TREATMENT OF CLOSED UNSTABLE TIBIAL SHAFT FRACTURE BY A UNILATERAL UNIPLANER EXTERNAL FIXATION. IS A SECOND OPERATIVE STEP NECESSARY?
Basrah Journal of Surgery,
2005, Volume 11, Issue 2, Pages 64-70
AbstractThis is a prospective study was conducted in Basrah University Hospital from January 1996–January 2001.
Thirty patients with thirty closed tibial shaft fractures were treated until healing with a unilateral uniplaner external fixation device that permits fracture site compression with weight bearing, after failure to maintain adequate closed reduction in plaster. There were twenty-five men and five women, age range from ten to fifty-five years with an average 29.9. Fractures were classified depending on the anatomic location, fracture configuration and extent of concomitant soft tissue injuries. Immediate bone graft was needed for two cases and delayed bone graft for two cases. All patients were permitted early partial weight bearing when their fractures showed early signs of union which took an average of eight to ten weeks and progressed to full weight bearing, with fixator dynamization in seventeen cases. Cast immobilization after removal of external fixation device was needed for all cases. Twenty-four cases showed complete healing. The time to fracture union ranged from twenty-six to thirty weeks average of twenty-eight weeks. The main complications were; four delayed union, two non-union, and twelve cases screw site infection four of which require screw changes with the other eight require antibiotic therapy and local cleaning and ten had stiffness of the ankle joint.
The study highly recommends the use of external fixation as a good alternative to internal fixation for treatment of closed unstable tibial shaft fracture in a compliant, tolerant patient. It provides easy techniques to apply without the need of second surgery to remove it. Most of the complications can be managed without removing the device.
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