Comparative Study of Intramedullary Flexible Nailing and External Fixator Result in the Management of Fractures Tibial Shaft. (Gustilo type II, type IIIA, and type IIIB)
Authors:   Department of Orthopaedic, LNCT Medical College and Sewakuj Hospital, Indore, Madhya Pradesh, India,, Soni Susheel Kumar , Patidar Sunil ,   Department of Orthopaedic, INDEX Medical College, Hospital and Research Center, Indore, Madhya Pradesh, India., Bajaj Manish ,   Department of Orthopaedic, INDEX Medical College, Hospital and Research Center, Indore, Madhya Pradesh, India., Mandovera Vaibhav ,   Department of Orthopaedic, LNCT Medical College and Sewakuj Hospital, Indore, Madhya Pradesh, India,
Published: February 2025

Background:Open tibial fractures, usually caused by high-energy trauma, are among the most common long bone fractures. Clinically, the treatment of open tibial fractures remains a major therapeutic problem for surgeons because of the poor soft tissue coverage and blood supply in the tibia, with resultant difficulties arising from infection and poor bone healing. In this study we will assess the results of intramedullary flexible nailing and external fixator in the management of fractures shaft tibia (G.A. type II, IIIA and IIIB)

Material & Methods:Twenty six patients who presented with open fractures of the tibial shaft type II, IIIA, and IIIB (Gustilo) were treated. We included the patients of both sexes, age between 18-65 years with diaphysial fractures 5cm distal to the tibial tuberosity and at least 5 cm proximal to the tibial plafond, irrespective of fibula fracture. Thirteen patients were treated by external fixator and Thirteen patients by flexible intramedullary nailing and the outcome were assessed.

Results:Mean age in our study was 36 years for flexible intramedullary nailing group and 38 years for external fixator group. Male involvement was in 69.23% (18 patients) and female involvement was 30.76% (8 patients). In present study for external fixation mean age was 38 years (25-60) , union rate was 84.4%, non–union rate 16.6% and malunion was 33.3%, Pin track infection rate was 50%., average time of union 27.08 weeks (26-30 weeks) and osteomyelitis is 16.6%. In present study results for flexible intramedullary nailing, the mean age is 36 years (20-62 years), mal-union is 8.3%, pain at nail head rate is 16.6%, average time of union is 25 weeks and Union achieved in all cases.

Conclusion:Flexible intramedullary nailing is more efficacious than external fixator in the management of fractures shaft tibia ( Gustilo type II, IIIA and IIIB). Advantages observed are maintaining limb alignment and fewer serious complication, fewer operation needed, and a better range of motion of adjacent joints obtained. It reduces hospital stay of patients and later patient can return early to work, thus minimizes psychological trauma and financial burden. Flexible intramedullary nailing has easy learing curve. External fixator group had more disability and difficulties in daily routine activity like sleeping, bathing and other social activity.

Keywords:G.A.- Gustilo Anderson Classification of Compound fracture , OM- Osteomyelitis , NA – Not Applicable, IM- Intramedullary nail.