Treatment of open tibial fractures: converting or continuing external fixation?

ABSTRACT

The treatment of open tibial fractures is still an orthopaedic challenge and full of complications. In many cases the use of external fixator that has been known as a nonunion machine is obligatory with a high incidence of pin track infection and other complications. The aim of this study was to compare the use of external fixation as a definite method for treatment of open tibial fractures with its subsequent conversion to internal fixation or casting. Sixty-seven young patients with type III open tibial fractures [Gustilo-Anderson classification] were treated with half pin external fixation. Twenty of them were converted into internal fixation after a period of 6-8 weeks. For another twenty-five, external fixator was removed and treatment continued with casting for a period lasting from 16 to 20 weeks. And for twenty two patients the fixator continued until complete union. The patients followed up for 10-16 months and were evaluated in terms of union time, union rate, infection, range of motion, malunion, non-union, nerve injury, and reduction. There was a meaningful difference only in the union time and superficial infection between the first group and the other two groups. The conversion of external to internal fixation can be considered as a safe, effective, less complicated, and more acceptable method for the treatment of open tibial fractures