Primary locked intramedullary nailing versus ilizarov fixation for gustilo type I–IIIA open tibial shaft fractures: a prospective comparative study

Background: Open tibial shaft fractures are challenging injuries with substantial risks of infection, delayed union, and functional impairment. Primary locked intramedullary nailing (PLIN) and Ilizarov fixation are commonly used definitive treatment options. The objective of the study is to compare the clinical, radiological, functional outcomes and complications of these two techniques in Gustilo–Anderson type I–IIIA open tibial shaft fractures. Methods: This prospective comparative observational study was conducted at Sylhet M.A.G. Osmani Medical College Hospital, Bangladesh, from April 2023 to March 2025. Seventy patients aged 18–65 years were included and equally allocated to PLIN (Group A, n=35) and Ilizarov fixation (Group B, n=35). Operative time, postoperative pain, weight-bearing status, fracture union, complications, and functional outcomes were assessed. Functional outcome was evaluated using the Karlström–Olerud score. Results: The mean operative time was significantly shorter with PLIN than Ilizarov fixation (71.14±10.92 vs. 101.86±20.51 minutes; p=0.001). At one-month, full weight bearing was achieved in 51.4% of PLIN patients versus 100.0% of Ilizarov patients (p=0.001). At six months, union was achieved in 100.0% and 94.3% of patients, respectively (p=0.493), with mean union times of 18.25±2.17 and 19.42±2.82 weeks (p=0.094). Complications were significantly more frequent with Ilizarov fixation (p=0.002). Good functional outcomes were observed in 77.1% of PLIN and 51.4% of Ilizarov patients (p=0.079). Conclusions: Both techniques achieved satisfactory outcomes; however, PLIN demonstrated shorter operative time and fewer complications, while Ilizarov fixation provided earlier full weight bearing.