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Circular frame versus reamed intramedullary tibial nail in the treatment of grade III open tibial diaphyseal fractures

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Abstract

Background

Grade III open tibial diaphyseal fractures are challenging to treat and controversy exists on whether to treat them with an intramedullary nail (IMN) or a circular frame (CF). This study aims to compare outcomes for intramedullary nail and circular frame in the treatment of open tibial diaphyseal fractures.

Methodology

Retrospective study at a major trauma center of all patients admitted with a grade III open tibial diaphyseal fracture between January 2016 and January 2022. The primary outcome measures were major complications: non-union, malunion, refracture, DBI and amputation. Secondary outcome measures were time to union and reoperation rates.

Results

Fifty-five patients were included in the study, 32 patients in CF group and 23 patients in IMN group. There were no significant differences in the baseline demographics of patients in both groups. Major complications were recorded in 13 limbs (54%) in IMN group and in 18 limbs (56%) in CF group which were not statistically significant (p = 0.797). Deep bone infection rates were noted in 4 (12.5%) in the CF group, compared to 1 (4%) in IMN group; however, the result was not statistically significant (p = 0.240). Amputation rates as a result of infected non-unions were seen in 1 limb (4%) in IMN group and 2 limbs (6%) in CF group (p = 0.99). Median time to union was significantly shorter in IMN group at 30 weeks compared to 30 weeks for CF group (p = 0.04).

Conclusion

IMN should be the treatment of choice in the treatment of grade III open tibial diaphyseal fracture, but CF should be considered for delayed treatment and in patients with bone loss.

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Data availability

Mahmood, Aatif (2024), “Open tibial fracture”, Mendeley Data, V1, https://doi.org/10.17632/9983zrykf3.1

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Authors and Affiliations

  1. Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2GW, UK

    Aatif Mahmood, Krishnakumar Subbaraman, Moheeb Gadullah, Deepa Bose & Paul Fenton

  2. Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK

    David Hawkes

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  1. Aatif Mahmood
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  2. Krishnakumar Subbaraman
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Correspondence to Aatif Mahmood.

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Mahmood, A., Subbaraman, K., Gadullah, M. et al. Circular frame versus reamed intramedullary tibial nail in the treatment of grade III open tibial diaphyseal fractures. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03946-2

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