External Fixation of Extra-Articular Open Tibial Fractures

Abstract External fixation is one of the most commonly used methods for the treatment of open tibial fractures. In everyday practice, for fixation of open tibial fractures we use the external fixator by Mitković. External fixator is unilateral and easy to use. This retrospective study included 59 patients with 59 open tibial fractures, of which 37 (62.71%) men and 22 (37.28 %) women, with mean age 43.92 (16-84) years. The fractures were localized in the proximal part of the tibia (11), tibial shaft (29) and distal part of the tibia (19). According to Gustilo classification, 12 (20.33 %) patients had Type I open tibial fractures, 15 (25.42%) patients had Type II open tibial fractures, and 32 (54.23%) (13 IIIA, 17 IIIB, 2 IIIC) patients had Type III open tibial fractures. The union rate without complications was 77.96 % (46). Nonunion and delayed union rate was 15.25 % (9). Malunion rate was 6.77% (4). Pin tract infection rate was 13.55 % (8). Compartment syndrome was observed in 5.08 % (3) of patients. The patients had fasciotomy done and the external fixator applied. The average time of fracture healing was 26 weeks (6.06 months). External fixation of open tibial fractures is a simple and effective method that enables the safe healing of fractures, early mobilization of patients, early weight-bearing as well as early rehabilitation.

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External skeletal fixation of the tibial shaft fractures

Vojnosanitetski pregled ◽

10.2298/vsp0501011m ◽

2005 ◽

Vol 62 (1) ◽

pp. 11-15 ◽

Cited By ~ 2

Author(s):

Sasa Milenkovic ◽

Milorad Mitkovic ◽

Mile Radenkovic

Keyword(s):

External Fixation ◽

External Fixator ◽

Weight Bearing ◽

Early Mobilization ◽

Tibial Shaft ◽

Closed Fracture ◽

Early Weight Bearing ◽

Shaft Fractures ◽

Pin Tract Infection ◽

Tibial Shaft Fractures

Aim. To present the possibility of a successful use of external skeletal fixation in treating the open and closed tibial shaft fractures with Mitkovic?s external fixator. Methods. External fixation was used in 115 patients with 118 fresh tibial shaft fractures, 82 males (71.3%) and 33 females (28.7%), average age 43.92 years (16?84). Open tibial shaft fractures were present in 37 (31.36%). All the fractures were treated with Mitkovic?s external fixator type M 20. Results. The results of external fixation were excellent or good in 94.07% of the cases, and bad in 5.08%. Pin tract infection appeared in 7 (5.93%) patients. In only 3 cases an external fixator was removed and treatment continued with the functional braces. Nonunion occurred in 6 (5.08%) patients, of which 4 were with open fractures (2 Gustilo type IIIB, 1 Gustilo type IIIA, 1 Gustilo type II) and 2 with the segment fractures. Compartment syndrome was observed in 1 (0.85%) patient with closed fracture. Malunion was found in 2 (1.69%) patients. Conclusion. External fixation of tibial shaft fractures is a simple and effective method to enable the safe healing of fractures, early mobilization of the patients, early weight-bearing, as well as early rehabilitation. Fixation of tibial shaft fractures was unilateral with convergent pins orientation, and there was also a possibility of compression and distraction.

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Open segmental fractures of the tibia treated by external fixation

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1212732g ◽

2012 ◽

Vol 140 (11-12) ◽

pp. 732-737 ◽

Cited By ~ 1

Author(s):

Ivan Golubovic ◽

Zoran Vukasinovic ◽

Predrag Stojiljkovic ◽

Zoran Golubovic ◽

Sonja Stamenic ◽

...

