Outcomes of primary internal fixation for open fractures of the lower limb: Experience from a tertiary care centre

Background: Open fractures usually result from high energy trauma which were traditionally managed with a staged procedure using an external fixator due to infection and soft tissue compromise. However, advances in infection control and better surgical techniques have enabled primary internal fixation in selected cases. This study aimed to evaluate the outcome of primary internal fixation in open fractures of lower limb in a tertiary care centre.Materials and Methods: A prospective observational study was conducted in a Tertiary Teaching Hospital between 2022 and 2023. 20 patients with open fractures of lower limb (Gustilo-Anderson type II, III A and IIIB) underwent primary internal fixation. Demographic data, fracture classification, time till surgery, MESS score, perioperative antibiotics and procedure done were recorded. Functional outcomes were assessed using VAS score and bone union radiologically. Infection rate and other complications like non-union were documented on follow up.Result: The cohort included 17 males (85%) and 3 females (15%) with a mean age of 31.8 years. Road traffic accidents account for 95% of injuries. Infection rates were 9% for Type II, 20% for Type IIIA, and 75% for Type IIIB fractures (p=0.032). Bone union at 12 months was achieved in 81.8% of Type II, 40% of Type IIIA, and 25% of Type IIIB fractures.Conclusion: Primary internal fixation in carefully selected patients can provide early mobilisation and definitive management when done under strict aseptic protocol and patient selection. Type II and IIIA patients show good outcomes and low infection rates. Very high infection rates of III B fractures call for change in protocol and patient selection. This study guides in choosing management protocols for open fractures in a high load Tertiary Teaching Hospital in India.