Complications of the AO external fixator in open type III tibial fractures

ABSTRACT

Thirty one cases were included in this prospective experimental study to pick up the pit falls of A.O tubular external fixator application in type-III open tibial fractures in the department of Orthopaedics, Mayo hospital, Lahore during 1993-1994. Out of these 9 [28.8%] had type III-A, 21 [67.2%] had type III-B and only 1 [4%] had type III-C open fractures. 53.8% of the cases presented within six hours of the injury, 26.4% within 24 hours and the remaining 19.8% cases presented late. Biplaner unilateral fixator was applied in 19 cases [61.6%], uniplaner unilateral double bar in 11 cases [35.2%] and uniplaner unilateral single bar fixator in 1 [3.2%] case. Duration of application of external fixation ranged from 9 days to 10 months [average 3 months]. The patients were explained about the possible complications of external fixation and asked them to report before their routine follow up visit if any complication arises. We had 43 minor and 33 major complications among which some were inherent to the severity of the injury and not solely due to the application of external fixator. Minor complications in descending order of frequency were pin tract infection [41.6%], malalignment [28.8%], pin loosening [19.2%], transient ankle joint stiffness [16%], acute localized osteoporosis and algodystrophy [9.6%], oedema [6.4%], malunion [6.4%], wrong placement of pins [6.4%] and pin bending [3.2%]. Major complications in descending order of frequency were wound infection [35.2%], delayed union [32%], non union [9.8%], amputations [6.4%]. Other major complications were vascular injury, secondary cellulitis, chronic osteomylitis, foot drop, compartment syndrome, shortening and mortality 3.2% each