TREATMENT OF CLOSED UNSTABLE TIBIAL SHAFT ‎FRACTURE BY A UNILATERAL UNIPLANER EXTERNAL ‎FIXATION. IS A SECOND OPERATIVE STEP NECESSARY?‎

Abstract

This is a prospective study was conducted in Basrah University Hospital from January 1996–‎January 2001.‎ ‎ Thirty patients with thirty closed tibial shaft fractures were treated until healing with a unilateral ‎uniplaner external fixation device that permits fracture site compression with weight bearing, ‎after failure to maintain adequate closed reduction in plaster. There were twenty-five men and ‎five women, age range from ten to fifty-five years with an average 29.9. Fractures were ‎classified depending on the anatomic location, fracture configuration and extent of concomitant ‎soft tissue injuries. Immediate bone graft was needed for two cases and delayed bone graft for ‎two cases. All patients were permitted early partial weight bearing when their fractures showed ‎early signs of union which took an average of eight to ten weeks and progressed to full weight ‎bearing, with fixator dynamization in seventeen cases. Cast immobilization after removal of ‎external fixation device was needed for all cases. Twenty-four cases showed complete healing. ‎The time to fracture union ranged from twenty-six to thirty weeks average of twenty-eight ‎weeks. The main complications were; four delayed union, two non-union, and twelve cases ‎screw site infection four of which require screw changes with the other eight require antibiotic ‎therapy and local cleaning and ten had stiffness of the ankle joint. ‎ The study highly recommends the use of external fixation as a good alternative to internal ‎fixation for treatment of closed unstable tibial shaft fracture in a compliant, tolerant patient. It ‎provides easy techniques to apply without the need of second surgery to remove it. Most of the ‎complications can be managed without removing the device. ‎