Management of open fractures of shaft of tibia in adults using interlocking intramedullary nailing

Open fractures of tibia remain a formidable injury in today’s motorized society for two reasons- they are common and they can be very challenging fractures to care for. Treating the spectrum of bone and soft tissue injuries that accompany open fractures of the tibia requires experience and judgement; an inadequate or inappropriate treatment can lead to severe complications. The prolonged nature of treatment of open tibial fracture frequently results in disruption of all aspects of patient’s life and their expectations for improved functional outcome from treatment continues to challenge the treating surgeon. The fundamentals of management of open fractures of tibia are ; immediate wound exploration, irrigation and debridement, bony stabilisation, use of antibiotics and early soft tissue coverage as reported in various published series by Burgess AR(1), Chapman(2), Gustillo RB(3), Rhinelander(4) etc. The methods of bony stabilisation continue to be topic of controversy. Restoration of structural stability, maintenance of acceptable mechanical axis for tibial shaft with maximal functional restoration and avoid further soft tissue damage are criteria of successful treatment. The options include cast immobilisation, open reduction and internal fixation with plates and screws, external fixation and intramedullary nailing. In this study, an assessment of time required for union of fracture with intramedullary nailing was done. Also to determine the complications during course of management of open fractures with intramedullary nailing and analyse their functional outcome.