Functional Outcomes After Modern External Ring Fixation or Internal Fixation for Severe Open Tibial Shaft Fractures

Area of Science:

• Orthopedic surgery
• Trauma care
• Rehabilitation medicine

Background:

• Open tibial shaft fractures present complex challenges in achieving optimal functional outcomes.
• Comparing fixation methods is crucial for guiding treatment decisions in severe fractures.

Purpose of the Study:

• To compare functional outcomes between external ring fixation (EF) and internal fixation (IF) for open tibial shaft fractures.
• To investigate differences in patient-reported function, ambulation, and assistive device use.

Main Methods:

• A multicenter randomized clinical trial (FIXIT study) involving 254 patients (18-64 years) with severe tibial fractures (Type-IIIA/IIIB).
• Patients were randomized to either internal fixation (IF, n=132) or external fixation (EF, n=122).
• Functional outcomes assessed at 6 weeks and 3, 6, and 12 months using SMFA, VR-12 PCS, and ambulation status.

Main Results:

• No significant differences in Short Musculoskeletal Function Assessment (SMFA) scores between IF and EF groups at any time point.
• Slightly higher Veterans RAND 12-Item Health Survey (VR-12) physical component scores (PCS) for IF at 3 months, but no difference by 12 months.
• External fixation (EF) was associated with a higher risk of using ambulatory assistive devices at 6 months (p < 0.0001).

Conclusions:

• Internal fixation (IF) and external fixation (EF) yield similar physical function outcomes for severe tibial fractures.
• A high rate of overall functional impairment was observed in both treatment groups.
• External fixation (EF) showed increased reliance on walking aids early in recovery (6 months).