doiSerbia

Open segmental fractures of the tibia treated by external fixation

Golubović Ivan (Ortopedsko-traumatološka klinika, Klinički centar, Niš)
Vukašinović Zoran (Institut za ortopedsko-hirurške bolesti „Banjica“, Beograd + Medicinski fakultet, Beograd)
Stojiljković Predrag (Ortopedsko-traumatološka klinika, Klinički centar, Niš)
Golubović Zoran (Ortopedsko-traumatološka klinika, Klinički centar, Niš + Medicinski fakultet, Niš)
Stamenić Sonja (Ortopedsko-traumatološka klinika, Klinički centar, Niš)
Najman Stevo (Medicinski fakultet, Niš)

Introduction. Open segmental fractures of the tibia are rare but severe injuries. In these fractures the wide zone of injury (damage of all structures of the lower leg) creates very unsuitable biological conditions for healing of the fracture. Objective. The aim of our work was to present the results of treatment of patients with segmental open fractures of the tibia treated by external fixation. Methods. We analyzed treatment results of 21 patients with open segmental tibial fractures who were treated using the method of external fixation at the Clinical Center Niš from January 1, 1995 to July 31, 2010. The average age of the patients was 53 years; the youngest patient was 27 years and the oldest one 80 years. According to the Gustilo open fracture classification, there were 3 (14.3%) type I, 6 (28.6%) type II, 8 (38.1%) type IIIA, and 4 (19.0%) type IIIB. All the patients were treated by a unilateral type Mitković external fixator by Traffix Company. Results. Union was attained in 16 (76.2%) fractures without severe complications (pseudoarthrosis, chronic osteitis and angular deformities of over 10 degrees). Among severe complications associated with open segmental tibial fractures, in two cases we registered septic pseudoarthrosis, in one aseptic pseudoarthrosis and in two large angular deformities of the tibia after union, with a valgus of over 10 degrees and extremity shortening of over 2 cm which required additional surgery. Conclusion. External fixation by the use of Mitković external fixator is one of the methods of choice in the treatment of open segmental tibial fractures, which incorporated with antibiotic therapy provides good biomehanical conditions for segmental fracture healing that enables good stability of the segmental tibial fracture and decreases the risk of deep infections.

Keywords: open segmental tibial fractures, external fixation, external fixator Mitkovic

Projekat Ministarstva nauke Republike Srbije, br. 41017: Virtuelni koštano­zglobni sistem čoveka i njegova primena u pretkliničkoj i kliničkoj praksi