascular supply as in the case of a plate. Further it may carry the risk of intra-medullary bacterial contamination.