Staged conversion from temporary external fixation to internal fixation for open fractures of tibial shaft / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the clinical efficacy and safety of planed conversion from temporary external fixation to internal fixation for open fractures of tibial shaft.Methods We retrospectively reviewed 31 patients with high-energy open fracture of tibial shaft who had been treated from October 2008 to October 2016 at Department of Orthopaedics,in our hospital.They were 20 males and 11 females,with an average age of 38.7 years (from 15 to 79 years).By the Gustilo classification,2 cases were type Ⅰ,9 type Ⅱ,17 type ⅢA and 3 type ⅢB;by the AO/OTA classification,3 cases were type 42A,10 type 42B,and 18 type 42C.External fixation was temporally applied for the fracture ends after thorough debridement to recover the tibial length and alignment.The wounds were closed directly in 23 cases and covered with vacuum sealing drainage in 8.The external fixators were removed after their systemic condition and/or local condition of soft tissue recovered.After plaster casts were maintained for 4 to 7 days to allow for healing of the pin tracts,conversion into secondary definite internal fixation started.Plating was applied in 24 patients and intramedullary nailing in 7 patients.Results The 31 patients gained fellow-up from 13 to 61 months (mean,22.3 months).All fractures gained bony union after an average of 18.7 weeks (from 14 to 31 weeks).No wound complication or infection was observed.According to the Johner-Wruh's criteria,24 cases were rated as excellent,4 as good and 3 as fair,giving an excellent to good rate of 90.3％.Conclusion The staged conversion from temporary external fixation to internal fixation is effective and safe for open fractures of tibial shaft,leading to limited complications of soft-tissue and a high rate of fracture union.