International Journal of Research in Orthopaedics | September-October 2017 | Vol 3 | Issue 5 Page 898 International Journal of Research in Orthopaedics Ali A et al. Int J Res Orthop. 2017 Sep;3(5):898-903 http://www.ijoro.org Original Research Article Treatment of open fracture of shaft of tibia-fibula Gustilo type III-B by SIGN interlocking nail and wound coverage by muscle flap within 72 hours of injury Ayub Ali 1 *, Mizanur Rahman 2 , Sajedur Reza Faruquee 3 , Tazul Islam 4 , Zamil Zaidur Rahim 5 , Abdullah Yusuf 6 INTRODUCTION Treatment of open fracture of tibia is difficult due to poor soft tissue coverage and blood supply of tibial shaft. Tibial fractures are also associated with high risk of infection, nonunion and malunion. Half a century ago Charnley was hopeful to find out the best method of treating a fracture of the shaft of tibia which can be stated with finality. 1 When the fracture is open, the condition is even more complex for contamination, and for high- energy injury, survivability of the limb and sometimes life is hanging in the balance. 2,3 Therefore, the debate is ABSTRACT Background: The open fracture of tibia-fibula Gustilo type III-B may threaten the survival of the injured leg. The objective of the study purpose was to see the effect of early coverage following fixation of open tibial shaft fracture. Methods: This clinical trial was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka from July 2004 to June 2006 for a period of two (2) years. Patients at age group of 18 years or above with both sexes presented with open fracture shaft of tibia-fibula Gustilo type III-B were selected as study population. The patients were surgically managed by SIGN Interlocking nail and wound coverage by muscle flap within 72 hours of injury. Bacteriological study of the wound was done in all cases. All fixation and coverage were performed within 72 hours of injury. Patients grading improved on subsequent follow up. Evaluation of results was done at every post- operative follow up. Results: A total number of 12 young patients with open fracture tibia-fibula Gustilo III-B were recruited for this study. Their age varies from 18 years to 48 years. A total number of 83.33% cases wound debridement was done within 12 hours of injury. Most of the soft tissue healed (91.67%) within 0 to 20 days. There were no cases developed limb length discrepancy angulations or rotation. Superficial infections were occurred in 1 (8.33%) case but no evidence of deep infection. In this study excellent result were obtained from 9 cases (75%), good results were found in 2 cases (16.67%), fair results from 1 case (8.33%). Conclusions: In conclusion early intramedullary fixation and exposed bone coverage by muscle flap is very important for prevention of infection, minimizing bone death simultaneously enhances bone healing. Keywords: Open fracture, Gustilo type III-B, SIGN interlocking nail, Muscle flap Department of Orthopaedics, 1 Sadar General Hospital, Cox’s Bazar, 2 Gafargaon Upazilla Health Complex, Mymensingh, 3 National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, 4 Upazilla Health Complex, Begumgonj, Noakhali, 5 Combined Military Hospital, Comilla, Bangladesh 6 Department of Microbiology, National Institute of Neurosciences & Hospital, Dhaka, Bangladesh Received: 03 June 2017 Revised: 19 July 2017 Accepted: 09 August 2017 *Correspondence: Dr. Ayub Ali, E-mail: drayubortho@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20173931