How should open tibia fractures be treated? A retrospective comparative study between intramedullary nailing and biologic plating

BACKGROUND
In this retrospective study, our purpose was to compare two treatment alternatives clinically.
METHODS
Forty-five patients who had grade I or II open tibia fractures were included. Twenty-five of them, treated via minimally invasive plate osteosynthesis (MIPO), comprised group I. The latter 20 cases, treated via partial reamed intramedullary nailing (PR-IMN), comprised group II. Clinical evaluation was made on the basis of modified Ketenjian’s criteria.
RESULTS
Full weight-bearing periods in groups I and II were 21 and 22.4 weeks, respectively. Non-union in one case of group I was revised with circular fixator. In another case, implant removal was needed due to chronic osteomyelitis. Mal-union was detected in another. In group II, two cases needed implant revision with intramedullary nail in one and circular fixator in another for non-union. Mal-union in one case and chronic osteomyelitis in another were the late complications in group II. At the last follow-up, satisfaction rates were: 21/25 in group I and 18/20 in group II. There was no significant difference between groups (p>0.05).
CONCLUSION
The clinical results of both groups were similar. Although intramedullary nailing is the first choice, MIPO is an alternative method for open tibia fractures.

Açýk tibia kýrýklarý nasýl tedavi edilmelidir? Ýntramedüller çivileme ve biyolojik plaklama arasýnda kýyaslamalý geriye dönük çalýþma

AMAÇ
Açýk tibia kýrýklarýnda iki farklý tedavi yönteminin geriye dönük incelemeyle karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Tip I ve II açýk tibia kýrýklý 45 olgu çalýþmaya alýndý. Olgularýn 25’i (Grup I) minimal invasif plak osteosentezi (MÝPO) ile, geriye kalan 20 olgu (Grup II) kýsmi oymalý intramedüller çivi ile tedavi edildi. Son kontrolde klinik deðerlendirme modifiye Ketenjiyan ölçütler kullanýlarak yapýldý.
BULGULAR
Olgularýn tam yüklenme süreleri Grup I’de 21, Grup II’de 22,4 hafta idi. Grup I’de kaynamama saptanan bir olguya halkasal fiksatörle yeniden tespit saðlandý. Bir olguda kronik ostemiyelit geliþmesi nedeniyle tespit cihazý çýkarýldý. Bir diðer olguda da kötü kaynama saptandý. Grup II’de kaynamama geliþen iki olguya; biri intramedüller çivi ile diðeri halkasal fiksatörle yeniden tespit uygulandý. Ek olarak bir olguda kötü kaynama, bir deðerinde ise kronik osteomiyelit geliþen geç komplikasyonlardý. Son kontrolde klinik yeterlilik oranlarý; Grup I’de 21/25, Grup II’de 18/20 idi. Bu sonuçlar arasýnda anlamlý fark saptanmadý (p>0,05).
SONUÇ
Her iki grupta saðlanan klinik sonuçlar benzerdir. Ýntramedüller çiviler açýk tibia kýrýklarýnda ilk tercih olmasýna raðmen MÝPO alternatif bir tedavi seçeneðidir.