Outcomes of Primary Definitive Internal Fixation of Compound Fractures within 72 h of Injury: A Prospective Cohort Study.

Introduction: Open (compound) fractures carry a high risk of infection and delayed healing. Early definitive internal fixation within 72 h, guided by objective injury-severity scoring, has emerged as an alternative to traditional staged fixation. This study aimed to evaluate the outcomes of primary definitive internal fixation performed within 72 h of injury in patients with compound fractures selected using the Ganga Hospital Open Injury Score (GHOIS ≤9).

Materials and methods: This prospective cohort study was conducted in a tertiary-care orthopedic center in India between March 2023 and November 2024, and included 140 patients with compound fractures (GHOIS ≤9) who underwent debridement and early definitive internal fixation within 72 h of injury under a standardized antibiotic protocol. Patients were followed for 1 year; outcomes assessed included fracture union, soft-tissue healing, functional outcome (modified Ketenjian and Sheldon criteria), hospital stay, and complications.

Results: Mean patient age was 37.08 years, with male predominance (60.71%). Road traffic accidents were the most common mechanism of injury (81.42%). Gustilo-Anderson Type IIIA fractures were most frequent (40%), and the mean GHOIS was 7.25. Mean time since injury was 3.82 h and mean time to definitive fixation was 45.8 h. Intramedullary nailing was the most common fixation method (54.28%). Soft-tissue coverage was not required in 47.14% of cases; primary split-skin grafting was used in 35.71%. Functional outcome was excellent or good in 64.28% of patients. Mean soft-tissue healing time was 3.75 weeks, mean time to union was 28.49 weeks, and mean hospital stay was 11.59 days. Infection (11.42%) was the most common complication, followed by stiffness and non-union (4.28% each) and delayed union (0.71%).

Conclusion: Primary definitive internal fixation of compound fractures within 72 h of injury, in appropriately selected patients with GHOIS ≤9, was associated with favorable functional outcomes, acceptable union and healing times, and a manageable complication profile. These findings support the feasibility of early definitive fixation in selected open tibial fractures; however, comparative studies are required to determine whether this approach offers advantages over staged fixation.