To The Editor:
In their article, "Analysis of Surgeon-Controlled Variables in the Treatment of Limb-Threatening Type-III Open Tibial Diaphyseal Fractures" (2007;89:923-8), Webb et al. may indeed have come to the correct conclusions, but I would point out that the study was limited to a comparison of outcomes following certain procedures such as external fixation and intramedullary nailing, with soft-tissue coverage.
The authors did not provide details about the nature and type of the fractures, which greatly influence the management of these injuries and the functional outcomes. It is not the particular procedure—i.e., external fixation or intramedullary nailing—that determines the likelihood of a successful outcome, but rather the primary injury characteristics that lead the surgeon to choose the treatment options. Hence, comparison done only on the basis of the procedures may not provide valid results.
Such outcome measures as infection, union, number of surgical interventions, weight-bearing status, and days of hospitalization are more pertinent than the particular treatment option.
In addition, the description of type-III open fracture is too wide, as noted by Rajasekaran et al.1 to explain why they developed the Ganga Hospital trauma severity score, and it is very difficult to obtain any valid conclusion for all type-III fractures combined.