External fixation of segmental tibial shaft fractures

Tibial shaft fractures are the most common type of large long-bone fractures. Segmental tibial shaft fractures are severe injuries and its treatment can be followed by a high incidence of complications, nonunion, delayed union, malunion, infection or compartment syndrome. The most common treatment strategy is intramedullary fixation. Results of the unilateral external fixation treatment for segmental tibial shaft injuries are presented in this paper.

Patients with segmental tibial shaft fractures, AO/OTA 42-C2 were treated as urgent cases by unilateral external fixation. Mitkovic-type external fixator was used in all of these fractures.

There were 32 patients with segmental tibial shaft fractures (AO/OTA 42-C2), 20 males and 12 females, average age of 43.5 years. Average time of union was 5.9 (4.1-7.4) months for closed and 6.2 (5.1-7.9) months for open fractures. Average follow-up was 18 (26-60) months. Nine patients (28.12%) had open segmental tibial shaft fracture (2 Grade I, 2 Grade II, 1 Grade IIIA, 4 Grade IIIB). Union rate was 81.25% (26 cases). Nonunion rate was 18.75% (6 cases) and malunion 3.12% (1 case). Nonunion was higher in patients with open fractures (4). Compartment syndrome had been diagnosed in 6 cases (18.75%) with closed fracture and fasciotomy was performed when external fixator was applied. There were no deep infections. Pin tract infection was present in 7 cases (21.85%).

Treatment of segmented tibial shaft fractures can be followed by a number of complications. Unilateral external fixation with convergent orientation of pins provides three-dimensional stability of the fracture and good biomechanical conditions for fracture healing, with lower complications rate.