Innovative Treatment in Grade 3 B Open Comminuted Tibial Fractures Using Hybrid Fixation (Khemka Technique)

Author(s): Sunil Khemka, Subeer Mukherjee, Ambrish Verma, Pritam Agrawal, Ram Khemka, Pradeep Patel*

Background: The incidence of open comminuted tibia fractures is on an increasing trend proportionate to an increase in high velocity motor vehicle accidents. These fractures are challenging to treat and usually give unfavorable results. Treatment protocols with regard to such fractures are still evolving and there is no widely acceptable consensus.

Aims and objectives: We share a series of Gustilo Anderson III B comminuted tibial fractures in which we used Ender’s Nail and LRS as a hybrid definitive fixation solution for skeletal stabilization.

Materials and methods: A prospective study was carried out from Jan, 2014 to Dec, 2023 with 90 patients in our series. The clinical and radiological evaluation was done at the end of the treatment with ASAMI Bony and Functional scoring system.

Results: Among 90 cases, we achieved excellent and good bony results in 93.3% cases as per ASAMI score. Similarly, functional results were excellent and good in 95.6% cases. Bone grafting was required in 20 patients, musculocutaneous flap in 24 and SSG in 26 cases. In 4 cases of infected non-union, implant removal, intramedullary bone grafting and antibiotic beads with revision fixation was done.

Conclusion: Advantage of this system is a very stable construct which is less cumbersome and less technically demanding procedure unlike Ilizarov fixation while avoiding the disadvantages usually associated with unilateral AO type fixators. Our technique is based on four cardinal principles of achieving a very stable construct, early mobilization, aggressive infection management with early and repeated aggressive wound debridement and soft tissue coverage as soon as possible.