The challenge of open tibial shaft fractures: When tomanage with external fixation and when to useintramedullary nailing?

Treatment of open tibial shaft fractures is challenging. External fixation (EF) is comparatively safe in treating these open injuries with the main advantages of easy application, minimal additional disruption, and convenient subsequent soft tissue repair. Tibial intramedullary nailing (IM) is optimal for the treatment of open tibial fractures. This study aims to report the outcomes of our multi-center experience in the management of open tibial shaft fractures, evaluating the efficacy and safety of using either the external fixation (EF) or intramedullary nailing (IM).In this study, clinical-radiographic results were evaluated in 26 cases of open fractures treated with an external fixator and intramedullary locking nail for the period from January 2012 to December 2016 at Level 1 trauma centers. Patients were evaluated for an average period of 12 months, observing the healing of the fracture at 1 month, 3 months, 6 months and 12 months. General assessment indicators included the direct cost of hospitalization and the times of the first surgery, full weight-bearing, and complete union. Infections and complications in union or limb alignment were compared as primary outcomes. Additionally, the number of patients who switched fixation system for various reasons was analyzed. The population we studied was predominantly male. The predominant etiology was due to traffic accidents. The type of fracture exposure was mostly type I. We mainly observed fracture healing with EF and had low complication rates. However, hospitalization health costs were high. In view of the obtained results from this study, it is clear that the type of treatment for open tibia diaphyseal fractures depends on the extent of the lesion and on the surgical manual skills of the surgeon, but in general, external fixation (EF) is a good method for preventing complications in cases of polytrauma and prevention of infection in open fractures.