Abstract
BackgroundThe hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the HEF for definitive management in patients with high-energy tibial shaft fractures.MethodsThe study was conducted on 34 patients with tibial shaft fractures who were admitted or referred to our institution and consented to HEF treatment from Jan 2016 to June 2019, including 27 males and 7 females with a mean age of 39 years (range 18 to 65 years). Patients' clinical and radiological data, and the final clinical outcomes at a minimum of 12 months follow-up were collected and retrospectively analyzed. All complications were documented according to Paley’s classification. The clinical outcomes were evaluated using the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.ResultsAll patients remained in the HEF for a mean of 26 weeks (range 15 to 52 weeks) and acquired complete bone union. The satisfactory alignment was achieved in all patients, and all the patients were able to perform daily activities with no difficulty at the last clinical visit. Complications included pin tract infection (44%), delayed union (6%), nonunion (3%), and joint stiffness (3%). The ASAMI bony result was excellent in 31 patients and good in 3. The ASAMI functional result was excellent in 27 patients, good in 6, and fair in 1.ConclusionsDefinitive management using the hexapod external fixator is an alternative and effective method for high-energy tibial shaft fractures, including technical advantages of early trauma-control, the versatility of achieving excellent alignment, and the continuity of device until bone union.
Highlights
The hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device
The hexapod external fixator (HEF), such as the Taylor spatial frame (TSF), is a symmetric configuration of the Stewart platform that consists of 2 rings or partial rings connected by 6 telescopic struts at special universal joints [6, 7]
Damage-control was initially managed by a monolateral external fixator in 18 cases (53%), and the HEF was initially applied to manage 4 patients (12%)
Summary
The hexapod external fixator (HEF) is increasingly used for high-energy tibial shaft fracture care as more general orthopedic surgeons are gaining expertise of this versatile device. The purpose of this study was to evaluate the clinical effectiveness of the HEF for definitive management in patients with high-energy tibial shaft fractures. The tibial shaft fractures are often the result of highenergy trauma, and most cases suffered significant soft tissue damage [1, 2]. The HEF provides all the advantages of multiplanar fixation of the Ilizarov system and is equipped with the versatility of spatial deformities correction without the alteration of frame construct. As for complex low limb trauma, especially in cases with poor surrounding soft tissues and significant extremity deformities, the HEF had become an attractive option in recent years
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