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Tibial Frx: comparison of IM nailing vs external fixation

- Discussion:
    - based on available data, the results of external fixation is comparable to IM nailing when the frx ends can be keyed together (maximal bone loading), in which case there will be minimal loss of reduction and minimal frx site motion w/ wt bearing;
    - proximal tibial frx: (see IM nailing of proximal tibial frx)
           - in the case of proximal fourth tibial frx, external fixation should be chosen over IM nailing when the frx can be keyed together w/ maximal bone loading;
    - Henley, et al (1998) 
           - 104 frx in IM nailing group vs. 70 frx in the external fixation group;
           - satisfactory alignment: 92% vs 69% (p=0.00005); (malalignment);
           - infection:
                 - infection at frx site: 13% vs 21% (no sig difference);
                 - in the EF group, 50% had at least one pin tract infection;
           - frx healing: (see non union and prognosis for healing);
                 - time to healing between the groups was not significant;
                 - only the Gustillo classification had a significant correlation on healing;
           - number of procedures after index procedure: 1.7 vs 2.7

Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: a prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators.

Treatment of open fractures of the tibial shaft: Ender nailing versus external fixation. A randomized, prospective comparison.

Unreamed intramedullary nail versus external fixation in grade III open tibial fractures.

Open tibial fractures: faster union after unreamed nailing than external fixation.

Superior results of tibial rodding versus external fixation in grade 3B fractures.

Unreamed interlocking nail versus external fixator for open type III tibia fractures.

Diagnosis and management of infection after tibial intramedullary nailing.

Treatment of grade-IIIb open tibial fractures. A prospective randomised comparison of external fixation and non-reamed locked nailing.

External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients.

Timely Fracture-Healing Requires Optimization of Axial Fixation Stability