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Treatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing

  • Trauma Surgery
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Abstract

Introduction

The aim of this study was to compare the radiographic results and clinical outcome of unreamed tibial nailing (UTN) and Ilizarov external fixation (IEF) for the treatment of type IIIA open fractures of the tibia.

Materials and Methods

Sixty-one patients with open type IIIA tibial shaft fractures were treated with an IEF (n = 32) or UTN (n = 29). Both groups were compared for union time, secondary outcomes of nonunion, infections, mechanical failure of the implant, and malunion.

Results

The average time-to-bone healing was 19 weeks (range 14–23 weeks) for IEF and 21 weeks (range 16–36 weeks) for UTN; it was significantly shorter in the IEF group (P = 0.039). One patient had refracture in the IEF group. Malunion occurred in four patients for each group. Posttraumatic osteomyelitis occurred in two patients in the IEF group and in three patients in the UTN group. In the IEF group, additional surgical procedures were indicated in three cases including sequestrectomy (n = 1), and pin replacement (n = 2). In the UTN group, seven patients needed additional surgery including bone grafting (n = 3), nail exchanged (n = 1), and posttraumatic osteomyelitis (n = 3).

Conclusion

The results of the current study showed that IEF technique had a notable incidence of pin-tract infection, joint contracture, and shorthening related to treatment of the delayed union. The UTN technique had the disadvantage of a posttraumatic osteomyelitis and delayed union requiring additional surgery. We believe that the decision to use IEF or UTN should be made on a case-by-case basis.

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Acknowledgment

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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Authors and Affiliations

  1. Orthopedic Department, Medical Faculty, Yeditepe University, Istanbul, Turkey

    Muharrem Inan

  2. Orthopedic Department, Medical Faculty, Dr Erciyes University, Kayseri, Turkey

    Mehmet Halici, Mehmet Tuncel & Sinan Karaoglu

  3. Orthopedic Department, Medical Faculty, Dr Mersin University , Mersin, Turkey

    Irfan Ayan

  4. Orthopedic Department, Yeditepe University Medical School, 34100, Istanbul, Turkey

    Muharrem Inan

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  1. Muharrem Inan
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  2. Mehmet Halici
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  3. Irfan Ayan
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  4. Mehmet Tuncel
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  5. Sinan Karaoglu
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Correspondence to Muharrem Inan.

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Inan, M., Halici, M., Ayan, I. et al. Treatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing. Arch Orthop Trauma Surg 127, 617–623 (2007). https://doi.org/10.1007/s00402-007-0332-9

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  • DOI: https://doi.org/10.1007/s00402-007-0332-9

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