Assessment & Evaluation of the Outcome for Closed and Open Method in Treatment of Segmental Tibial Fracture

Abstract

Segmental tibial fractures are considered to be a special type of injury associated with high complication rates and are defined by the presence of two or more distinct fracture lines with completely isolating an intermediary segment і.е interruption of bone integrity at two levels(majority) or moreand are usually caused by a high-energy direct trauma with important soft tissue damage effect the both intramedullary and periosteal vascularization, which are predisposed to slow healing with creation of unsuitable biological conditions for fracture union. The aim of our study was to evaluate and assess the outcome of our policy on dealing with closed segmental fracture of the tibia treated by (closed or open) application of external tubular device fixator (AO group of ASIF) .Within the period between October 1, 1998 and September 30, 2010 in Al Nasiriya military hospital, AL Amara military hospital and Al Husain teaching hospital, we collect 38 patients with displaced and minimally displaced closed segmental tibial fractures. We exclude the multiply injured patients died after surgical treatment in the course of further management, open fractures, and all the patients lost for follow up. The minimally or undisplaced fractures were treated by closed application of the external device, while those with significantly displaced fractures, firstly managed by calcaneal continuous traction for a few days as an attempt for reduction, some of them were reduced to minimally displaced or acceptable position which were treated also by closed method, and some are remain significantly displaced, treated by open reposition and external fixation with the help of X-ray control for all cases. A range of motion exercise of ankle and knee joints post operatively were encouraged. The mean age was 38.81 years. We collect and study 38 closed segmental tibial fractures i.e. (two fractures focuses for one bone), so we are dealing with 76 fractures in 38 patients. All the patients were treated by AO unilateral external fixator arranged in multiplanartechnique for more rigid fixation and regarded as a definitive procedure for holding the fractures until clinical& radiological union.Once a considerable callus seen, a loosening of the distal clamps and a very graduated weight bearing started, with the help of the crutches to permit an axial compression on the fractures sites until a secure union of the bone. Then the external fixation was removed and a partial weight bearing was continued with the help of the crutches until consolidation. Healing of the bone occurred in 52 fracture focuses (68.42%) patients, and 24 fractures (31.57%) patients reported significant complications in the course of treatment that required further surgical management, 18 of them delayed union (23.68%) patients and 6 of the fracture focuses(7.89)patients go to nonunion.The delayed union treated simply by dianamyzation with chips bone graft and sometimes rearrangement of the external fixator particularly the loose pines, all of them healed completely, while the nonunited were treated by (Revision procedure):(revision of the external fixator with wider pins and extensive refreshment of the fracture ends and added a considerable amount of bone graft), so all of them were united successfully. We conclude that the external fixation is a suitable method for the treatment of segmental tibial fractures with an acceptable rate of