Fast pinless external fixation for open tibial fractures: preliminary report of a prospective study

Abstract

A major drawback of conventional fixator system is the penetration of fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and outer environment, leading to higher infection rates on conversion to intramedullary nailing. This study was designed to prospectively evaluate the role of new rapid pinless external fixators in primary stabilization of open tibial shaft fractures. In our study, a prospective study of 96 consecutive patients of open tibial shaft fractures treated with new rapid pinless external fixator and reamed intramedullary nail was carried out. The bone healing status, ability to maintain alignment were examined for radiologic outcome, whereas initial management, length of hospital stay, associated morbidity, range of knee and ankle motion, time to partial and full weight-bearing, employment status and perioperative and postoperative complications were used for clinical evaluation. We followed up for over two years for the patients underwent clinical and radiologic after the surgery. The mean hospital stay was 15 days (ranges, 8-68). Bone healing was achieved for all cases except 3 patients who were lost to follow-up study. No patient suffered compartment syndromes. There was no statistically significance in range of motion among the knees of injury and uninjured limbs at final follow-up (P > 0.05). To the last follow-up, there were no cases of deep infection or implant-related fractures. Seventy-one patients who were employed before the injury returned to work after the operation, 16 had changed to less strenuous work. We concluded that better results can be achieved on clinical and radiologic evaluation of primary stabilization with rapid pinless external fixator and early exchange reamed intramedullary nail for suitable patients with open tibial shaft fractures. The incident rate of relative complications is low. The rapid pinless external fixator can be combined favorably with the reamed intramedullary nail and is a valuable addition to the conventional external fixator systems.

Keywords: Open tibial fracture; intramedullary nailing; pinless fixator.

Figure 1

Elements of the REPF: carbon fiber rods, tube-to-tube clamps, universal clamps.

Figure 2

A 26-year-old-man sustained a second degree compound fracture of the tibia (AO classification 42B3) together with multiple injuries. A. Anteroposterior and lateral radiographs. B. Postoperative radiograph shows well aligned fracture stabilized with REPF. C. Mobilization on the 3th day postoperative with partial weight-bearing. D. Once the general condition of the patient had improved, a conversion procedure to a reamed intramedullary nail was done on the 7th day. Postoperative radiograph AP and lateral of the fracture showing good reduction and fixation with reamed tibial nail.

Figure 3

Open tibial fracture (AO classification 42C3) with severe soft tissue injury in a 43-year-old-man who was involved in an automobile accident. A. Anteroposterior and lateral radiographs. B and C. Primary treatment included application of the REPF and muscle pedicle flaps. D. Conversion to a reamed intramedullary nail on the 14th day.