IntroductionThe treatment of open tibial fractures remains controversial. The choice of technique for stabilisation needs to be analysed. External fixation has numerous complications at pin sites, non-union or delayed union [4,10,17]. The biomechanical and biological advantages of intramedullary nailing in closed fractures have been expanded to open tibial fractures with the potential risk of infection and instability [18]. Our policy is to treat closed tibial and open type I fractures conservatively or with reamed interlocking intramedullary nailing and type II or type III with external fixation. The purpose of this paper is to analyse the results of dynamisation of external fixation and comparison with the simple unilateral static frame.
Patients and MethodsWe studied fifty-eight patients with 64 open tibial fractures treated with external fixation (38 type II, 19 type III A and 7 type III B) [6]. Thirty-eight (65.6 %) had been injured in road traffic accidents, nine (15.5 %) had direct blows, six (10.3 %) minor falls and five (8.6 %) had fallen from height. Twenty-one patients (36.2 %) had associated injuries. While in the emergency room, a specimen from the soft tissue was taken for culture and intravenous antibiotics were administered. Whether the fracture was type II or type III it was treated with cefalosporin and aminoglycoside. The patient then was taken to the operating room for irrigation with 6±10 l normal saline, hyperoxide and Betadine solution. Thereafter debridement was carried out. The fracture was stabilised by external fixation. In 19 fractures a static simple frame was used and in 45 the dynamic external fixation of Hoffmann-Monotube was used. Post-operatively the antibiotic therapy was continued for five days. Wound debridement was performed in the operation theatre during the first week and soft tissue reconstruction by a plastic surgeon was carried out when necessary. Nine of nineteen fractures with the static external fixation were changed to cast brace in 6 weeks. All fractures with the dynamic frame were dynamised between 3 to 8 weeks depending on fracture pattern and stability.
Results
Fracture healingThirty-eight fractures (59.4 %) went to union on average after 17 weeks. According to the type of fracture, the average time to healing was 19.2 weeks for type II (Fig. 1), 27 weeks for type III A, and 30 weeks for type III B (Fig. 2). Seventeen fractures (26.6 %) had delayed union. Eight (47 %) were treated by simple static external fixation and nine (20 %) by the dynamic technique. Eight fractures (47 %) with delayed union were successfully treated with reamed interlocking intramedullary nailing, nine (37.5 %) with the static, and six (66.6 %) with dynamic frame went to bony union between 6 to 8 months. Ten fractures (15.6 %) developed non-union; four (21 %) after treatment with simple external fixation and six (13.3 %) with the dynamic fixation.
InfectionIn twelve patients (18.8 %) infection developed at pin sites of the external fixator. All responded to local care and antibiotic treat...
Although the Russell-Taylor reconstruction nail (RTRN) was primarily used to treat diaphyseal and cervical femoral fractures its configuration permitts its use also in difficult subtrochanteric comminuted fractures with diaphyseal involvement.
Material and method
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