Injury, Int. J. Care Injured 45S5 (2014) S32–S35 Introduction Open tibial fractures are usually caused by high-energy trauma. These fractures are particularly difficult to treat because of poor coverage of soft tissue and poor blood supply in some regions [1]. This diagnosis indicates an urgent surgical treatment with debridement, antibiotic therapy and bone stabilisation. The use of external fixators, plates and screws, and, more recently, locked intramedullary nailing for stabilisation of tibial fractures is described in the literature [2-8]. The use of intramedullary nailing is increasingly employed. Bhandari et al. [9] reported superior results with intramedullary nailing of IIIA open fractures according to the classification of Gustillo and Anderson [10,11], with fewer complications and re-operations [12-17]. However, the majority of studies used in this publication did not have a standard configuration of the external fixator. Biomechanical studies have shown that biplanar external fixation has an effective stiffness that is similar to that of the long bone [18]. The aim of this study was to compare the bone healing in patients with open diaphyseal tibial fracture treated with biplanar external fixation and reamed locked intramedullary nailing. Method This was a randomised prospective study that was conducted in the Orthopaedics and Traumatology Unit of the ABC Foundation. The study was approved by the Ethical Research Committee of the ABC Foundation Medical School (029/2011) and registered at Clinicaltrials.gov with the number NTC02064595. A total of 68 patients with limb trauma who required surgical stabilisation were included in the study between 2011 and 2013. Inclusion criteria included age at least 18 years and open tibial shaft fracture (occurring five centimetres below the tibial tuberosity and seven centimetres above the ankle joint line) grades I, II and III A as classified by Gustillo and Anderson [10]. Exclusion criteria included the presence of extensive skin and soft tissue lesions or arterial injury that required surgical repair KEYWORDS Tibial fractures External fixators Intramedullary fixation of fractures Quality of life Fractures ABSTRACT Introduction: Open tibial fractures are usually caused by high-energy trauma. There is no consensus about the best treatment for these fractures. Biomechanical studies show that fixing on two planes approaches the rigidity of the bone, whereas the use of interlocking intramedullary nailing is widely used and reported to produce better therapeutic results in fracture healing. Objective: To compare bone tissue repair in patients with open diaphyseal tibial fracture treated with biplanar external fixation or reamed locked intramedullary nailing. Method: Prospective randomised study with 68 patients undergoing two types of surgical treatment: biplanar external fixation or reamed locked intramedullary nailing. Consolidation, complications (infection, malunion and non-union) and quality of life using the SF-36 Health Survey were assessed 12 months after surgery. Results: Consolidation occurred in 84.6% of patients who underwent reamed intramedullary nailing, and in 90.3% of patients who were treated with biplanar external fixation. In the intramedullary nailing group, there were two cases of non-union, three cases of malunion and two cases of infection. In the patients treated with biplanar fixation, there were three cases of non-union, five cases of malunion and no cases of infection. There were no statistically significant differences between the treatment groups for these results. Patient quality of life was statistically equal for both methods. Conclusion: Treatment with biplanar external fixation was associated with statistically similar results compared with intramedullary locking. © 2014 Elsevier Ltd. All rights reserved. Bone tissue repair in patients with open diaphyseal tibial fracture treated with biplanar external fixation or reamed locked intramedullary nailing Fábio Lucas Rodrigues a, *, Luiz Carlos de Abreu b , Vitor Engrácia Valenti b , Andre Lage Valente a , Rafael da Costa Pereira Cestari a , Pedro Henrique Isoldi Pohl a , Luciano Miller Reis Rodrigues a a Disciplina de Ortopedia e Traumatologia. Faculdade de Medicina do ABC. Santo André, SP. Brasil b Laboratório de Delineamento de Estudos e Escrita Científica. Faculdade de Medicina do ABC. Santo André, SP. Brasil * Corresponding author at: Rua Henrique Calderazzo 321 Santo André, SP, Brasil. E-mail address: lucas72@ig.com.br (F. Lucas Rodrigues). 0020-1383/$ – see front matter © 2014 Elsevier Ltd. All rights reserved. Contents lists available at SciVerse ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury