Comparison of Intramedullary Nailing and External Fixation in the Treatment of Open Tibial Fractures

Background and purpose: External fixation is currently considered as a standard treatment for open tibial fractures; however, due to the long-term hospitalization and some other complications, some researchers have proposed intramedullary nailing as the alternative surgical treatment. This study was conducted to compare the treatment of open tibial shaft fractures by external fixation and intramedullary nailing. Materials and methods: This randomized controlled clinical trial was conducted on 113 patients with open tibial fractures type I and II (Gustilo classification) during a two year period. These patients were divided in two groups and 59 cases were operated using external fixation and 54 fractures were fixed with intramedullary nailing. The patients were compared for complications such as union time, delay in the union, nonunion and infection. Results: One hundred and thirteen patients (95 males and 18 females) with the age range of 18-50 years (average age: 34.3) were enrolled in this study. Among the 59 patients treated with external fixator, 8 had delayed union. Three of these eight patients suffered from the nonunion and did not have any progress in callus formation till 6 months after the treatment. On the other hand, among the patients (54 cases) treated with intramedullary nailing, 2 cases suffered from the delayed union and one had nonunion. The difference between the two methods of treatment in delayed union and nonunion situation was not statistically significant (P>0.05). Conclusion: Due to the reduced hospital stay in intramedullary method and the necessity of doing repeated surgery and applying intramedullary nailing when the patients are not treated with external fixation, the researchers recommend intramedullary nailing as the first option in treating such patients.