Clinical efficacy and biomechanical property of tibiofibula fracture treated with unilateral versus taylor fixator in elderly patients

Abstract

Objective To compare the clinical efficacy and biomechanical property between unilateral fixator (UF) and Taylor fixator (TF) for treating Gustilo Ⅱ tibiofibula fracture. Methods In this retrospective study, 86 patients with open tibiofibula fracture admitted from January 2012 to August 2015 were divided into an UF group (n=49) or a TF group (n=37) according to fixing method, and their clinical efficacy and biomechanical property were compared.Providing the finite element model was fully proved effective, the axial stiffness, bending stiffness and torsional stiffness of UF and TF were tested by this model.Additionally, the torsional stiffness was measured at every 10° revolving around the model. Results The operation time was shorter in UF group (43.2±11.7) min than in TF group (63.6±9.8) min (P=0.027), and blood loss was less in the UF group (32.1±13.8) ml than in TF group (57.6±23.1) ml (P<0.001). All the patients were followed up for 8-31 months (mean: 13.8 months). The healing time was shorter in the UF group (4.6±1.7) months than in the TF group (5.7 ±2.1) months (P=0.039). The complication rates were 4.5% (9/201) in the UF group, which was significantly less than that in the TF group (12.0%, 14/117) (P<0.05). For biomechanical property, the axial, bending and torsional stiffnesses were higher in the UF group[(341.47 N/m, 80 Nm/deg, and (210-430) N/m, respectively]than in the TF group[226.83 N/m, 72 Nm/deg, and (242-287) N/m, respectively]. Conclusions In the treatment of open tibiofibula fracture, UF is easier to operate and has better agreement with the biomechanical property and better ability to resist a rotation and a compression, which is obviously superior to TF.Besides, UF is better than TF for fracture recovery. Key words: Fracture fixation; Tibial fractures; Fibular fractures; Finite element analysis