Clinical Study on Open Fractures of the Tibial Shaft

Open fractures of the shaft of the tibia occur frequently because of the progression of industrialization, Different methods of treatment have been advocated as regards the care of the open wound and the method of stabilization of the fracture fragments. The reports, published until recently, have differed with respect to rates of morbidity and end results. With this in mind, we reviewed a consecutive series of 30 open fractures of the tibia at the Department of Orthopedic Surgery of the Eulji General Hospital between 1981 and 1983 by a variety of methods. The following results were obtained. 1. The highest incidence of fractures was encountered in 3rd decades(43.3%) and male to female ratio was 4: 1. 2. The most common cause of fractures was traffic accident(66.6%). 3. The most common anatomical level of fractures was middle third of the shaft(46.7%). 4. The severity of injury was classified according to the Ellis classification as follows. Minor group, 8 cases(40%), Moderate group, 8 cases(26.7%,), Major group, 10 cases(33.3%). 5. The most common associated injury was ipsilateral fibular fracture. 6. Of 30 cases, 11 patients(36.6%) had an open wound more than 5cm in length, 10(33.3%.) between 2.5 and Scm and 4(13.4%) below 2.5cm, and primary closure after thorough debridement and copious irrigation was done in 17 cases(56.7%). 7. Pin and plaster method was applied in 3 cases of minor group and 3 of moderate group, intramedullary nailing was applied in 9 of minor group and 5 of moderate group, and Hoffmann device was applied in 10 of major group. 8. The majority of cases(66.7%) were operated on within 1 week after injury, 9(30%) between 1 and 2 weeks and 1(3.3%) between 2 and 3 weeks. 9. The fractures in middle third of the shaft of the tibia treated with intramedullary nailing revea.ed the shortest healing time(average 13 weeks). 10. Complications such as delayed union, infection and disabled joint shiffness were encountered mainly in cases with severe soft tissue injuries.