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Volume 12 Issue 3 ( July-September ) 2023

Original Articles

To evaluate the results of primary stabilization of compound fracture both bone leg with flexible nail along with external fixator
Dr. Maninder Singh, Dr. Gurpreet Singh, Dr. Satnam Singh

Background: The tibial shaft is one of the most common sites of open fractures. The present study was to evaluate the results of primary stabilization of compound fracture both bone leg with flexible nail along with external fixator. Materials & Methods: 25 patients with compound fractures of both bone leg were included. All the cases were treated at department of Orthopaedics in Guru Nanak Dev Hospital, attached Govt. Medical College, Amritsar and were followed for about 9 months. Evaluation of patients in terms of age/sex/mode of trauma was done. Musculoskeletal examination of patient was performed to rule out associated fractures. Stabilization of patient with intravenous fluids, oxygen and blood transfusion as and when required. Assessment of injured limb as regards to extent of wound, soft tissue injuries and neurovascular status was done. Depending upon the soft tissue injury, grading of the compound fracture according to Gustilo and Anderson Classification was done. Antiseptic dressing and primary immobilization of involved limb by POP Back splint was done. Results: Age group 20-30 years had 4 (16%), 31-40 years had 9 (36%), 41-50 years had 7 (28%) and 51-60 years had 5 (20%) patients. The Mean± SD age was 41.0±4.5 years. Out of 25 patients, males comprise 17 (68%) and females 8 (32%). The mean± SD injury to surgery time was 3.12± 0.8 hours. Right side was involved in 14 and left in 11. Diabetes and hypertension was seen in 3 each. In 16 (64%) cases, the mode of injury was RTA, in 5 (20%) was fall and in 4 (16%) was others. The difference was significant (P< 0.05). The mean duration of hospital stay was 5.08± 0.7 days, time to union was 22.1± 3.5 weeks, time to return to work was 22.5±4.8 weeks. Varus/valgus angulation was 0.92± 0.04 degrees, antero-posterior angulation was 1.4± 0.08 degrees and limb length discrepancy was 2.08±0.9 mm. Gait following treatment was normal in 23 and mild limp was seen in 2. 23 were able to squat and 2 did not. 23 were able to run and 2 did not. At 4 weeks, final functional outcome was good in 3 and fair in 22 patients. At 8 weeks, good in 9, fair in 16. At 12 weeks, good in 23 and fair in 2 patients. At 6 months, excellent in 2 and good in 23 patients and at 9 months, excellent in 22, good in 2 and poor in 1 patient. The difference found to be significant (P< 0.05). Complications noted were neurovascular involvement in 2 (8%), infection in 3 (12%) and shortening in 1 (4%) patient. Conclusion: Compound fractures of both bone leg are quite common. Traditional treatment options for compound fractures of both bone leg are antegrade insertion of elastic intramedullary nails, open reduction plate fixation, and external fixator fixation. Primary stabilization with flexible nail along with external fixator has a definite role in the management of compound fracture both bone leg. The technique offered better outcome with lesser post- operative complications.

 
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