COMPARATIVE STUDY OF EXTERNAL FIXATOR AND INTRAMEDULLARY NAILING IN PATIENTS WITH GUSTILO TIBIO FIBULAR FRACTURE TYPE III A: A RANDOMIZED CONTROLLED TRIAL

Background: Gustilo type IIIA tibiofibular fractures present a significant challenge in orthopedic trauma due to extensive soft tissue damage and high risk of complications such as infection, malunion, and non-union. Optimal fixation strategy remains debated, particularly in severe open fractures. Objective: To assess and compare the clinical outcomes of intramedullary nailing (IMN) versus external fixation (EF) in the management of Gustilo type IIIA tibiofibular fractures. Study Design: Prospective randomized controlled trial. Setting: Conducted at Khyber Teaching Hospital, Peshawar, Pakistan. Duration of Study: January 2024 to June 2024. Methods: A total of 140 patients aged 18–65 years with confirmed Gustilo type IIIA tibiofibular fractures were enrolled and randomized into two equal groups: IMN group (n=70) and EF group (n=70). All procedures were performed under standardized surgical protocols. The primary clinical outcomes assessed included fracture union, malunion, non-union, infection, and need for reoperation. Follow-up assessments were conducted for at least 12 months postoperatively. Statistical analysis was performed using SPSS version 26. Chi-square test was used for categorical variables and p-values < 0.05 were considered statistically significant. Results: The IMN group showed superior clinical outcomes to the EF group. Successful union was achieved in 91.4% of IMN patients versus 78.6% in the EF group (p=0.03). Malunion rates were lower in the IMN group (4.3% vs. 14.3%, p=0.04), as were non-union (5.7% vs. 17.1%, p=0.03), reoperation (7.1% vs. 18.6%, p=0.04), and infection rates (4.3% vs. 18.6%, p=0.008). Conclusion: Intramedullary nailing demonstrated significantly better outcomes than external fixation in managing Gustilo type IIIA tibiofibular fractures, with higher union rates, fewer infections, and reduced need for reoperation. IMN should be considered a preferable option for this fracture type in appropriately selected patients.