A Prospective Study to Compare the Outcome of Surgical Treatment of Compound Tibia Fractures by Staged Intramedullary Nailing After Preliminary External Fixation versus Primary Intramedullary Nail

Compound tibia diaphysis fractures that have extensive soft 7 tissue loss/destruction because of high energy trauma are a challenging problem (1). 8 Among all tibial fractures about 23% fractures are open and most of these are Gustilo 9 Anderson grade III (2) and most of them are due to the road traffic accident (51) Various modalities of 11 treatment were used in the past for the management of compound fracture of tibia and 12 these includes application of POP cast with window for dressing, use of external fixator 13 as definitive management till union. Material and methods-In this observational study, we stabilized compound leg fractures with external fixators, followed by interlocking nail procedures, comparing outcomes with primary interlocking nailing in 60 patients and were randomly divided into two groups of 30 each, with follow-up assessments at 1, 3, 6, and 9 months, evaluating functional outcomes based on the modified Johner Wruh's score. Result-In primary nailing, the average healing time was 19.30 weeks, with a non-union rate of 3.3%, and 33% excellent and 47% good results. In staged nailing, the average healing time was 20.87 weeks, with a non-union rate of 6.6%, and 10% excellent and 30% good results post-external fixator. Conclusion-Primary nailing facilitates early radiological union, enabling prompt weight bearing, minimal morbidity, and swift patient mobilization, offering robust fixation and rotational stability, leading to the quickest return to functional status compared to staged nailing.