External fixation and secondary intramedullary nailing of open tibial fractures. A randomised, prospective trial

J Bone Joint Surg Br. 1997 May;79(3):433-7.

Abstract

We performed a prospective, randomised trial in 39 patients with open tibial fractures treated initially by external fixation to compare cast immobilisation (group A) and intramedullary nailing (group B) as a sequential protocol planned from the onset of treatment. The results showed that group B achieved faster union (p < 0.05) than group A with less malunion or shortening and a greater range of movement. Patients treated by intramedullary nailing required fewer radiographs and outpatient visits (p = 0.0015) and had a more predictable and rapid return to full function. We feel that these severe fractures are better treated by delayed intramedullary nailing and that this has an acceptable rate of complications.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Casts, Surgical
  • Emergencies
  • External Fixators*
  • Female
  • Fracture Fixation, Intramedullary*
  • Fractures, Open / diagnostic imaging
  • Fractures, Open / surgery*
  • Fractures, Ununited / epidemiology
  • Humans
  • Male
  • Prospective Studies
  • Radiography
  • Tibia / diagnostic imaging
  • Tibia / surgery
  • Tibial Fractures / diagnostic imaging
  • Tibial Fractures / surgery*
  • Treatment Outcome