TEMPORARY EX-FIX IN OPEN TIBIAL FRACTURES: ROOM FOR IMPROVEMENT?

Abstract

Introduction: To investigate adequacy of temporary ex-fix in grade III open fractures of the tibia, prior to definitive treatment by Flap & Frame at 2 UK trauma centres.

Methods: From 2000 – 2006 all open fractures of the tibia treated by the Ilizarov Method at our two institutions were entered onto the Flap & Frame database. The database was searched for all temporary external fixators placed prior to definitive Ilizarov fixation. Data collected - ex-fix type, whether revision necessary, reasons for revision.

Results:

• - 97 grade III open fractures in 95 patients

• - 64 required temporary spanning ex-fix:

• - 23 applied at trauma centre / 41 at DGH

• - 14/64 ex-fixes required revision (prior to definitive Ilizarov):

• - poor plastics access (6) / instability (2) /both (6)

• - All 14 revised were applied in a DGH, i.e. 14/41 DGH ex-fix needed revision (34%)

• - Ex fixes revised after application at trauma centre vs. DGH = 0/23 vs. 14/41, p< 0.01 X²

• - Revision of Hoffman hybrid vs. monolateral ex fix = 4/4 vs. 10/60 p< 0.001 X²

• - Non modular system (Orthofix) vs. modular systems (Hoffman II / AO) = 7/17 vs. 0/39 (p< 0.001)

Discussion: Naique and Pearse described a revision rate of skeletal fixation of 48% in grade IIIb open fractures referred to their tertiary centre. In our series 34% of temporary external fixators needed revision. Modular systems (Hoffman II and AO) required no revision, irrespective of application at a trauma centre or DGH.

All Hoffman hybrids needed revision, due to instability and plastics access. Significantly more non modular (Orthofix) ex-fixes required revision compared to modular, for poor plastics access.

We recommend modular external fixator application (Hoffman II or AO) to avoid problems with temporary external fixation of open tibial fractures. Hybrid temporary external fixation should be abandoned in such injuries.