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.
The Ilizarov external fixator - a useful alternative for the treatment of proximal tibial fractures A prospective observational study of 30 consecutive patients