• Morgan Laigle, Louis Rony, Raphaël Pinet, Romain Lancigu, Vincent Steiger, and Laurent Hubert.
• Département de chirurgie osseuse, CHU Angers, 4, rue Larrey, 49933 Angers cedex 9, France. Electronic address: morgan_laigle@hotmail.com.
• Orthop Traumatol Sur. 2019 Sep 1; 105 (5): 1021-1024.

IntroductionTreatment of open tibial shaft fracture is controversial due to the risk of infection. We assessed results in a continuous series of open tibial shaft fractures treated by primary intramedullary nailing.HypothesisFactors can be determined for non-union and onset of infection following primary intramedullary nailing in open tibial shaft fracture.Patients And MethodA retrospective study assessed open tibial shaft fractures treated by primary intramedullary nailing between January 2007 and December 2013. Fractures were classified on the AO and Gustilo classifications. Infection rates and time to union were compared.ResultsEighty-five patients (85 fractures) were included: 13 Gustilo type I, 43 type II, 19 type III-A and 10 type III-B. Eight patients had infection (9%). Healing and union were obtained after nail exchange and reaming in 5 cases, and after bone transport in 2. One patient showed non-union at last follow-up. Infection risk did not correlate with Gustilo (p=0.55) or AO type (p=0.69). The interval between trauma and wound debridement was significantly longer in infected patients (p=0.048). Eighty-three fractures (97.6%) healed, at a mean 6.9±6.1 months (range, 2-40). Non-union was associated with AO type (p=0.04), and showed a non-significant association with Gustilo type (p=0.06).DiscussionTime to treatment was the only factor influencing risk of infection. Non-union was related to AO comminution grade. Primary intramedullary nailing seemed reliable if treatment was early, with rigorous debridement. The advantages then are early resumption of weight-bearing and low patient burden.Level Of EvidenceV, retrospective study.Copyright © 2019. Published by Elsevier Masson SAS.

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