Fixation Of Compound Fractures Of Tibia By Intermedullary Nail After The Golden Period

Patients often reach the hospital late after passage of golden hours (initial 6 hours) after sustaining high-velocity injuries. The decision of internal fixation in compound fractures of the tibia becomes a formidable challenge in patients reaching the hospital late. The purpose of the present study was to find out if internal fixation could be safely undertaken in these patients.Thirty patients, having 30 compound fractures (10 Type II, 15 type III A and 5 IIIB), which were internally fixed after 6h but within 24h after injury, were included in the present analysis. Follow-up ranged six to eighteen months.Result: Overall infection rate noted was (n = 4) 13.3% (0% in II, 6.66%in IIIA and 6.66% in IIIB). Nonunion was seen in two fractures. Functional evaluation using Katenjian's criteria, showed 73% (22 fractures of 30) good to excellent results.Conclusion: Satisfactory results may be obtained in compound fractures even if fixed after the golden period, provided strict protocol such as aggressive debridement, prophylactic antibiotic coverage, early soft tissue reconstruction and timely bone grafting is followed. The primary coverage of the wound is discouraged.