Comparison of the Outcome of Intramedullary Nailing Versus External Fixator Fracture Repair in Gustilo Type IIIA Tibio Fibular Fracture

Objective: To compare the outcome of intramedullary nailing versus external fixator fracture repair in patients presenting with Gustilo Type IIIA tibiofibular fracture. Study Design: Cross-sectional study. Place and Duration of Study: Department of Orthopaedics, Jinnah Postgraduate Medical Center, Karachi Pakistan, from Feb to Nov 2020. Methodology: A total of 200 patients were included. Patients were divided into two Groups. In Group-1, intramedullary nailing was done. In Group-2, uniplanar external fixation was done. Both Groups were followed up for six months for assessment of bone union. Results: The mean age in the Intramedullary Nailing (IMN) Group was 39.21+6.24 years and in the External Fixator (EF) Group mean age was 37.48+8.41 years. In our study, it was found that 81(81%) patients in the EF-Group showed bone union, while 92 patients in the IMN-Group showed bone union. Malunion occurred in 10 in the EF-Group, while only six in the IMN Group. Non-union of bone was unfavourable in the 18 patients of EF- Group and 7 in the IMN-Group. The infection rate was also higher (16%) in patients treated with EF. We noted a significant association between union, non-union, infection and mode of treatment with the p-value of 0.023, 0.019 and 0.046, respectively. Conclusion: Bone union outcome of Gustilo IIIA open tibial shaft fractures appear superior when treated by Intramedullary Nailing technique compared to External Fixation.