Unreamed rod with early wound closure for grade IIIA and IIIB open tibial fractures: analysis of 40 consecutive patients.
This study evaluated 40 patients with grades IIIA and IIIB open tibial fractures from July 1987 to September 1990. Aggressive debridement of all dead tissue and bone, irrigation with > 9 L of fluid, and emergent intramedullary unreamed rodding (mean time from the emergency room to the operating room: 4 hours 20 minutes) was performed in all patients. Surgical debridement was repeated every 48 to 72 hours until the wound could be successfully closed (mean time: 6.2 days). Progressive weight bearing in a short leg cast was allowed depending on the fracture configuration, with full weight bearing usually beginning at 6 weeks. Additional autogenous iliac crest bone grafting was performed at 2 to 4 months if required. There were 14 grade IIIA and 26 grade IIIB open tibial fractures. Thirty-nine of the 40 patients underwent follow-up until union was obtained both clinically and radiographically. One patient was lost to follow-up. Complications included three soft-tissue infections and two late subflap abscesses. There was no evidence of osteomyelitis in any of these cases. Aggressive debridement and early wound closure appear to be the key in the successful use of unreamed interlocking intrameduallary rods for fixation of open tibial fractures.