Abstract
BackgroundThe treatment of open tibial shaft fractures is challenging. External fixation (EF) is comparatively safe in treating these open injuries, meanwhile it has the advantages of easy application, minimal additional disruption, and convenient subsequent soft tissue repair. Nevertheless, its application is accompanied by a series of problems in alignment and bone healing. Therefore, limited internal fixation (LIF), such as cortical screws, has been used based on the external fixator for better therapeutic effect. The aim of this study is to compare the outcomes of EF combined with LIF and simple EF in the management of open tibial shaft fractures, evaluating the efficacy and safety of using the combined technique in treating such fractures.MethodsFrom January 2012 to December 2016, patients with open tibial shaft fractures treated with EF with or without LIF augmentation were identified. A total of 152 patients were included in the analysis, and there were 85 patients in the simple external fixation group and 67 patients in the EF-LIF group. General assessment indicators included the direct cost of hospitalization and the times of first surgery, full weight bearing, and complete union. Infections and complications in union or limb alignment were compared as primary outcomes. Additionally, the number of patients who changed the fixation system for various reasons were analysed.ResultsEffective follow-up of all participants for statistical analysis was obtained. The follow-up time averaged 17.15 months (range: 12.00 to 24.00 months) in the EF group and 16.20 months (range: 12.00 to 19.00 months) in the EF-LIF group. Combined fixation provided shortened time to bear full weight and achieve complete bone union, while requiring additional first surgery time. No significant difference was found in infection rates or direct cost of hospitalization. Delayed union and non-union in the EF-LIF group were significantly decreased (20.9% versus 40.0, 1.5% versus 14.1%, p < 0.05). In limb alignment, patients with combined fixation exhibited reduced malreduction, loss of reduction, and malunion. In terms of secondary fixation, the EF-LIF group showed a markedly lower incidence (5.8% versus 34.1%, p < 0.001).ConclusionCompared with simple EF, combined fixation is an effective and safe alternative for management of open tibial diaphyseal fractures. It provides superior initial reduction, better stability and decreases the risk of inferior alignment and delayed union without increasing the risk of infection.
Highlights
The treatment of open tibial shaft fractures is challenging
Study design All open tibial fractures treated with simple External fixation (EF) (Hoffmann II External Fixation System, Stryker Corporation, Kalamazoo, Michigan, USA) or EF augmented by limited internal fixation (LIF), including cortical screws and the Ni-Ti arched shapememory connector [19,20,21,22] (ASC, Swan Biological Memory Medical Devices Co., Ltd., Huzhou, Zhejiang Province, China), at our trauma centre were identified through the hospital’s electronic patient files system in the period between January 2012 and December 2016
Utilization of the limited internal fixation For the limited internal implants, the Ni-Ti arched shape-memory connector (ASC) were applied in 30 patients, cortical screws were used in 27 patients, and a combination of ASCs and cortical screws were used in 10 patients
Summary
The treatment of open tibial shaft fractures is challenging. External fixation (EF) is comparatively safe in treating these open injuries, it has the advantages of easy application, minimal additional disruption, and convenient subsequent soft tissue repair. Open tibial fractures account for over 40% of all open fractures and are frequently accompanied by significant damage to soft tissues, including skin, muscle, and neurovascular structures [1] These fractures are especially prone to serious complications, such as infection, malunion, and non-union, adding to the incidence of readmission and reoperation [2, 3]. Based on relevant studies, external fixation as a definitive treatment should warrant more attention for possible issues related to pin-track infection, unsatisfactory alignment, and poor union, leading to unplanned secondary fixation procedures and consequent additional burdens to patients in physiology and economy [5, 10,11,12,13,14]
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