Complex Fractures of the Tibia and a Modular External Fixator

Abstract

The aim of the study is to analyse the results and the rate of consolidation of 65 tibia and fibula fractures in 62 patients (mean age 41 years) who have been stabilised between July 1995 and June 1998 by Hoffmann II external fixator. According to AO classification, the series included 21 type A, 15 type B, and 19 type C fractures. Eighty percent were open fractures according to Gustilo, of which 32 percent were grade III. A standard surgical protocol with debridement followed by an abundant irrigation was followed in 70 percent of the cases. Under systemic antibiotic coverage, the fractures were stabilised by an external fixator using a montage chosen according to the fracture type and the extent and location of lesions of the soft tissues. Soft tissue coverage for grade III B fractures was carried out after 13 days on average by a fasciocutaneous or muscular free flap. An early bone graft was placed in 25 percent of cases without waiting for delayed consolidation. Eighty-eight percent of fractures united after 23 weeks when using the standard protocol, allowing the removal of the external fixator after 17 weeks on average. In 13 percent of the cases a pin tract infection occurred but no deep infection was found. In 12 percent of patients a delay of consolidation or a pseudarthrosis was seen requiring a change of method in order to obtain the union. Use of a protocol which must be followed by the surgical team treating the open fractures of the tibia and fibula reduces the incidence of complications. Debridement of bone and soft tissues is the keystone of this protocol. The stabilisation of the fractures with a fixator is also a crucial element in the treatment of the grade III open fractures of the leg.

Key words

External fixator - Open fractures - Tibia-fibulas

References

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