OBJECTIVE: To compare unreamed intramedullary nailing (IMN) with external fixation (EF) in @entity1 with @entity1605 , IIIA, and IIIB open @entity174 of the tibial shaft. DESIGN: An inception cohort of consecutive @entity1 with @entity1605 , IIIA, and IIIB @entity174 incurred between January 1988 and March 1993 were systematically allocated into one of two treatment groups. @entity1 were treated and followed with a prospectively designed protocol. @entity1 AND SETTING: All @entity1 were skeletally mature and had incurred a @entity174 of the tibial diaphysis within twenty-four hours of presentation to the tertiary care hospital, a Level I @entity130 Center. One hundred seventy-four @entity174 in 168 @entity1 were stabilized with either IMN (104) or half-pin EF (70). There were 132 @entity1 and thirty-six @entity1 , with an average age of thirty-three years (range, 14 to 77 years). INTERVENTION: Except for the selection of the fixation device, open @entity174 care was similar in the two treatment groups. All @entity1 underwent emergent irrigation and debridement with concomitant skeletal stabilization. Cephalosporin antibiotics were administered perioperatively for twenty-four to forty-eight hours. No wounds were closed primarily. Delayed primary closure, skin grafting, and/or myoplasty were performed between three and ten days after injury. MAIN OUTCOME MEASURES: The main outcome measures were final @entity174 alignment, presence of @entity281 or @entity32 , hardware failure, time to union, and the number of operative procedures. RESULTS: The IMN group had significantly fewer incidences of @entity893 than did the EF group [8 vs. 31 percent; p = 0.00005; confidence interval (CI) = 0.18, 0.76] and had significantly fewer subsequent procedures (mean of 1.7 vs. mean of 2.7 per @entity174 ; p = 0.001; CI = 0.45, 1.59). IMN resulted in fewer @entity281 / inflammatory problems than did EF at the injury site (13 vs. 21 percent; p = 0.73; CI = -0.63, 0.45) and significantly fewer at surgical interfaces (i.e., pin sites, nail and interlocking screw insertion sites; 2 vs. 50 percent; p = 0.000; CI = 0.39, 0.60). No significant difference was found in the healing rates for the two implant groups. The more severe Gustilo injury types had longer healing times regardless of the type of fixation. CONCLUSIONS: Results suggest that unreamed interlocking intramedullary nails are more efficacious than half-pin external fixators, in particular with regard to maintenance of limb alignment. However, the severity of soft tissue injury rather than the choice of implant appears to be the predominant factor influencing rapidity of bone healing and rate of @entity130 .

Treatment of type II, IIIA, and IIIB open XXXX of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators.

@entity1 :: ('9606', 'Species') :: ['women', 'Patients', 'patients', 'PATIENTS', 'men'] @entity32 :: ('MESH:D007249', 'Disease') :: ['inflammation'] @entity1605 :: ('OMIM:217000', 'Disease') :: ['Type II'] @entity174 :: ('MESH:D050723', 'Disease') :: ['fractures', 'tibial fractures', 'fracture'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection', 'infections'] @entity893 :: ('MESH:D017760', 'Disease') :: ['malalignment'] @entity130 :: ('MESH:D014947', 'Disease') :: ['Trauma', 'injury site infection']
@entity174 :: (MESH:D050723,Disease) :: ['fractures']
