Retrospective comparison of postoperative infection and bone union between late and immediate intramedullary nailing of Gustilo grades I, II, and IIIA open tibial shaft fractures.

BACKGROUND

The optimal method of skeletal stabilization is still controversial. Therefore, we examined the clinical outcomes associated with late (L) versus immediate intramedullary nailing (IMN).

METHODS

This was a retrospective comparative study of trauma registry data from an emergency medical care center (university hospital). We examined 85 open tibial shaft fractures (85 patients) treated with L or immediate (I) IMN from January 2004 to December 2010. The L and I groups comprised 37 (33 men, 4 women) and 48 (44 men, 4 women) patients, respectively. The postoperative infection rate, time to bone union, and delayed union/non-union were evaluated.

RESULTS

The mean ages at the time of trauma in the L and I groups were 41.8 (18-79) and 42.0 (18-71) years, respectively; the mean follow-up periods were 15.0 (6-39) and 18.3 (8-36) months, respectively. A higher rate of postoperative infection was found in the L group than in the I group (p=0.004). Superficial/deep infection developed at a higher rate in the L group than in the I group (p=0.042 and 0.045, respectively). Among patients with Gustilo grade IIIA fractures, postoperative infection occurred at a higher rate in the L group than in the I group (p=0.008). However, the delayed union rate, non-union rate, and time to bone union were not significantly different between the groups.

CONCLUSIONS

Gustilo grade IIIA fractures had a high infection rate, which is likely due to various factors, including pin-site infection after external fixation. We think that I IMN is safer than L IMN, and it should be the treatment of choice.

LEVEL OF EVIDENCE

Retrospective comparative study, level III.