Keyword(s):

External Fixation ◽

External Fixator ◽

Tibial Fractures ◽

Type I ◽

Severe Injuries ◽

Results Of Treatment ◽

Additional Surgery ◽

Segmental Fracture ◽

Segmental Fractures ◽

Angular Deformities

Introduction. Open segmental fractures of the tibia are rare but severe injuries. In these fractures the wide zone of injury (damage of all structures of the lower leg) creates very unsuitable biological conditions for healing of the fracture. Objective. The aim of our work was to present the results of treatment of patients with segmental open fractures of the tibia treated by external fixation. Methods. We analyzed treatment results of 21 patients with open segmental tibial fractures who were treated using the method of external fixation at the Clinical Center Nis from January 1, 1995 to July 31, 2010. The average age of the patients was 53 years; the youngest patient was 27 years and the oldest one 80 years. According to the Gustilo open fracture classification, there were 3 (14.3%) type I, 6 (28.6%) type II, 8 (38.1%) type IIIA, and 4 (19.0%) type IIIB. All the patients were treated by a unilateral type Mitkovic external fixator by Traffix Company. Results. Union was attained in 16 (76.2%) fractures without severe complications (pseudoarthrosis, chronic osteitis and angular deformities of over 10 degrees). Among severe complications associated with open segmental tibial fractures, in two cases we registered septic pseudoarthrosis, in one aseptic pseudoarthrosis and in two large angular deformities of the tibia after union, with a valgus of over 10 degrees and extremity shortening of over 2 cm which required additional surgery. Conclusion. External fixation by the use of Mitkovic external fixator is one of the methods of choice in the treatment of open segmental tibial fractures, which incorporated with antibiotic therapy provides good biomehanical conditions for segmental fracture healing that enables good stability of the segmental tibial fracture and decreases the risk of deep infections.

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Comparison of Clinical Outcomes of Flexible Intramedullary Nailing (FIN) with External Fixation in Pediatric Open Tibial Fractures

10.53350/pjmhs2115113455 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3455-3457

Author(s):

Malik M. Yasin Awan ◽

Mudassar Nazar ◽

Abdul Qayyum Baig ◽

Rizwan Anwar ◽

Muhammad Abdul Hanan ◽

...

Keyword(s):

Clinical Outcome ◽

External Fixation ◽

Intramedullary Nailing ◽

External Fixator ◽

Group Versus ◽

Tibial Fractures ◽

P Value ◽

Fracture Rate ◽

Open Tibial Fractures ◽

Flexible Intramedullary Nailing

Objective: To compare the clinical outcome of flexible intramedullary nailing (FIN) with external fixator in pediatric open tibial fractures. Subjects and Methods: In this randomized comparative study, 80 children having age 5 year to 14 years who presented with open tibial fractures were included. The study was conducted from June-2020 to June-2021 in Islam Hospital Sialkot and Allama Iqbal Memorial Hospital Sialkot. Patients were divided into two equal groups. Group A: underwent external fixation and group B: underwent flexible intramedullary nailing for the surgical management of tibial fractures. Frequency of infections surrounding pins, painful bursitis and re fracture rate within 3 months after surgery was recorded. Results: The mean age of children was 8.42±3.82 years in external fixator group versus 8.40±4.0 years in FIN group (p-value 0.97). Infection-surrounding pins occurred in 9 (22.5%) children were belonging to external fixator group and 01 (2.5%) children was belonging to FIN group (p-value 0.007). Refracture occurred in 6 (15.0%) patients in external fixator group and in no (0.0%) children in FIN group (p-value 0.01). Painful bursitis occurred 2 (5.0%) patient was in external fixator group and in 13 (32.5%) in FIN group (p-value 0.002). Conclusion: Clinical outcome is better in patients treated with FIN as compared to the external fixator for the treatment of pediatric open tibial shaft fractures. Keywords: Flexible intramedullary nails, External fixator, Tibial fractures.

