ArticleJournal of orthopaedic case reports2026
Outcomes of Primary Definitive Internal Fixation of Compound Fractures within 72 h of Injury: A Prospective Cohort Study.
Article in Journal of orthopaedic case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Open (compound) fractures carry a high risk of infection and delayed healing. Early definitive internal fixation within 72 h, guided by objective injury-severity scoring, has emerged as an alternative to traditional staged fixation. This study aimed to evaluate the outcomes of primary definitive internal fixation performed within 72 h of injury in patients with compound fractures selected using the Ganga Hospital Open Injury Score (GHOIS ≤9). Materials and Methods: This prospective cohort study was conducted in a tertiary-care orthopedic center in India between March 2023 and November 2024, and included 140 patients with compound fractures (GHOIS ≤9) who underwent debridement and early definitive internal fixation within 72 h of injury under a standardized antibiotic protocol. Patients were followed for 1 year; outcomes assessed included fracture union, soft-tissue healing, functional outcome (modified Ketenjian and Sheldon criteria), hospital stay, and complications. Results: Mean patient age was 37.08 years, with male predominance (60.71%). Road traffic accidents were the most common mechanism of injury (81.42%). Gustilo-Anderson Type IIIA fractures were most frequent (40%), and the mean GHOIS was 7.25. Mean time since injury was 3.82 h and mean time to definitive fixation was 45.8 h. Intramedullary nailing was the most common fixation method (54.28%). Soft-tissue coverage was not required in 47.14% of cases; primary split-skin grafting was used in 35.71%. Functional outcome was excellent or good in 64.28% of patients. Mean soft-tissue healing time was 3.75 weeks, mean time to union was 28.49 weeks, and mean hospital stay was 11.59 days. Infection (11.42%) was the most common complication, followed by stiffness and non-union (4.28% each) and delayed union (0.71%). Conclusion: Primary definitive internal fixation of compound fractures within 72 h of injury, in appropriately selected patients with GHOIS ≤9, was associated with favorable functional outcomes, acceptable union and healing times, and a manageable complication profile. These findings support the feasibility of early definitive fixation in selected open tibial fractures; however, comparative studies are required to determine whether this approach offers advantages over staged fixation.
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