UNREAMED ROD WITH EARLY WOUND CLOSURE FOR GRADE IIIA AND IIIB OPEN TIBIAL FRACTURES - ANALYSIS OF 40 CONSECUTIVE PATIENTS

This study evaluated 40 patients with grades IIIA and IIIB open tibial fractures from July 1987 to September 1990. Aggressive debridement of all dead tissue and bone, irrigation with >9 L of fluid, and emergent intramedullary unreamed redding (mean time from the emergency room to the operating room: 4 hours 20 minutes) was performed in all patients . Surgical debridement was repeated every 48 to 72 hours until the wou nd could be successfully closed (mean time: 6.2 days). Progressive wei ght bearing in a short leg cast was allowed depending on the fracture configuration, with full weight bearing usually beginning at 6 weeks. Additional autogenous iliac crest bone grafting was performed at 2 to 4 months if required. There were 14 grade IIIA and 26 grade IIIB open tibial fractures. Thirty-nine of the 40 patients underwent follow-up u ntil union was obtained both clinically and radiographically. One pati ent was lost to follow-up. Complications included three soft-tissue in fections and two late subflap abscesses. There was no evidence of oste omyelitis in any of these cases. Aggressive debridement and early woun d closure appear to be the key in the successful use of unreamed inter locking intrameduallary rods for fixation of open tibial fractures.