Functional and Radiological Outcome in Patients Undergoing Conversion from External Fixation to Definitive Internal Fixation for Open Tibial Fractures-A Prospective Observational Study.

Background: Open tibial diaphyseal fractures pose significant management challenges due to soft tissue damage, infection risk, and delayed union, with consensus on timing and prognostic markers evolving. Objectives: The study evaluates the clinical, radiological, and functional outcomes of open tibial fractures managed with staged fixation and evaluates the use of C-reactive protein (CRP) levels for internal fixation timing. Methods: A study in Chennai, India, involving 54 adult patients with Gustilo-Anderson Grade I to IIIB open tibial diaphyseal fractures, was conducted from June 2023 to May 2025. The patients underwent initial external fixation and internal fixation, with CRP levels guiding conversion timing. Functional outcomes were assessed using Johner and Wruhs' criteria and radiological union was measured using the modified Radiological Union Score for Tibia (mRUST). Results: The union rate in fractures was 92.6%, with Grade I and II fractures showing near-complete union, and Grade IIIA and IIIB showing union in 85.7% and 72.7%, respectively. Functional recovery was excellent or good in 88.9% of patients, with better outcomes in lower-grade fractures. The infection rate was 9.3%, primarily superficial. Delayed union and nonunion were more prevalent in Grade IIIB fractures. Conclusion: Staged fixation effectively manages open tibial diaphyseal fractures, promoting infection control and functional outcomes, but Grade IIIB fractures require additional interventions and extended follow-up.