Primary (Immediate) versus Secondary (Delayed) Nailing in the Management of Gustillo-Anderson Type 3A Open Tibial Fractures – A Comparative Study

Comparison of Immediate and Delayed Nailing in Gustilo-Anderson Type IIIA Open Tibial Fractures

Abstract

Objective: To compare the outcomes of open tibial fractures managed with immediate versus delayed intramedullary nailing in adults. Study Design: Prospective Cohort study. Settings: Department of orthopedic surgery, Mayo hospital, Lahore Pakistan. Duration: January to December 2023. Methods: 60 patients (30 in each cohort) were observed. In primary (one-staged) nail group, intramedullary nailing was performed after debridement. In secondary (two-staged) nail group, initial debridement and external fixation were done, followed by conversion to intramedullary nailing after one week. Bone and soft tissue infection, radiological union, and functional outcome were observed after surgery. Results: Of the 60 patients, 48 (80%) were males and 12 (20%) were females. Mean age was 32.24 ± 10.76 years, ranging from 17 to 60 years. The right tibia was involved in 42 (70%) patients while left in 18 (30%). Road Traffic Accident (RTA) caused 46 (76.6%) cases, followed by firearm injuries 7 (11.6%) and falls 4 (6.6%). Mean union time in single-staged nail group was 12.67 ± 5.36 weeks compared to 13.18 ± 3.61 weeks in two-staged group. There was no significant difference in union time between the groups (p=0.226). No correlation existed between age and union time (p=0.478), while a significant negative association between soft-tissue infection and union time was observed (p < 0.001). Outcomes between groups showed no significant difference (p=0.827). Conclusion: Primary nailing can be safely and effectively performed in Gustilo-Anderson type IIIA open tibial-shaft fractures under antibiotic cover and timely debridement.