External fixation in the treatment of open tibial shaft fractures

Abstract

Besides the conquasant fractures, open tibia shaft fractures belong to the group of the most severe fractures of tibia. Open tibia shaft fracture is one of the most common open fractures of long bones. They most frequently occur as a result of traffic accidents caused by the influence of a strong direct force. Within the period from January, 2000 to December 31, 2005 at the Clinic for Orthopaedics and Traumatology, Clinical Center Nis, 107 patients with open tibial fractures were treated. We analyzed 96 patients with open tibial fracture. In the series analyzed, the male sex was prevalent--there were 74 men (77.08%). The mean age was 47.3 years. The youngest patient was 17 years old, while the oldest patient was 79. According to the classification of the Gustilo et al. in the analysed group there were 30 (31.25%) open tibial fractures of the I degree, 31 (32.29%) of the II degree, 25 (26.05%) of the III A degree, 8 (8.33%) of the III B degree and 2 (2.08%) of the III C degree. In 95 of the patients the treatment of open tibia shaft fractures consisted of the surgical treatment of wound and the external fixation of the fractured bone using "Mitkovic" type external fixator with a convergent method of pin applications. One primary amputations had been done in patients with grade IIIC open tibial fracture with large soft tissue defect. Of the 96 open tibial fractures available for follow-up, 73 (76.04%) healed without severe complications (osteitis, pseudoarthrosis, valgus malunion and amputation). There were nine (9.38%) soft tissue pin track infections and six (6.25%) superficial wound infections. The mean time of union was 21 (14-36) week. Among severe local complications associated with open tibial fractures, in eight patients (8.33%) was registered osteitis, and in nine patients (9.38%) fracture nonunion and the development of pseudoarthrosis. Three of the patients (3.13%) had more than 10 degree valgus malunion. In one patients (1.04%) deep pin track infection developed. Two patients (2.08%) had below the knee amputation (one primary in patient with type III C open fracture and one secondary after the development of deep infections). Surgical treatment of wounds, external fixation, leaving the wounds open and performing necessary debridements, adequate drug therapy administration are essential for obtaining good results in patients with open tibial shaft fractures.