External fixation of segmental tibial shaft fractures
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ORIGINAL ARTICLE
External fixation of segmental tibial shaft fractures Sasa Milenkovic1 · Milan Mitkovic1 · Milorad Mitkovic1 Received: 7 May 2018 / Accepted: 28 October 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract Purpose Tibial shaft fractures are the most common type of large long-bone fractures. Segmental tibial shaft fractures are severe injuries and its treatment can be followed by a high incidence of complications, nonunion, delayed union, malunion, infection or compartment syndrome. The most common treatment strategy is intramedullary fixation. Results of the unilateral external fixation treatment for segmental tibial shaft injuries are presented in this paper. Methods Patients with segmental tibial shaft fractures, AO/OTA 42-C2 were treated as urgent cases by unilateral external fixation. Mitkovic-type external fixator was used in all of these fractures. Results There were 32 patients with segmental tibial shaft fractures (AO/OTA 42-C2), 20 males and 12 females, average age of 43.5 years. Average time of union was 5.9 (4.1–7.4) months for closed and 6.2 (5.1–7.9) months for open fractures. Average follow-up was 18 (26–60) months. Nine patients (28.12%) had open segmental tibial shaft fracture (2 Grade I, 2 Grade II, 1 Grade IIIA, 4 Grade IIIB). Union rate was 81.25% (26 cases). Nonunion rate was 18.75% (6 cases) and malunion 3.12% (1 case). Nonunion was higher in patients with open fractures (4). Compartment syndrome had been diagnosed in 6 cases (18.75%) with closed fracture and fasciotomy was performed when external fixator was applied. There were no deep infections. Pin tract infection was present in 7 cases (21.85%). Conclusion Treatment of segmented tibial shaft fractures can be followed by a number of complications. Unilateral external fixation with convergent orientation of pins provides three-dimensional stability of the fracture and good biomechanical conditions for fracture healing, with lower complications rate. Keywords Tibia · Segmental fractures · External fixation
Introduction Tibial shaft fractures are the most common type of large long-bone fractures. Successful treatment involves evaluating of multiple factors, including bony and soft-tissue injuries. Segmental tibial shaft fractures inherently lead to greater risk of complications such as delayed union, nonunion, malunion, infection or compartment syndrome [1]. Many methods have been developed for the definitive surgical treatment of tibial shaft fractures. Most surgeons prefer intramedullary nail to stabilize tibial shaft fractures [2] External fixation or plating is also considered as an other treatment method, depending on various factors such as * Sasa Milenkovic [email protected] 1
Medical Faculty, Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre Nis, University of Nis, Nis, Serbia
surgeon experience, fracture severity, fracture location or the degree of soft-tissue injury. Definitive treatment of tibial shaft fractures by external fixation has been reserved for patients
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