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Tarsocrural Arthrodesis: A Clinical Report Using a Circular External Fixator

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632546 ◽

1998 ◽

Vol 11 (04) ◽

pp. 193-196 ◽

Cited By ~ 9

Author(s):

R. M. Radasch ◽

C. T. Trostel

Keyword(s):

Soft Tissue ◽

External Fixation ◽

External Fixator ◽

Weight Bearing ◽

Clinical Report ◽

Early Weight Bearing ◽

Articular Fractures ◽

Intraarticular Fractures ◽

Tarsal Bones ◽

Fixation System

SummaryArthrodesis is a well documented treatment option for comminuted intraarticular fractures, irreparable collateral ligament injuries, limb salvage for ischiatic nerve injury, and severe degenerative joint disease of the tarsocrural joint (1-6). Conservative splint or bandage application often results in a less than favorable outcome in the management of these types of injuries. Common techniques to achieve tarsocrural arthrodesis include divergent Steinmann pin placement, lag screw or compression plating and external skeletal fixation (1-5). This report describes a tarsocrural arthrodesis using a circular external fixation system to manage an open, severely contaminated, comminuted intra-articular fracture of the talus and calcaneous, with extensive soft tissue degloving injuries. The decision to use a circular external fixation system was based on its ability to (1) adequately stabilize the tibialtarsal region, (2) be applied with minimal soft tissue and vascular disruption, (3) allow adequate post-operative soft tissue wound management, and (4) be tolerated well by the patient allowing early weight bearing of the limb.Severe tarsocrural injuries were diagnosed on a four-year-old mixed breed dog including articular fractures of the tubercalcaneous, talus, fibula, multiple tarsal bones and the second metatarsal bone. A circular ring external fixator was used to arthrodese the joint. Twelve weeks following surgery the limb was functional without any mechanical gait alteration and with minimal to zero discomfort.

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Distal Tibia Metaphyseal Fractures: Which is Better, Intra-medullary Nailing or Minimally Invasive Plate Osteosynthesis?

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.09.004 ◽

2018 ◽

Vol 24 (1) ◽

pp. 66-71

Author(s):

Kawalkar Abhijit Chandrakant ◽

Badole Chandrashekher Martand

Keyword(s):

Intramedullary Nailing ◽

Weight Bearing ◽

Distal Tibia ◽

Tibial Fractures ◽

Minimally Invasive Plate Osteosynthesis ◽

Early Weight Bearing ◽

Significant Difference ◽

Duration Of Surgery ◽

Tibia Fractures ◽

Distal Tibia Fractures

Introduction Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPPO technique. Methods The study was conducted between Jan 2011 to Dec 2012. 63 patients with extra-articular distal tibia fracture treated with intramedullary nailing and MIPPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score. Results 31 patients were treated with intramedullary nail & 32 with MIPPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPPO group. Conclusion Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures & helps in early weight bearing and ambulation of patient with fewer complications.

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Unilateral external fixator as the primary and definitive treatment modality in type iii b open tibial fractures: A retrospective study

Indian Journal of Orthopaedics Surgery ◽

10.18231/j.ijos.2019.010 ◽

2019 ◽

Vol 5 (1) ◽

pp. 52-56

Author(s):

Navdeep Singh ◽

◽

Rashid Anjum ◽

Jatin Aggarwal ◽

Amrit Rai Badgal ◽

...

Keyword(s):

Retrospective Study ◽

External Fixator ◽

Treatment Modality ◽

Tibial Fractures ◽

Definitive Treatment ◽

Open Tibial Fractures ◽

Type Iii

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A COMPARATIVE STUDY OF IN VIVO EFFECT OF PERCUTANEOUS BONE MARROW INJECTION VS WITHOUT INJECTION ON UNION OF OPEN TIBIAL SHAFT FRACTURES WITH EXTERNAL FIXATOR

10.36106/paripex/2900868 ◽

2020 ◽

pp. 1-2

Author(s):

Hrishikesh Desai ◽

Kirtiraj G ◽

Abhay P

Keyword(s):

