[Use of an external fixator in open tibial shaft fractures as definitive treatment]
L A Patiño-Domínguez1, R Reyes-Pantoja, J A Silva-Méndez
1Ortopedia y Traumatología IV, Hospital General Dr. Miguel Silva Morelia, Michoacán. drluispatio@yahoo.com.mx
Background:
We conducted a study evaluating the clinical and radiologic results of the open tibial shaft fractures using an external fixator as definitive treatment.
Methods:
Clinical, observational, descriptive, prospective and longitudinal study. Forty-six patients were included, 40 males (87%) and 6 females (13%), whose age was 31.02 +/- 14.62 years; the time elapsed from the accident to admission in the Emergency Room was 1-16 hours, with a mean of 5.1 +/- 3.35 hours. Ten patients (21.74%) had a Gustilo grade I open fracture, and 36 patients (78.26%) a Gustilo grade II fracture. They were also classified according to the AO classification, with the following resulting groups: 13 (28.9%) patients were A3, 12 (26.1%) were B3, 8 (17.4%) B1, 8 (17.4%) were B2, and 5 (10.9%) were A2. The dynamization of the fixator was done at a mean of 11.56 +/- 1.10 weeks.
Results:
Forty-three patients had healing at 23.51 +/- 3.62 weeks; Gustilo I fractures healed at 22.8 +/- 3.5 weeks; Gustilo II fractures at 23.7 +/- 3.7 weeks, with a P value of 0.48. In 3 patients (6.53%), due to absence of healing, the external fixator was exchanged for an intramedullary nail with a bone graft, with healing occurring at 18 weeks. Six infections (13%) were reported at the nail insertion site; angulations ranged from 0 degrees to 8 degrees, which is tolerable.
Conclusions:
This fixator is safe in properly selected patients, since the few complications that occurred are similar to other reports using different internal fixation methods.
