CONTRIBUTING FACTORS INFLUENCING TYPE-III OPEN TIBIAL FRACTURES

Ninety-five patients with severe open tibial fractures (96 fractures) were treated with nonoperative treatment alone (NO group, n = 16), imm ediate internal fixation (I group, n = 22), delayed internal fixation (D group, n = 34), or external fixation (EF group, n = 24). The D grou p was divided into a delayed internal fixation group following nonoper ative treatment (D1 group, n = 14), and a delayed internal fixation gr oup following external fixation (D2 group, n = 20). Using the classifi cation system of Gustilo, there were 43 type IIIA, 42 type IIIB, and 1 1 type IIIC open tibial fractures. There were 17 deep infections (type IIIA, n = 3; IIIB, n = 12; me, n = 2). The difference in the deep inf ection rate (DIR) between the type IIIA and type IIIB fractures was st atistically significant (7.0% vs. 28.0%, p < 0.05). The DIRs in groups NO, I, D1, D2, and EF were 12.5, 27.3, 7.1, 35, and 4%, respectively. There was a significant difference in DIR between the D2 group and th e EF group. The DIR in the D (D1 + D2) group and group I showed no sig nificant difference. There was no relationship between the DIR and eit her Injury Severity Score or skin closure time. The authors of this st udy, therefore, do not feel there is an advantage to immediate interna l fixation over delayed procedures for Gustilo type III open fractures of the tibia. However, careful attention must be given to the applica tion of delayed internal fixation, especially intramedullary nailing, after external fixation.