Background: Open tibial shaft fractures are common high-energy injuries frequently associated with soft tissue damage and contamination, leading to a high risk of infection, delayed union, and nonunion. Achieving stable fixation and infection control remains a major challenge in their management. Antibiotic-coated intramedullary interlocking nails have emerged as an effective solution, providing both mechanical stability and localized high antibiotic concentrations at the fracture site.
Aim: To evaluate the functional and radiological outcomes of antibiotic-coated intramedullary interlocking nails in the management of open tibial shaft fractures. Materials and Methods: This prospective study was conducted in the Postgraduate Department of Orthopaedics, Government Hospital for Bone and Joint Surgery, Government Medical College Srinagar, from May 2021 to January 2024. Twenty-one skeletally mature patients (>18 years) with Gustilo-Anderson type I, II, and IIIA open tibial fractures were included. All patients underwent early debridement, antibiotic-coated intramedullary interlocking nailing, and standardized postoperative care. Patients were followed for 9 months with clinical and radiological evaluation. Functional assessment was done using the Modified Johner-Wruhs criteria.
Results:Out of 21 patients, 18 (85.7%) were males and 3 (14.3%) females, with a mean age of 33.9 years. Road traffic accidents were the most common cause of injury (71.4%), followed by falls (19.0%) and sports-related injuries (9.6%). According to the Gustilo-Anderson classification, 7 cases (33.3%) were type I, 10 (47.6%) type II, and 4 (19.1%) type IIIA. The average time to radiological union was 18.3 weeks. Superficial infection was observed in 2 patients (9.6%) and deep infection in 1 patient (4.8%), all of which resolved with appropriate treatment. No cases of nonunion or implant failure were reported. At the final follow-up, 12 patients (57.1%) achieved excellent, 6 (28.6%) good, and 3 (14.3%) fair functional outcomes according to the Modified Johner-Wruhs criteria.
Conclusion: Antibiotic-coated intramedullary interlocking nailing provides a reliable method for managing open tibial shaft fractures, combining stable fixation with local antibiotic delivery. It significantly reduces infection rates, promotes faster union, and achieves excellent to good functional outcomes in the majority of patients. This technique is safe and effective for Gustilo type I to IIIA fractures and can be considered a preferred approach in similar clinical scenarios.
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