ADVANTAGES OF UNREAMED NAILING IN GRADE 3 B OPEN TIBIAL FRACTURES COMPARED WITH EXTERNAL FIXATION

Between 1987 and 1993, 41 grade 38 open tibial shaft fractures were tr eated with the unreamed tibial nail (URTN n = 22) or an external fixat or (FIX n =19). The method of treatment was left to the choice of the operating surgeon. Three below the knee amputations were performed, th ree patients died, and three were lost to follow-up. In all, 32 patien ts were followed up to union or at least for 1 year. There were no sig nificant statistical differences between the two groups (P<0.2, chi-sq uared, t-test) with respect to fracture type, fracture location, age, gender or accompanying injuries. The URTN group showed significantly b etter results regarding time to full weight-bearing (URTN 11+/-4 weeks ; FIX 20+/-11 weeks, P<0.01 M-W) Mann-Whitney Test, number of reoperat ions (URTN 1.04; FIX 2.89; P<0.01 M-W), isolated bone grafting (URTN 3 /22; FIX 8/19; P<0.05 chi-squared), and average Karlstrom and Olerud s core (URTN 30+/-4; FIX 26+/-5; P<0.05 M-W). In all, 15/17 URTN patient s and only 6/15 FIX patients achieved unlimited walking distance (P<0. 01 M-W). Time to bony union, infection, and nonunion were not signific antly different between groups.