Antibiotic Impregnated Nailing in Compound Fractures of Tibia-A Prospective Study

Introduction: Antibiotic nails are taking over the traditional method of fixation of open fractures of tibia now and are becoming a treatment of choice for Gustilo Type I, II and IIIA fractures. They not only hasten the bone union as a single step procedure but also decrease the systemic side effects of parenteral antibiotics postoperatively. These nails elute the antibiotic exactly in right doses where it is needed to combat the infection and prevent a possible delayed union or hostile environment in Gustilo type I, II and IIIA compound tibial fractures. Aim: To study the clinical and radiological outcome of antibiotic impregnated Intramedullary (IM) nailing in compound tibial fractures. Materials and Methods: Twenty five adults having compound tibial shaft fractures of Gustilo Type I and Type II and IIIA were treated with antibiotic impregnated IM nails to evaluate the outcome. Data collection, compilation, and analysis performed using microsoft excel 2007. Results: Results were excellent to good in 92% (Lysholm's scale). Partial weight bearing commenced at 5.44 weeks and full weight bearing after 10.48 weeks of operation on an average. Radiological union achieved in 12 to 18 weeks (average 15.55 weeks) in all AO (Arbeitsgemeinschaft fur Osteosynthesefragen, German for "Association for the Study of Internal Fixation") group A, group B fractures with Gustilo type I injury. Complex (AO group C), while Gustilo type II took 12 to 22 weeks (average 16.69 weeks). One Gustilo type IIIA fracture showed delayed union (beyond 22 weeks). There was minimal incidence of infection [overall 24% (20% in type II-superficial in 12% and deep in 8% cases; 4% in type IIIA-deep)]. One Gustilo type IIIA fracture showed infection along the deeper tissue planes. Conclusion: Antibiotic impregnated nails can be a trustworthy alternative single stage treatment modality obviating the need of multiple procedures to achieve the bony union in open fractures of tibia.