Operative treatment of III grade open fractures of the tibial diaphysis.

UNLABELLED Open fractures, especially III grade open fractures of the tibial diaphysis, according to the Gustilo classification still remains a serious therapeutic problem. The aim of the study was to evaluate the clinical results after operative treatment of III grade open fractures of diaphysis of the tibia and to promote a new method of fracture fixation. MATERIAL AND METHODS 48 patients with open fractures of the tibial diaphysis, classified as type III A and B, according to the Gustilo classification, were operatively treated. Patients were divided into two groups depending on the manner of fracture fixation. Patients in group A (30 pts.) were treated with an external fixator and those in group B (18 pts.) with unreamed intramedullary nails. The time of the union of the fracture, problems with the union (malunion and nonunion), infection, different complications and the functional outcome were examined. Late complications and their treatment were not the object of the study. The follow-up period was at least 12 months. The results of the study showed a mean time of union of 38.4 weeks in patients in group A, and 32.8 for those in group B. Malunion was noticed in 5 (16.6%) in group A and 2 (11.1%) in group B, nonunion in 4 (13.35) in group A and in 2 (11.1%) patients in group B. Superficial infection developed in 7 (23.3%) and deep in 6 (20%) of the patients in group A and in group B in 4 (22.2%) and 2 (11.1%) of the patients. Results from the functional examination showed 26.6% excellent and the same percent of fair results in group A. In group B there were 55.5% excellent and 11.1% fair results. Different types of complications were noticed in the patients from both groups. The final results of the examination showed a shorter time of union, a lower percentage of complications and a better functional outcome in the patients in group B. Unreamed intramedullary interlocking nailing of open fractures of the diaphysis of the tibia (grade III A and B according Gustilo classification) is a relatively safe method of operative treatment with fewer complications compared with external fixation.