Open tibial shaft fractures: a comparative analysis of different methods of fixation in southwestern Greece.

A change in the method of managing open-grade-III tibial shaft fractures provided a new opportunity for a comparative study. One series of patients was treated exclusively by internal fixation and compared with another series treated with external fixation solely as well as with a series treated initially by external skeletal fixation and later by "Sarmiento walking plaster." The latter method was found to be a successful treatment and a good alternative to internal fixation for open grade-II and grade-III tibial shaft fractures when soft-tissue healing was completed. The supplementary use of the Sarmiento walking plaster had dramatically decreased the duration of hospital stay, saving the patient from an additional operation. There were no nonunions in this series. In open grade-I-II tibial shaft fractures, the deep infection rate in the cases in which internal fixation was used was significantly higher (5.4%), than that observed in the cases treated with external fixation, in which there was no deep infection. The nonunion rate was higher (22%) in the external fixation group compared with the internal fixation group (9%). The functional impairment of the ankle joint of the affected limb was less (15%) by using internal fixation than that of either the external fixation group (20%) or the group where the external fixation was changed to a Sarmiento walking plaster (35%).