Bone Marrow ◽

External Fixator ◽

Autologous Bone Marrow ◽

Tibial Fractures ◽

External Fixators ◽

Open Tibial Fractures ◽

Autologous Bone ◽

Group 2 ◽

Radiological Union

Background : Open tibial fractures are notorious fractures because the open wound leaves us with limited options and means multiple operations with long intervals for the patient. The usual method of treatment of contaminated, late presenting and complicated fractures is a temporary external fixator followed by conversion into a costly definitive procedure once the wound has healed. The secondary definitive procedure also means extra cost in an already economically stressed patient.In our set up we have to often let patients leave with a plaster cast after removing the external fixator for economic constrains. Per cetaceous autologous bone marrow injection while the patient is on external fixator is one alternative that we have tried to deal with this problem hoping for a primary union without any costly intervention. Materials and methods : We had 42 cases of open tibial fractures which were treated with external fixator and per cutaneous bone marrow injection while 38 other cases which were used as control with only the external fixator and no injections. We included open fractures of only Gustilo Anderson type II,IIIA and B for our study. Study was conducted between period of June 2012 and December 2013 at SBKS medical college . Results : In group one, 34 of the 42 patients had a radiological union before 12 weeks while another 2 in 16 weeks. For group 2 , only 16 of the 38patients had radiological union at 12 weeks and no more at 16 weeks. The average time of union for group 1 was 10 weeks while of group 2 was 12 weeks .Function of the union cases of both the groups was similar in all aspects including distance of walking and ability to carry out daily activities. Conclusion : Per cutaneous autologous bone marrow injections are cheap , easily available and successful alternative to a secondary procedure for open tibial fractures on external fixators.

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Comparison between External Locking Plate Fixation and Conventional External Fixation for Extraarticular Proximal Tibial Fractures: A Finite Element Analysis

10.21203/rs.3.rs-955261/v1 ◽

2021 ◽

Author(s):

Dejan Blažević ◽

Janoš Kodvanj ◽

Petra Adamović ◽

Dinko Vidović ◽

Zlatko Trobonjača ◽

...

Keyword(s):

Finite Element ◽

External Fixation ◽

External Fixator ◽

Tibial Fracture ◽

Locking Plate ◽

Plate Fixation ◽

Tibial Fractures ◽

Proximal Tibial Fracture ◽

Locking Plate Fixation ◽

Maximum Stiffness

Abstract BackgroundGood clinical outcomes for locking plates as an external fixator to treat tibial fractures have been reported. However, external locking plate fixation is still generally rarely performed. This study aimed to compare the stability of external locking plate fixator with that of conventional external fixator for extraarticular proximal tibial fractures, using finite element analysis. MethodsThree models were constructed: (1) external locking plating of proximal tibial fracture with lateral proximal tibial locking plate and 5-mm screws (ELP), (2) conventional external fixation of proximal tibial fracture with an 11-mm rod and 5-mm Schanz screws (EF-11), and (3) conventional external fixation of proximal tibial fracture with a 7-mm rod and 5-mm Schanz screws (EF-7). The stress distribution, displacement at the fracture gap, and stiffness of the three finite element models at 30-, 40-, 50-, and 60-mm plate–rod offset from the lateral surface of the lateral condyle of the tibia were determined. ResultsThe conventional external fixator showed higher stiffness than did the external locking plate fixator. In all models, the stiffness decreased as the distance of the plate–rod from the bone surface increased. The maximum stiffness was 121.06 N/mm in the EF-11 model with 30-mm tibia–rod offset. In the EF-7 model group, the maximum stiffness was 40.00 N/mm in the model with 30-mm tibia–rod offset. In the ELP model group, the maximum stiffness was 35.79 N/mm in the model with 30-mm tibia–plate offsetConclusionsExternal locking plate fixation is more flexible than conventional external fixation, which can influence secondary bone healing. External locking plate fixation requires the placement of the plate as close as possible to the skin, which allow low-profile design, because the increased distance of the plate from bone can be too flexible for bone healing.

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