OUTCOME OF TIBIAL SHAFT FRACTURES WITH SEVERE SOFT-TISSUE INJURY TREATED BY UNREAMED NAILING VERSUS EXTERNAL FIXATION

Materials: Between 1987 and 1991, 114 fresh tibial shaft fractures wit h severe soft tissue injury, which met the inclusion criteria, were tr eated and retrospectively reviewed. There were 48 cases in the unreame d nail (unreamed tibial nail (UTN)) group and 66 cases in the external fixation (EF) group. Methods: Soft tissue injury was classified by th e Gustilo and Tscherne methods. There were 18 AO type A, 56 type B, an d 40 type C fractures. There was no significant difference in fracture type, soft tissue injury, age, and additional injury between the grou ps. Outcome was assessed using the Karlstrom score after 28 months. Re sults: There were a significantly higher number of reoperations in the EF group. Mean time to bony healing was 25.8 weeks. In the EF group, there was a 26% rate of pin tract infection, whereas 19% of cases had bolt breakages in the UTN group. In the UTN group, 40% had good result s, compared with 27% in the EF group. In the UTN group, there were sig nificantly fewer ante- and recurvatum deformities of more than five de grees. Conclusions: Treatment of tibial fractures by UTN, compared wit h EF, gave a lower reoperation rate and better functional outcome.