Injury
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In the management of Type IIIb injuries, Gustilo's classification has the disadvantages of a poor intra and inter-observer agreement rate, low specificity and sensitivity to salvage and inability to predict functional outcomes. We propose here a validated score which assesses the severity of injury to the covering structures, skeletal structures and functional tissues of the injured limb separately along with providing weightage to the presence of co-morbid factors. ⋯ According to the total score, injuries were treated by 'Fix and close' protocol; 'Fix, Bone Graft and Close' protocol, 'Fix and Flap' protocol or 'Stabilise, Watch, Assess and Reconstruct' protocol. The score was thus found to be useful clinically not only to assess salvage but also to provide guidelines in reconstruction.
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Intramedullary nailing is the treatment of choice for unstable or displaced tibial fractures. Titanium nails have been advocated for their improved biocompatibility and biomechanical properties but concerns are held about increased complications. We present results of 225 tibial fractures in 221 patients (90% follow-up) treated with the ACE titanium tibial nail (DePuy International Limited, Leeds, UK) inserted between 1995 and 2003 in one hospital department, which show no increased complications compared with the published literature. ⋯ Median union time was unaffected by open injury, reaming or age. Ninety (43.3%) patients required re-operation of which 23 (11%) had a second re-operation. In total 43 (20.7%) nails were removed, without any complication as previously reported for this nail.