Treatment of unstable tibial diaphyseal fractures with minimal internal and external fixation

We prospectively studied 20 patients whose selected unstable tibial diaphyseal fractures were treated with the combined techniques of minimal internal fixation and external fixation. Five fractures were closed and 15 were open (six Grades I and II, nine Grade III). Seventeen were due to high-energy injuries. The minimum followup was 2 years. All fractures healed, one with malalignment. Time to union averaged 12 weeks in closed fractures and 19 weeks in open fractures. All high-energy fractures underwent bone grafting. The external fixation was removed by dynamization. Thirteen complications occurred in nine patients, all with open fractures. Three of 120 pins became infected (2.5%). Early bone grafting and dynamization of the external fixation prevented the malunions and nonunions reported previously with this technique.