Do additional intramedullary elastic nails improve the results of definitive treatment with external fixation of open tibia fractures? A prospective comparative study

SummaryPurposeExternal fixation has been associated with a high incidence of complications and poor outcomes due to the instability and difficulty in treating open tibia fractures. We use intramedullary (IM) elastic nails to supplement the external fixator. We compared the results of fractures treated by external fixation with and without IM–elastic nail.HypothesisThe combination of external fixation with IM–elastic nails may be used as an alternative to solve problems due to the external fixators alone in open tibia fractures.MethodsGroup 1 included prospectively 26 cases (15 males and 11 females, mean age 37.5 ± 12.4 years) treated with external fixation and IM–elastic nails, whereas group 2 consisted of 28 cases (23 males and five females, mean age 30.7 ± 14.0 years) treated with standard external fixation. Functional and bone results were made using the criteria proposed by ASAMI.ResultsThe mean follow-up period was 3.96 ± 2.0 years in group 1 and 3.32 ± 2.1 years in group 2. The mean duration to external fixation and mean time to union were significantly lower in group 1 (P < 0.001). In addition, bone and functional results were significantly higher in group 1 (P < 0.01), however, pin track infections were lower in group 1 (P < 0.01).ConclusionOur results showed the improvement in outcomes with IM–elastic nails: decreased duration of external fixation need and decreased bone healing delay. Therefore, this method may be a superior alternative for preventing complications related to external fixation in open tibia fractures.Level of evidenceLevel III: prospective comparative study.