A comparison between delayed and immediate intramedullary nailing in the treatment of comminuted and open fractures (grade 1) of the tibia.

The authors studied a group of 215 comminuted or open (Grade 1) fractures of the tibial diaphysis in order to compare two methods successively adopted at the 1st Clinic and 3rd Division of the Rizzoli Orthopaedic Institute. We at first chose to delay nailing in these two types of fracture for 4 weeks (131 cases) and obtained good results in terms of consolidation, but only fair results in terms of functional recovery of ankle and subtalar movement and axial alignment of the tibia. Successively, we used immediate osteosynthesis with a screwed nail (84 cases), the results of which were better for all the parameters considered. The criteria for delaying intramedullary osteosynthesis in grade 1 open fractures are still valid, particularly when there are problems which necessarily delay operative treatment within 8 hours of injury. However, immediate treatment is essential in these fractures when they are associated with vascular lesions or in patients with multiple injuries. Finally, the authors express their preference for intramedullary nailing as compared with external fixation for the treatment of these open fractures with limited exposure.