~ 44 ~ International Journal of Orthopaedics Sciences 2016; 2(4): 44-47 ISSN: 2395-1958 IJOS 2016; 2(4): 44-47 © 2016 IJOS www.orthopaper.com Received: 10-08-2016 Accepted: 11-07-2016 Dr. Neelanagowda VP Patil Associate Professor MMCRI, Mysore, Karnataka, India Dr. Rahul Uttamrao Kamble Postgraduate, Dept. of Orthopaedics, MMCRI, Mysore, Karnataka, India Dr. S H Bellad Associate Professor MMCRI, Mysore, Karnataka, India Dr. Veeresh Pattanshetty Postgraduate, Dept. of Orthopaedics, MMCRI, Mysore, Karnataka, India Dr. Sachin V Bakare Postgraduate, Dept. of Orthopaedics, MMCRI, Mysore, Karnataka, India Dr. Anand Patil Postgraduate, Dept. of Orthopaedics, MMCRI, Mysore, Karnataka, India Correspondence Dr. Rahul Uttamrao Kamble Postgraduate, Dept. of Orthopaedics, MMCRI, Mysore, Karnataka, India Comparative study between the unreamed intramedullary nailing and the limb reconstruction system (LRS, Orthofix) in type IIIa open tibial shaft fractures Dr. Neelanagowda VP Patil, Dr. Rahul Uttamrao Kamble, Dr. S H Bellad, Dr. Veeresh Pattanshetty, Dr. Sachin V Bakare and Dr. Anand Patil DOI: http://dx.doi.org/10.22271/ortho.2016.v2.i4.010 Abstract Background: The tibia is exposed to frequent injury; it is the most commonly fractured long bone. Because one third of the tibial surface is subcutaneous throughout most of its length, open fractures are more common in the tibia than in any other major long bone. We evaluated and compared the outcome of the unreamed intramedullary nailing and limb reconstruction system (LRS, Orthofix) in the treatment of type IIIA Gustilo-Anderson open fractures of tibial diaphysis. Materials and methods: This study involved prospective evaluation of 160 patients of type IIIA open fracture of tibia treated at our institute between August 2008 to December 2015. 80 cases were treated with orthofix were labelled as group A and 80 cases treated with unreamed intramedullary nailing were labelled as group B. Result: Average time of union in group A was an average 35 weeks (30-40 weeks) in 64 cases (80%) with 16 cases (20%) of non-union which were subsequently treated with bone grafting and showed union at an average 40 weeks (38-44 weeks). Group B showed average time of union at an average 29 weeks (24-38 weeks) in 66 cases (82.5%) with 10 cases(12.5 %) of infective non-union at which subsequently treated with external fixator and showed union at average 36 weeks (34-38 weeks). 4 cases which showed delayed union were dynamised and bone grafted and showed union at an average 32 weeks. Conclusion: Intramedullary nailing can be used in the management of type IIIA fractures as it allows early union and primary closure with the avoidance of secondary procedures with the risk of higher rate of deep infection. Orthofix gives lower rate of infection with slightly delayed union compared to nailing with the need for secondary procedures. Keywords: Type IIIA open tibia fracture, unreamed intramedullary nailing, limb reconstruction system, orthofix, LRS 1. Introduction Fractures of the tibia and fibula are relatively common and have been recognized as serious and debilitating injuries for centuries [1] . Because of its location, the tibia is exposed to frequent injury; it is the most commonly fractured long bone. Because one third of the tibial surface is subcutaneous throughout most of its length, open fractures are more common in the tibia than in any other major long bone [2] . Management of type IIIA Gustilo-Anderson [3, 4] open tibial diaphyseal fractures is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or bone grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, malunion, nonunion and higher patient dissatisfaction [5] . IM nailing is the most common treatment of tibial diaphyseal fractures [1] . The literature supports irrigation and debridement followed by immediate nailing of lower grade (Type I and type II) open tibial fractures [6, 7] . The large prospective SPRINT trial [8] also showed a low infection rate for primary nailing of open tibial fractures [8] . The outcomes of tibial nailing in studies with predominantly higher grade (Type IIIA, IIIB, and IIIC) open fractures have not been as positive.