Treatment of the Open Tibial Shaft Fractures: a comparison of the Ilizarov external fixator and unreamed interlocking intramedullary nail

Wang, Jin Man; Roh, Kwon Jae; Yun, Yeo Hon; Kim, Dong Jun; Yoo, Jae Doo; Kim, Byeong Geun

Abstract

Open fractures of the tibial shaft have a high incidence of complication and often result in poor outcomes. The most common method of stabilization is the external fixation by way of the Ilizarov method but the small diameter interlocking intramedullary nailing has also been introduced. The purpose of this study is to analyze the result of Ilizarov method and to compare its results with those of delayed intramedullary nailing used in the treatment of open tibial shaft fractures. We analyzed 81 patients with open tibial shaft fractures, treated using Ilizarov external fixator, or by delayed locked intramedullary nailing between January 1987 and December 1994. The follow-up period was an average 14.5 months. Out of the 81 patients, 58 patients were treated by nails and 23 patients by Ilizarov external fixators. Both groups were given the same initial management but the operation of the nailing group was delayed until proper soft tissue coverage and healing of the wound were evident. In the Ilizarov method group, 58 fractures obtained union within 26 to 53 weeks (average of 32.8 weeks) and in the nailing group, 23 fractures showed union within 14 to 51 weeks (average of 21.2 weeks). There was a significant difference between the two groups (P<0.05). Complications in the Ilizarov group included 4 nonunions, 12 delayed unions, 3 malalignments, 14 wound infections and 13 stiff ankles. There were no nonunion, 10 delayed unions, 8 malalignments, 6 wound infections and 11 stiff ankles in the nailing group. In this study, the Ilizarov group had more delayed unions and nonunions took a longer period of time to obtain the union, and had a more limited range of motion in the ankle, than the nailing group. The nailing group was easier to manage, especially in the soft tis-sue procedure, and it did not require a high level of compliance while having a relatively low risk of malunion.