IMPROVING THE REDUCTION OF TIBIAL FRACTURES TREATED BY EXTERNAL FIXATION

Abstract

Fractures of the tibia should be reduced as accurately as possible. Fractures opened for internal fixation can be reduced accurately under direct vision, but unstable closed fractures treated by external fixation must be reduced by indirect means. Most surgeons reduce the fracture by manipulation, insert the bone-screws, apply the fixator and then manipulate the fracture again to improve the reduction before locking the fixator. Using this technique it is difficult to obtain a perfect reduction. A poor reduction can prolong healing time and may lead to malunion causing long-term impairment of function. A good reduction lessens the loading imposed on the bone-screws and fixator. We describe a device with which closed tibial fractures can be reduced with a predictable high degree of precision prior to external fixation.

A reduction device, the Staffordshire Orthopaedic Reduction Machine (STORM), was developed. Externally fixed unstable closed tibial fractures reduced by conventional methods (n=37) were compared with those reduced using the STORM (n=41). In the STORM group, the holes for the fixator pins were only drilled once the fracture had been perfectly reduced and no further manipulation was undertaken after the fixator had been applied. Reductions were assessed by measurements of radiographs taken at, and 4 weeks after, fixator removal. All cases were treated with monolateral external fixation.

The STORM significantly improves the precision of reduction of unstable tibial fractures without increasing operating time. Its use obviates the need for reduction joints on external fixators for the tibia.