ABSTRACT
Background: Fractures of the tibial shaft are important for tworeasons. The first is that they are common, the second is thatthey are controversial - and anything that is both common andcontroversial must be important. Fractures of the shaft of thetibia cannot be treated by following simple sets of rules.Because of its location tibia is exposed to frequent injury and itis the most commonly fractured long bone.Objective: To evaluate the treatment of open tibial shaftfracture of Gustilo IIIA grade by Trans osseous osteosynthesistechnique with Illizarov External Fixator as a primary anddefinite mode of treatment.Methods: Clinical trial (Quasi Experimental study) fromJanuary 2009 to June 2010 (18 months) at National Institute ofTraumatology and Orthopaedic Rehabilitation Purposivesampling was done according to availability of the patients andstrictly considering the inclusion and exclusion criteria andsample size was 17 no of cases.Results: 14 male and 1 female patient between 17 and 51years were studied. Most common age group in this serieswere 26-35 year age group ((53.33%) and average age of thepatients was 30 years with SD of ±8.67. Most of the patientswere male and road traffic accident was the leading cause ofinjury (70.58%). Left side involved in (58.82%) most of thecases and 2 patients had bilateral fractures. Commonest site ofthe fractures were middle third (58.82%) of the tibia. Most ofthe fractures were comminuted type of fractures (47.05%).Most of the patients were operated on the day of admissionand in some cases within 4 - 7 days of admission. Averageduration of hospital stay was 8.06 days ranging from 1 day to28 days. Total duration of treatment was average 186.66 days(26 weeks) highest 291 days (42 weeks) and lowest 140 days(20 weeks). Most of the patient had soft tissue healing bygranulation tissue formation (35.29%). Others were treated byprimary closure, Delayed primary closure, secondary closure,partial thickness skin grafting.Conclusion: In this study the results of open tibia fracture(Gustilo IIIA) by Transosseous osteosynthesis technique withIlizarov External Fixator has been found to be satisfactory.Though there were a few minor complications with the fixatorthe dynamisation and compressing ability of this stable frameprovided good union without any second surgical procedure orbone grafting and prevented any malunion.
ABSTRACT
In the orthopedic Department of Jeonbug National University Hospital, twenty-five open tibial shaft fractures were reviewed and analyzed with osteomedullography and bone scanning with radioactive isotopes from June 1981 to October 1983. The results are as follows. 1. The cases of injury were mostly traffic accident(70.8%) and majority was found between second decade and third decade. Males were 11 times more frequent than females. 2. In the shape and location of fractures, comminuted fracture(60%) was most common, and fracture of middle one third(48%), lower one third(28%) were in order. 3. In the open tibial fractures, Grade I. of soft tissue injury was most frequent(64%). As inthe plate fixation was required, we should it placed atypically on the posterior surface of the tibia. 4. In the osteomedullography at 3 months after treatment, the rate of positive finding was 80 and intraosseous crossing vein(Kaski sign 1) was observed most frequently. 5. In the profile of the bone scanning with radioactive isotopes, the rate of single-peak uptake was 76% and twin-peak uptake was 24%. 6. In the negative Osteomedullogram and twin-peak uptake on the profile of the bone scanning, bone graft was necessary. 7. In the case of difficult diagnosis for union process of tibia fracture, osteomedullography and bone scanning with radioactive isotopes were considered useful method of early diagnosis.