Unilateral external fixator as the primary and definitive treatment modality in type IIIB open tibial fractures: A retrospective study

Introduction: Intramedullary (IM) nailing is considered the method of choice for treatment of closed diaphyseal fractures of the tibia. However, there is controversy in the literature regarding the best way of managing open type III B fractures. The aim of this study was to evaluate the effectiveness of unilateral external fixator as primary and definitive treatment for Gustilo and Anderson compound grade III B open tibial fractures. Materials and Methods: This was a retrospective case series of patients with Gustilo and Anderson compound grade III B open tibial fractures treated in our institution from Jan 2010 to May 2014. All the cases that were treated with unilateral tubular external fixators within 24 hours of injury were included. Serial debridement and early coverage if required, was done within seven days. Dynamisation and partial weight bearing was started at 8-10 weeks on observing early signs of fracture healing. Weight bearing with patellar tendon bearing cast was permitted at 12–16 weeks, on visualization of bridging callus and continued till radiological and clinical union. Results: There were 31 males (83.7%) & 6 females (16.2%) with Gustilo IIIB fractures with a mean age of 37.43± 8.92 years and a standard error of 0.55. The commonest mode of trauma was road traffic accidents followed by fall from height & direct trauma to the limb. All the patients were operated in emergency within 24 hours with debridement of wound and primary external fixation. The average time to union was 22.13 ±2.68, superficial pin track infection occurred in 11 cases & deep infection leading to loosening of Schanz screw was seen in two patients. Delayed union was seen in two patients whereas, non-union was seen in three patients requiring secondary procedures. Conclusion: The results show that unilateral external fixators can be used as primary and definitive treatment for compound type IIIB tibial shaft fractures with satisfactory outcomes. These are particularly helpful in resource limited setups, where the operating surgeons may not have a wide range of implants and instrumentation at their disposal owing to low financial profile of patients.