Objectives: To compare the rates of deep infection, flap failure and nonunion after temporary internal fixation (TIF), with temporary external fixation (ex-fix) in the management of Gustilo-Anderson (GA) type IIIB open tibia fractures. Design: Retrospective comparative cohort. Setting: Level 1 trauma center. Patients/Participants: 64 consecutive patients with a GA type IIIB open diaphyseal tibia fracture (OTA/AO 42) were treated between May 2014 and May 2016. 47 patients (TIF = 24; ex-fix = 23) met the inclusion criteria and underwent two-stage reconstruction. Definitive fixation was with an intramedullary nail.Intervention: Temporary fracture stabilization at the first stage debridement was achieved with either TIF with a plate, or ex-fix.
Main Outcome Measurement: Deep infectionResults: There were 4 complications in the ex-fix group (3 infection and 1 nonunion) and 2 complications in the TIF group (1 infection and 1 flap failure). Multiple regression modelling revealed infection (p=0.610), nonunion (p=0.918) and flap failure (p=0.112) were not significantly associated with the mode of temporary fixation or other demographic and treatment variables. The odds ratio of patients treated with TIF developing an infection compared to those treated with an ex-fix was 0.29 (95% CI 0.03 to 3.01).Conclusion: TIF of type IIIB open diaphyseal tibial fractures appears to be a safe alternative to conventional external fixation.
Level of Evidence: Therapeutic Level III
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