HIGH ENERGY TIBIAL FRACTURES MANAGED BY EXTERNAL FIXATORS

Abstract

A prospective study on the management of 23 patients with complex high energy tibial fractures was carried out to assess the outcome following the use of different external fixators. They were all followed up clinically and radio logically till fracture union.

The average age 42 years (range 13–77 years) 17 male & 6 females. Fourteen were closed and 9 open. Eight were falls from height, 9 RTAs, one crush injury and one assault. All of the open fractures were grade 3. Six patients had proximal tibial fractures (one Schatzker Type-II, one Type-IV, two Type-V and two Type-VI) They united at an average of 20 weeks (range 10–40 weeks). Seven were Shaft fractures average duration to union 30 weeks (range 8–104 weeks), and eight were Pilon fractures (Two Ruedi & Allgower Type-II & Six Type-III) they united at an average duration of 13 weeks (range 7–20 weeks)

All patients achieved clinical and radiological union at a mean duration of 22 weeks. Sheffield Ring fixator [SRF] was used primarily in 11 patients, none failed. Two had initial monolateral fixators which were converted to SRF. Two were managed with Illizarov frames and three with hybrid fixators. Seven patients had an initial monolateral fixator, two failed and were converted to a Sheffield fixator, 2 planned conversion to an intramedullary nail, one developed a delayed union and was converted to a Sheffield fixator, only two continued till union. Nine patients developed pin tract infection needing Antibiotics, three of them developed Osteomyelitis, Four had failure of fixation needing a second operation.

Two developed malunion, one managed with total knee replacement, another required Ankle fusion. The average SF 12 score for the Sheffield group PCS was 52.1 and MCS of 51.7. For the Monolateral fixator group PCS was 47.2 and MCS of 48.1. For the Hybrid fixator group PCS of 34.7 and MCS of 42.7 and for the Ilizarov group PCS was 39.85 and MCS was 55.05.

In this cohort of complicated High energy Tibial fractures, those managed with Circular Frames especially SCF augmented with interfragmantary screws proved to be most successful with a very lower failure rate and better patient satisfaction.