Session VII - Tibia

Reamed Nailing of Grade IIIB Open Tibial Fractures

John Keating, FRCS; Piotr Blachut, FRCS(C); Peter O'Brien, FRCS(C); Charles Court-Brown, FRCSEd, Royal Infirmary, Edinburgh, Edinburgh, Scotland

Methods: Reamed intramedullary nailing was carried out on 57 grade IIIB open tibial fractures in 55 patients. Significant bone loss was present in 28 (49%) fractures at the completion of the debridement.

Results: The mean time to union was 43 weeks (range, 14 to 94 weeks). Union occurred at a mean time of 32 weeks if there was no bone loss and at 45 weeks with bone loss. Thirteen fractures (23%) had revision nailing and 15 fractures (26%) required bone grafting. Fractures complicated by infective problems healed at a mean time of 53 weeks. Infective complications occurred in 10 (17.5%) fractures. Four of these were early, and occurred within 6 weeks of injury. The remaining 6 occurred more than 4 months after the injury and were designated as late infective complications. Nine were controlled with appropriate intervention, and one patient had an amputation for osteomyelitis.

Discussion: Reamed nailing of grade IIIB open tibial fractures is considered a controversial method of treatment. Further surgery to treat nonunion and deep infaction is commonly required. We have developed algorithms based on our experience to deal with both problems. Unreamed nailing has been advocated as being safer but clinical data on their use has been limited. Results in the present series are comparable to or better than results obtained with unreamed nails or external fixation. Functional outcome was satisfactory.

Conclusion: Reamed nailing is a satisfactory treatment for grade IIIB open tibial fractures.