Outcomes of open tibial shaft fractures treated by external fixation method

Abstract

Tibia is vulnerable to open fractures due to its relative inadequacy of soft tissue coverage. The optimal treatment method of open tibial fractures is still controversial. External fixators are widely used as a definitive treatment method for open fractures. The aim of the current study was to evaluate the outcomes of external fixators applied for open tibial shaft fractures. All open tibial fractures treated with external fixators between December 1999 and October 2008 were reviewed retrospectively. 48 limbs of 47 patients were included in this study. Fractures were classified as Type I in 4 (8.3%), Type II in 18 (37.5%), and Type III in 26 (54.2%) according to Gustilo-Anderson classification. The mean follow-up period was 58.3 months. 28 patients (29 limbs) underwent unilateral external fixation, and 19 patients received Ilizarov ring fixator. Fracture healing rates were 100% in Type I fractures, 88.9% in Type II fractures, 81.8% in Type IIIA fractures, 28.6% in Type IIIB fractures, and 62% in Type IIIC fractures. The mean time for removal of the external fixator was 24.06±12.44 weeks. The mean time to fracture union was 27.27±13.19 weeks. According to Karlstrom and Olerud criteria, the mean functional score was 31.04±3.77. Functional results were excellent in 6 limbs (12.5 %), good in 16 limbs (33.3 %), acceptable in 8 limbs (16.7%), moderate in 10 limbs (20.8%), and poor in 8 limbs (16.7%). Deep tissue infection developed in 5 limbs (10.4%). Osteomyelitis developed in 4 limbs (8.3%). The findings of our study suggest that satisfactory results can be obtained by using external fixators for the treatment of open tibial shaft fractures.