[External fixator as primary and definitive treatment of tibial fracture with severe soft tissue damage]

The initial treatment of choice of fractures with severe soft tissue damage of the leg is the stabilization with an external fixator. After successful healing the question arises whether to continue the initial treatment with the external fixator to bone union or to change the initial concept by an internal fixation. Our experience with 62 fractures of the tibia (follow-up of 59 fractures) from 1985 to 1989 shows that 72% of the fractures were healed by the external fixator alone. Delayed union or pseudoarthrosis occurred in 17% and were mostly treated by late internal fixation. An analysis of the fracture types (new AO classification) did not show certain fracture types, that did not respond to the external fixator treatment alone. We conclude that the reason for a delayed union or pseudoarthrosis is less a morphological than a biological one. We recommend the first and final external fixator as treatment for fractures with severe soft tissue damage of the leg.