SINGLE CENTRE PROSPECTIVE STUDY OF 196 CLOSED TIBIAL DIAPHYSEAL FRACTURES TREATED BY MONOLATERAL EXTERNAL FIXATION

Abstract

Single centre prospective study of 196 closed tibial diaphyseal fractures treated by monolateral external fixation.

Methods: Surgical management of all patients followed protocol of senior author (PBMT), with regard to technique and fracture reduction.

Operations performed by several different surgeons including senior author.

Definitive fixator used as a reduction tool in 34 cases, fracture reduction device used in 162 patients – ST.O.R.M

Followed up in a dedicated external fixator clinic by the senior author until one year post fracture healing.

Fracture healing was determined by fracture stiffness measurements.

Results: 196 tibial fractures in 196 patients, average age 29 (range 12–80).

111 right sided and 85 left sided.

166 male and 30 female.

116 fractures due to low energy and 80 due to high energy.

Mechanism of injury: football 75, fall 52, RTA 49, direct blow 7, assault 4, rugby 3, crush 2, dancing 2, bowling 1, roller skating 1.

33 patients had an additional 74 injuries: 35 fractures (3 open), 7 compartment syndromes, 3 dislocations, 7 head injuries, 16 chest injuries, 9 soft tissue injuries.

According to AO classification system: 33 A1, 47 A2, 42 A3, 15 B1, 46 B2, 7 B3.

Time to # healing was 19 weeks on average (range 9–87)

X ray data: 15 patients had deformity > 5 degrees in the coronal plane and 1 of these also had deformity > 10 degrees in the saggital plane.

One patient underwent osteotomy for correction of malunion.

85 patients had a total of 279 pin site infections requiring Abx (6 with 14 pin infections requiring iv abx), and 33 pins were removed due to persistent infection. 15 patients had 32 ring sequestra which settled with debridement under GA.

7 fixators removed early due to pin site infection.

1 established osteomyelitis-lautenbach.

7 refractures, all healed(5 with pop, 2 with further fixator)

Non-union: 5 hypertrophic, 2 atrophic-all healed with further external fixation.

Malunion: 1

Conclusion: Our results show that external fixation of closed tibial fractures is a viable alternative to other treatment methods with regard to healing time and angular deformity.

Our study also uses a well validated end point to define fracture healing and does not rely on the difficulty of defining healing on clinical or radiological grounds which is known to be unreliable. This is the first time this highly repeatable methodology has been used for such fractures.