Objectives: In a developing country such as ours, patients with Type III open Tibial fractures often reachthe hospital late (after initial 6 hours) of sustaining high–velocity trauma. Primary internal fixation becomes a formidable challenge in such patients. Due to the paucity of articles exclusively dealing with this topic, we did a study to determine the functional outcome of primary intramedullary nailing in these patients.

Materials and Methods: A prospective study was conducted with patients above 18yrs of age with Type3A and 3B open TibialDiaphyseal fractures presenting late after injury, initially treated with thorough wound debridement and lavage, followed by internal fixation with intra–medullary nailing. Patients were followed up at fixed intervals for a period of 1year.

Results :50 patients were enrolled in the study, 46 males and 4 females, time elapsed from injury tosurgery ranged from 7hrs to as long as 5 days, average –2.66 days.46 patients had a RUST score of 12 at 1yr follow–up. Functional outcome with Ketenjian and Shelton Criteria was excellent– good in 42 patients. 4cases (8%) developed non–union, 6 cases (12%) developed post–op infection (Osteomyelitis).

Conclusion : Thorough wound debridement and lavage, followed by primary intra–medullary nailing ofType 3A & 3B open Tibialdiaphyseal fractures, have shown good results despite delay in presentation and surgery, in comparison to external fixation and secondary nailing.