INTRODUCTION The treatment of open tibial fractures remains controversial. Nonunions and infection is quite common in tibial fractures owing to the deficient 1,2 blood supply and soft tissue cover around it . Open fractures of the tibial shaft remain to be one of the most complex, problematic and 3 controversial orthopaedic injuries . Among various causes of open tibia fractures bomb blast injury is emerging as the leading cause in our 5 country . The other causes being are motor vehicle accident, fall from height, fall of a heavy 4 object and fire arm injury . The aim of the operative treatment is to have an anatomically functional extremity which allows early recovery of the patients to the pre-injury 6 status . Surgical treatment of open fractures means treatment of the soft tissue injuries and the 7 stabilization and fixation of the fracture . 8 Fractures of the tibia can be fixed both externally 9 as well as internally but external fixation is a preferred way of treatment in open tibia fracture. Even most of unstable closed tibial shaft fractures can be treated with method of the external fixation in a more efficient manner than with other methods. Due to its subcutaneous localization is 10 suitable for the application of the external fixator . Easy applicability and minimal hinderence with the blood supply of the tibia has made external fixation a very popular mode of treatment, but these advantages have been outweighed by the high incidence of pin-track infection, difficulties relating to soft-tissue management and the potential for 11 malunion . The aim of this study was to determine the outcome of the use of external fixator in the treatment of open tibial shaft fractures in terms of union, nonunion, malunion and pin site infection. ORIGINAL PROF-2454 The Professional Medical Journal www.theprofesional.com OPEN TIBIAL SHAFT FRACTURES; TREATMENT WITH EXTERNAL FIXATOR 1 2 3 Dr. Muhammad Imran Khan , Dr. Muhammad Saqib, Dr. Waqar Alam ABSTRACT… Objective: The purpose of the study was to evaluate the clinical results after operative treatment of open tibia fractures (grade IIIA/B) with external fixator. Material and methods: 25 patients with open fractures of the tibial diaphysis, classified as type III A and B, according to the Gustilo classification, were operatively treated in Agency Headquarter Hospital Landikotal. All the patients were treated with an external fixator. The time of the union of the fracture, problems with the union (malunion and nonunion), infection were examined as treatment outcome. Late complications and their treatment was not the object of the study. The follow-up period was at least 8 months. Result: The end results of the external fixation of 25 tibial shaft fractures, 18 (72%) men and 7 (28%) women, average age 37.7 (16-65). The union rate was 83%. Nonunion rate was 12%. And malunion rate was 5% (fig-I). Fifteen patients had Gustilo type IIIA injury while 10 patients had type IIIB injury (fig-II). Pins tract infection rate was 10%. The average time of fractures healing was 28.5 weeks (15-22). There were 3 cases with wound infection and no sequestrum formation. Conclusions: External fixation is a simple and effective means of treating all types of open tibial shaft fractures. Key words: Open tibia fracture, external fixation, Gustilo Anderson’s classification. Article Citation: Khan MI, Saqib M, Alam W. Open tibial shaft fractures; treatment with external fixator. Professional Med J 2014;21(4): 654-658. 1. FCPS District specialist Orthopaedic Unit Agency Headquarter Hospital, Landikotal 2. MBBS Medical Office Orthopaedic Unit Khyber teaching hospital, Peshawar 3. MBBS, MRCS, FCPS (Orthopaedics) Fellowship in Spine Surgery Consultant Orthopaedic & Spine Surgeon District Headquarter Hospital Timargara, Dir (Lower), KPK. Article received on: 07/03/2014 Accepted for Publication: 15/04/2014 Received after proof reading: 16/08/2014 Correspondence Address: Muhammad Imran Khan House no 292, Street-10, Sector N-1, Phase-4, Hayatabad, Peshawar immykhan655@gmail.com www.theprofesional.com 654 Professional Med J 2014;21(4): 654-658.