FACTORS AFFECTING HEALING TIME IN FRACTURES OF THE TIBIAL DIAPHYSIS TREATED BY EXTERNAL FIXATION

Abstract

Introduction: We present a prospective comparative study of 200 consecutive patients of closed tibial shaft fractures treated by external fixation using two different fracture reduction methods. Factors affecting fracture healing, including the effect of quality of reduction, was studied.

Methods: The healing time for all these fractures was determined by a combination of clinical, radiological and fracture stiffness measurements. The effect of smoking, AO classification type, associated fractures, initial and final angulation and translation on healing time was evaluated using nonparametric tests and regression analysis.

Results: Healing time was affected most by presence of Compartment syndrome followed by smoking status and final translation at fracture site. Having a compartment syndrome significantly increased fracture healing time (mean 286.7 days versus 139.2 days). There was no difference in healing times between the two different reduction machines. Angulation was found not to affect healing time, but translation did. Both initial and final translation were better using STORM (Staffordshire Orthopaedic Reduction Machine). The amount of axial shortening was also reduced by using STORM.

Conclusion: Healing time is affected by translation at fracture site, which is a factor under the control of the surgeon. The second reduction method using STORM, helps achieve better reduction.