Abstract
In this prospective study, 25 patients with closed tibial shaft fractures were treated by two different methods of treating fracture tibia ie, external fixation and plating. Thirteen patients were treated by uniplanar unilateral external fixation device AO/ASIF type and 12 patients treated by plating. There were 22 male and 3 female, there age ranges from 12-45 years. Seventeen patients sustain car accident as a cause of tibial fracture, associated fibular fractures were in 17 patients. There was no case of malunion in both modalities of treatment. Average time of fracture union with external fixation was 24 weeks. In external fixation union rate was 46%, delayed union 31% and non union 23%, complications were pin tract infection 46%, ankle stiffness 31%, algodystrophy 31% and broken schanz screws in 15.3%. Average time of fracture union with plating was 22.5 weeks. In plating, union rate was 59%, delayed union 33% and non union 8%; while complications were superficial infection 8%, deep infection 8% and ankle stiffness 8%. The non union was 100% in the middle 1/3 and 75% was transverse fracture configuration. The degree of soft tissue injury, fracture site and configuration has a great effect on union, delayed union, non union and infection also will affect the choice of treatment. In our study we try to evaluate two different modalities of treatment, which are plating and external fixation as definitive method of treatment of closed tibial shaft fracture and we try to compare between the 2 as regards of different aspect like; time of union and complication in each modality and its relation with type of fracture site, configuration, degree of soft tissue injury, this in turn will guide us to a better or more proper choice of treatment modality in the future.
Highlights
Tibia is currently the most commonly fractured long bone in the body[1].Fracture shaft tibia is a common and frequently perplexing problem in our locality
Operative time was less with external fixation (45-60 minutes) than in plating (50-90 minutes); because with external fixation no need for large skin incision and less extensive soft tissue dissection; most of the time the incision is as little as the fracture site can be hold while the pins can be inserted percutaneously; in contrast to plating large skin incision with subcutaneous and muscles planes dissection and more periosteal stripping are needed in order to insert the plate and hold it with bone holders and safe application of screws
Union rate is within the expected period of time in external fixation was 46%, which is less than reported by Hamdan[2] who reported 78.6% and Mubder[9] who reported 80%
Summary
Tibia is currently the most commonly fractured long bone in the body[1]. Fracture shaft tibia is a common and frequently perplexing problem in our locality. The blood supply to the tibia is more precarious than that of bones enclosed by heavy muscles[3]. Fractures of the tibia generally are associated with fibula fracture, because the force is transmitted along the interosseous membrane to the fibula[4]. In fracture tibia the torsion fractures tend to create a longitudinal tear of the periosteum and may not disrupt endosteal vessels, whereas transverse fractures usually tear the periosteum circumferentially and completely disrupt the endosteal circulation[5]; this is a corner stone in choosing the modality of treatment. Tibial shaft fracture is more difficult to manage than to diagnose
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