Treatment of distal tibial fractures with a hybrid external skeletal fixator / 中华创伤骨科杂志

ABSTRACT

Objective To report the clinical results of managing distal tibial fractures with a hybrid external skeletal fixator.Methods From January 2006 to June 2013,39 patients with distal tibia fracture were managed with limited-close or limited-open reduction and a hybrid external skeletal fixator.They were 26 men and 13 women,with an average age of 40.1 years (range,from 23 to 65 years).According to AO classification,15 fractures were of type A3,8 of type B2,10 of type B3,2 of type C2 and 4 of type C3.According to Gustilo classification,of the 12 open fractures,8 were of type Ⅱ,3 of type Ⅲ a and one of type Ⅲ b.According to Tscherne classification of soft tissue injury,4 cases were of grade l,24 of grade 2,and 11 of grade 3.Open fractures were managed first with radical debridement.Those complicated with fibular fracture were managed first with open reduction and internal fixation of distal fibula followed by close or limited-open reduction and minimal internal fixation depending on the position of distal tibial fracture.Next,the hybrid external skeletal fixation was applied.Five cases were immobilized with trans-articular fixators.The data were recorded regarding interval from injury to surgery,operation time,perioperative blood loss,hospital stay,time of external fixation,time of bony union,and complications.The ankle function was evaluated clinically with the Maryland Scale system at the final follow-ups.Results The 39 patients were followed up for 12 to 18 months (average,14.5 months).Primary incision healing was achieved in 37 cases,but the other 2 patients with open fracture suffered delayed wound healing which was cured by dressing changes for 4 weeks.Altogether,38 cases achieved normal fracture union and their average time of external fixation was 13.5 weeks.The time for complete infusion of fracture lines on X-rays averaged 19.7 weeks.Delayed union occurred in one case whose fracture united after removal of the external fixator,internal fixation with a locking plate and autogenous bone grafting.One case was complicated with pin track infection which was healed after debridement,drainage for 8 weeks and removal of the external fixator.No neurovascular complications were observed.According to the Maryland Scale system,the ankle function was excellent in 8 cases,good in 24 and fair in 7,with an excellent and good rate of 82.1％.Conclusions The hybrid external skeletal fixator is good for distal tibial fractures,because it can cffectively protect the skin and minimize invasion to the soft tissues,reducing incidences of skin necrosis and wound infection.Moreover,since it is flexible in screwing and structure formulation,it facilitates wound management,eslpecially in the management of open fractures.