Open fractures occur as a result of great violence. Hence they are associated with considerable damage to the soft tissue envelope due to dissipation of the energy, displacement and comminution of long fragments. Secondary to this, there is local disruption of blood supply which results in more necrotic tissues. This impedes new angiogenesis as well as decreases the viability of the mesenchyme cells. Because of the severe violence, this fracture may be of compound nature. This deals to even more necrosis and by predisposing to infection, it further increase the risk of non-union. These high velocity injuries majority were associated with bone loss. These fractures requires staged reconstruction, it further increase the risk of nonunion. Some surgeons use external fixation as a primary treatment until the soft tissues have healed and then employ another technique to secure union. Theoretically, the biomechanical and biological advantages of reamed intramedullary nailing would be expected to give good results, but the method has hazards, in particular infection. We therefore performed a prospective study to analyse the outcome of conversion to internal fixators in open fractures of lower limbs.
Tscherne H. Management of open fractaures 1983; 162: 10-32.
Kocher MS. Early limb salvage: open tibia fractures of Ambroise Pare (1510-1590) and Percivall Pott (1714-1789). World journal of surgery 1997; 21: 116-22.
Guthrie HC and Clasper JC. Historical origins and current concepts of wound debridement. Journal of the Royal Army Medical Corps 2011; 157: 130-2
Giannoudis PV1, Harwood PJ Long-term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture, grade IIIB/IIIC open fracture and amputation). 2009 injury
Court-Brown CM, Rimmer S, Prakash U, McQueen MM. The epidemiology of open long bone fractures. Injury 1998;29:529-34.
Howard M, Court-Brown CM. Epidemiology and management of open fractures of the lower limb. Br J Hosp Med 1997;57:582-7.
Rajasekaran S and Sabapathy SR. A philosophy of care of open injuries based on the Ganga hospital score. Injury 2007; 38: 137-46
Mc Graw J and et al. Treatment of open tibial shaft fractures, external fixation and secondary IM nails. J.Bone joint surgery AM 1988; 70: 900-911.
Bhandari M, Zlowodzki M, Tornetta P, 3rd, Schmidt A, and Templeman DC. Intramedullary nailing following external fixation in femoral and tibial shaft fractures. Journal of orthopaedic trauma 2005; 19: 140-4.
Robson MC, Duke WF, and Krizek TJ. Rapid bacterial screening in the treatment of civilian wounds. The Journal of surgical research 1973; 14: 426-30.
Crowley DJ, Kanakaris NK, and Giannoudis PV. Debridement and wound closure of open fractures: the impact of the time factor on infection rates. Injury 2007; 38: 879-89.
Werner CM, Pierpont Y, and Pollak AN. The urgency of surgical debridement in the management of open fractures. The Journal of the American Academy of Orthopaedic Surgeons 2008; 16: 369-75.
Peter J. Nowotarski, Clifford H Turen .Conversion of External Fixation to Intramedullary Nailing for Fractures of the Shaft of the Femur in Multiply Injured Patients VOL. 82-A, NO. 6, JUNE 2000
Immediate interlocking nailing versus external fixation followed by delayed interlocking nailing for Gustilo type IIIB open tibial fractures HJ Park, M Uchino, K Nakamura, M Ueno, Y Kojima, M Itoman Journal of Orthopaedic Surgery 2007; 15(2):131-6
External fixation and Secondary Intramedullary Nailing of Open Tibial Fractures – A Randomized Prospective Trial . Pedro Antich- Adrover, David Marti- Garin 1997 British Editorial Society of Bone and Joint Surgery VOL. 79-B, NO. 3,
Two stage Fixation of Fracture Shaft of Femur in Polytrauma Patients Aslam Siddiqui, Zameer Soomro, Mehtab Pirwani, Ata-ur-Rahman, Younis Soomro 65 Vol. 21 No. 2 August 2009
F. Lavini • E. Carità • C. Dall’Oca • R. Bortolazzi. Internal femoral osteosynthesis after external fixation in multiple-trauma patients. Traum Limb Recon (2007) 2:35–38
Treatment of Distal Femur and Proximal Tibia Fractures With External Fixation Followed by Planned Conversion to Internal Fixation . J Trauma. 2008;64 :736–739. Volume 64 ,Number 3
Conversion of external fixation to internal fixation in a non-acute, reconstructive setting: a case series T. Monni , F. F. Birkholtz. Traum Limb Recon (2013) 8:25–30
P A Blachut ; R N Meek ; P J O'Brien External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. A sequential protocol. J Bone Joint Surg Am, 1990 Jun;72(5):729-735
Secondary Intramedullary Nailing After Primary External Fixation In The Treatment Of Tibial Fractures ..A Bashir, T Dar, A Badoo, M Ganie .Journal of Orthopedic Surgery. 2008 Volume 12 Number11.Dabezies EJ and D'Ambrosia RD. Treatment of the multiply injured patient: plans for treatment and problems of major trauma. Instructional course lectures 1984;
Benson DR, Riggins RS, Lawrence RM, Hoeprich PD, Huston AC, Harrison JA. Treatment of open fractures: a prospective study. J Trauma 1983; 23:25-30
Yassir B. Al-Arabi *, Michael Nader The effect of the timing of antibiotics and surgical treatment on infection rates in open long-bone fractures: A 9-