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Dr Supratim Roy
Dr Preetam Marutrao Salunkhe
Dr Bhavesh Patidar
Dr Yogesh Bhangale
Dr. C M Badole


Definitive fixation, External fixator, Limited internal fixation, TENS nail


Background –Treating open fractures in the tibia has always been a challenge for orthopedic surgeons due to the complexities of the injury. External fixators are used in the treatment of these types of fractures as an initial stabilization method, followed by definitive surgical procedures. Several authors have used external fixators as a definitive method for the treatment of fractures, but there were difficulties in initial reduction and maintaining the reduction, thereby increasing the chances of malreduction, malunion, and non-union. Some authors used limited internal fixation to increase the biomechanical stability of the construct with good results, but very few have been reported in the literature. In our study, we used intramedullary tens nails along with external fixators as a method to improve the stability of the structure. and evaluated the outcome in terms of union, limb alignment, and infection. 

Methods – We have operated on 20 cases of compound tibial diaphyseal fractures with external fixators along with intramedullary TENS nails. The patients were followed over a period of 9 months, and various parameters like limb alignment in the form of varus or valgus, anteroposterior angulation, limb shortening, status of union, and complications like pin tract infection, superficial and deep infection, and time to full weight bearing were assessed.


Results – In our study, we could achieve a union rate of 65% and a non-union rate of 15%. According to the modified Anderson and Hutchins criteria, good limb alignment could be achieved in 65%, moderate in 30%, and poor in 5%. Complications were only pin tract infections in 1 case. It took an average of 4.83 months for full weight bearing to be achieved.

Conclusion - As a definitive technique, external fixators paired with intramedullary TENS nails efficiently treat compound tibial diaphyseal fractures. Increased stability, an improved initial reduction, assistance in maintaining the reduction and length, a decreased risk of malalignment, and a delayed union are all provided without raising infection risk.

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