Complications and Functional Outcomes in Open Tibia-Fibula Fractures: A Retrospective Analysis from a Tertiary Care...

Open (compound) fractures of the tibia and fibula diaphysis remain a major challenge in orthopedic trauma due to their high risk of infection, non-union, and chronic osteomyelitis. Effective management requires timely debridement, stable fixation, and meticulous soft-tissue handling . This study aimed to analyze the complication rates and identify the major determinants influencing outcomes in patients with open tibial fractures treated at a tertiary care center.

A retrospective analysis was conducted on 138 consecutive patients with Gustilo-Anderson Grade I-IIIB open fractures of the tibia fibula diaphysis. Data recorded included demographics, Gustilo grade, definitive treatment type, presence of comorbidities, and time lag to surgery. Outcomes evaluated were fracture union, osteomyelitis, soft-tissue healing time, Barthel index, and duration of hospital stay. Statistical analysis included Chi-square/Fisher's exact tests, Independent Sample t-tests, and multivariate logistic regression, with P < 0.05 considered significant.

The mean age of patients was 35.3 ± 14.7 years, with 81.2% males. The overall non-union rate was 22.5%, and osteomyelitis occurred in 18.1%. The Gustilo-Anderson grade was the most significant determinant of non-union and complications (P < 0.001), with rates increasing from 3.3% in Grade I to 66.7% in Grade IIIB. The mean delay to definitive treatment was 5.2 days in non-union cases versus 4.2 days in union cases (P = 0.02). Intramedullary nailing (IMN) showed the highest union rate (91.5%) and the lowest infection rate (8.5%), whereas external fixation (Ilizarov/limb reconstruction system) was associated with higher complication rates, reflecting higher injury grades.Diabetes mellitus was significantly correlated with non-union (P = 0.001).

The severity of initial soft-tissue injury and delay to definitive treatment are the two most critical determinants of outcome in open tibia fibula diaphyseal fractures. Gustilo-Anderson grade remains the only independent predictor of both non-union and infection. Early debridement, stable fixation (preferably with IMN in lower-grade injuries), and comprehensive soft-tissue management are essential to minimize complications and improve functional recovery.