External fixation in open tibial fractures best evidence
This document summarizes evidence from extensive research on the treatment of open tibial fractures comparing external fixation to nailing. It finds that for type 3B open fractures with bone loss, contamination, and delayed presentation, external fixation may have lower deep infection rates than nailing. However, existing studies have had a low number of type 3B cases. A high-quality randomized controlled trial is still needed directly comparing nailing to external fixation for severe 3B open tibial fractures. External fixation can allow for repeat debridement but risks loss of alignment, while infection after nailing requires multiple surgeries. The best treatment choice depends on the specific fracture characteristics and surgeon experience.
External fixation in open tibial fractures best evidence
- 1. EXTERNAL FIXATION IN OPEN TIBIAL FRACTURES-BEST EVIDENCE Hitesh Gopalan U Clinical Asst Professor www.orthoevidence.com www.orthopaedicprinciples.com
- 2. Extensive Research Reamed Vs Unreamed External Fixation Vs Nailing Ex Fix followed by Delayed Nailing SPRINT trial, Tornetta et al.,, Bhandari et al., Petrisor et al., Schemitsch et al., Swiontkowski et al..Giannoudis et al..
- 4. External Fixation 3B Bone loss Extensive periosteal stripping Contamination Delayed Presentation
- 5. Meta analysis 5 Randomised control trials comparing Ex Fix Vs Nailing Ex Fix Vs Nailing: no difference in deep infection rates The no of patients with type 3B injuries was low(eg., SPRINT Trial) Bhandari M, Guyatt GH, Swiontkowski MF, Schemitsch EH: Treatment of open fractures of the shaft of the tibia. J Bone Joint Surg Br 2001;83:62-68 LEVEL 2.
- 6. High Quality RCT Need for a high quality RCT that compares nailing Vs external fixation in 3B fractures
- 7. Infection after IM nailing Catastrophe Multiple Surgeries Prolonged treatment Circular Fixator
- 8. Grading of Complications Reoperation Dynamisation Bone Grafting Pin tract infections Treatment for an infected IM nail
- 10. External Fixation Deep infection rates: 4-6% Loss of alignment Pin Tract Infections Union rates are similar with Nailing Vs Ex Fix Giannoudis PV, Papakostidis C, Roberts C: A review of the management of open fractures of the tibia and femur. J Bone Joint Surg Br 2006;88:281-289. LEVEL -3
- 11. Surgeon Choice Surgeons across North America Surgeons across India
- 12. Delayed Conversion Loss of alignment Shorter Duration of Ex fix Safe Interval(10-14 days) Bhandari M, Zlowodzki M, Tornetta P III, Schmidt A, Templeman DC: Intramedullary nailing following external fixation in femoral and tibial shaft fractures. J OrthopTrauma 2005;19:140-144. LEVEL- 2
- 13. Reamed nailing Vs Ex Fix Experimental data on thermal necrosis(Schemitsch et al..) Inflammatory mediator release(Il-6 and HLA DR release)- correlates well with sepsis Schemitsch EH, Kowalski MJ, Swiontkowski MF, Senft D: Cortical bone blood flow in reamed and unreamed locked intramedullary nailing: A fractured tibia model in sheep. J OrthopTrauma 1994;8:373-382
- 14. Bone Loss
- 15. Delayed Presentation Delays in Debridement Delays in Antibiotic administration External fixation: repeat debridements
- 16. Infection External fixator Antibiotic loaded cement Conversion to a Ring fixator
- 18. Infection after IM nail Removal of IM Nail ALBC Ring fixator: Excision and Bone transport
- 19. Evidence Cycle Ask Act Acquire Apply Appraise “EBM Begins and Ends with the Patient”
- 21. Thank You