Double Reverse Traction-Assisted Versus Traditional Freehand Closed Reduction With Hexapod External Fixator in...

Area of Science:

• Orthopedic surgery
• Trauma care
• Biomedical engineering

Background:

• Open tibial shaft fractures (OTSFs) present complex challenges due to high-energy trauma, soft tissue damage, and infection risks.
• Conventional freehand reduction techniques for OTSFs can be inefficient, leading to increased soft tissue injury and radiation exposure.

Purpose of the Study:

• To evaluate the efficacy of a double reverse traction-assisted (DRTA) technique for closed reduction of OTSFs managed with hexapod external fixators (HEFs).
• To compare the DRTA technique with traditional freehand reduction in terms of reduction accuracy, efficiency, and complication rates.

Main Methods:

• A retrospective cohort study of 55 patients with AO/OTA type 42-A or 42-B OTSFs treated with HEF.
• Patients were divided into two groups: DRTA (n=28) and Freehand (n=27).
• Data collected included reduction time, fluoroscopy time, external fixation duration, radiographic outcomes, postoperative corrections, and complications, assessed using ASAMI criteria.

Main Results:

• The DRTA group showed significantly shorter fracture reduction time (12.13 min vs. 17.14 min) and fluoroscopy time (8.12 min vs. 13.75 min) compared to the Freehand group (p < 0.001).
• Superior radiographic alignment was observed in the DRTA group, with significantly reduced residual translation and angulation (p < 0.05).
• The DRTA group had a lower electronic prescription count for postoperative correction (0.9 vs. 1.4; p < 0.05) and a nonsignificant trend toward lower complication rates (32.1% vs. 48.1%).

Conclusions:

• Both reduction techniques yielded favorable outcomes, but the DRTA technique demonstrated enhanced efficiency and accuracy in fracture reduction.
• The DRTA technique is a feasible and promising alternative for managing OTSFs, potentially reducing complications.
• Larger, prospective, randomized controlled trials are needed to definitively confirm the advantages of the DRTA technique.