Recapitulation of primary nailing in open diaphyseal fractures of tibia


  • Pradeepkumar Theeppainthan Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
  • Thayumana Sundaram Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
  • Prabhakaran Anbalagan Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
  • Selvakumar Pandiyan Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
  • Chitarth Rajasekaran Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
  • Hemnath Pandiyan Department of Orthopaedics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India



Primary nailing, Tibia, Open fractures


Tibia fractures are the commonest long bone fracture, most commonly resulting from high velocity injury. We investigated whether primary nailing in open tibia fractures were producing satisfactory outcomes and we compared the outcomes in terms of fracture union and rates of infection. We identified 202 citations related to our searches from our key words, out of which 89 were original articles, which were eligible and others were case reports and review articles. We found 4 from these references which had the parallel inclusion criteria and were reviewed. All 4 studies had almost similar time period for the fracture union. Infection rates in this study were directly related to the severity of the grade of injury, which were commonly experienced in grade III injuries. In conclusion, our analysis had no significant difference in postoperative healing duration, implant failure rates, postoperative infection and secondary operation rates in primary nailing for open tibia fractures.



Briel M, Sprague S, Heels-Ansdell D, Guyatt G, Bhandari M, Blackhouse G, et al. Economic evaluation of reamed versus unreamed intramedullary nailing in patients with closed and open tibial fractures: results from the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT). Value Health. 2011;14:450–7.

Melvin JS, Dombroski DG, Torbert JT, Kovach SJ, Esterhai JL, et al. Open tibial shaft fractures: I. Evaluation and initial wound management. J Am Acad Orthop Surg. 2010;18:10–9.

Fischer MD, Gustilo RB, Varecka T. The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury. J Bone Joint Surg Am. 1991;73:1316-22.

Gustilo RB, Anderson JT. Prevention of infection in the treatment of on thousand and twenty five open fractures of long bones: retrospective and prospective analyse. JBJS Am. 1976;58:453-8.

Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type 3 (Severe) open fractures: a new classi cation of type 3 open fractures. J Trauma. 1984;24:742-6.

Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Joint Surg. 1986;68:877-87.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.

Choudhary BM, Amer S, Kumar RD, Vanchi PK. Management of Open Tibial Shaft Fractures Treated By Primary Intramedullary Interlocking Nailing. IOSR-JDMS. 2015;14:52-6.

Seron S, Rasool MN. Outcomes of intramedullary nailing for open fractures of the tibial shaft. SA Orthop J. 2018;17(1):24-9.

Abdelaal M, Kareem S. Open Fracture Tibia Treated by Unreamed Interlocking Nail. Long Experience in El-Bakry General Hospital. Open J Orthop. 2014;4:60-9.

Joshi D, Ahmed A, Krishna L, Lal Y. Unreamed interlocking nailing in open fractures of tibia. J Orthop Surg (Hong Kong). 2004;12(2):216-21.

Keating JF, O'Brien PJ, Blachut PA, Meek RN, Broekhuyse HM. Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. J Bone Joint Surg. 1997;79:334-41.

Bach AW, Hansen ST. Plates versus external fixation in severe open tibial shaft fractures: A randomized trial. Clin Orthop Relat Res. 1989;241:89–94.

Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swiontkowski MF. Treatment of II, IIIA and IIIB open fractures of the tibial shaft: A prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998;12:1–7.

Hobrook JL, Swiontkowski MF, Sanders R. Treatment of open fractures of the tibial shaft: Ender nailing versus external fixation: A randomized, prospective comparison. J Bone Joint Surg Am. 1989;71:1231–9.

Tornetta P, Bergman M, Watnik N, Berkowitz G, Steuer J. Treatment of grade IIIB open tibial fractures: A prospective randomized comparison of external fixation and non-reamed locked nailing. J Bone Joint Surg Br. 1994;76:13–9.

Wanson TV, Spiegel JD, Sutherland TB, Bray TJ, Chapmann MW. A prospective evaluation of the Lottes nail versus external fixation in 100 open tibial fractures. Orthop Trans. 1990;14:716.

Finkemeier CG, Schmidt AH, Kyle RF, Templeman DC, Varecka TF. A prospective, randomized study of intramedullary nails inserted with and without reaming for treatment of open and closed fractures of the tibial shaft. J Orthop Trauma. 2000;14:187–93.

Donnally CJ, Lawrie CM. Primary Intra-Medullary Nailing of Open Tibia Fractures Caused by Low-Velocity Gunshots: Does Operative Debridement Increase Infection Rates? Surgical Infections. 2018;19(3):273-7.

Henkelmann R, Frosch KH, Glaab R, Lill H, Schoepp C, Seybold D, et al. Infection following fractures of the proximal tibia. A systematic review of incidence and outcome. BMC Musculoskelet Disord. 2017;18(1):481.

Mudiganty S, Daolagupu AK. Treatment of infected non-unions with segmental defects with a rail fixation system. Strategies Trauma Limb Reconstr. 2017;12(1):45–51.

Singh A, Jiong-Hao JT, Wei DT, Liang CW, Murphy D, Thambiah J. Gustilo IIIB Open Tibial Fractures: An Analysis of Infection and Nonunion Rates. Indian J Orthop. 2018;52(4):406–10.

Young S, Lie SA. Risk Factors for Infection after 46,113 Intramedullary Nail Operations in Low- and Middle-income Countries. World J Surg. 2013;37(2):349–55.

Cheng H, Chen BP. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt). 2017;18(6):722–35.

Court Brown CM, Christie J, McQueen MM. Closed Intramedullary Tibial Nailing: Its use in closed and Type I open fractures. J Bone Joint Surg. 1990;72B:605-11.

Karlström G, Olerud S. Ipsilateral fracture of the femur and tibia. J Bone Joint Surg Am. 1977;59:240–3.

Lefaivre KA, Guy P, Chan H, Blachut PA. Long-term follow-up of tibial shaft fractures treated with intramedullary nailing. J Orthop Trauma. 2008;22(8):525-9.

Fong K, Truong V. Predictors of non-union and reoperation in patients with fractures of the tibia: an observational study. BMC Musculoskelet Disord. 2013;14:103.

Mehmood M, Deshpande S, Khan SM, Singh PK, Patil B, Rathi R. Epidemiology of Delayed Union of Long Bones. J Trauma Treat. 2017;6:370.

Weber WJ. Factors Associated With Development of Nonunion or Delayed Healing After an Open Long Bone Fracture: A Prospective Cohort Study of 736 Subjects. J Orthop Trauma. 2016;30(3):149-55.

Lua JYC, Tan VH, Sivasubramanian H, Kwek EBK. Complications of Open Tibial Fracture Management: Risk Factors and Treatment. Malaysian Orthop J. 2017;11:18-22.

Teitz C, Carter C, Dennis H, Frankel V. Problems associated with tibial fractures with intact fibulae. J Bone Joint Surg. 1980;62:770-6.






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