User

Functional Outcome Evaluation of Grade III Open Tibial Fracture Treated by External Fixation as Definitive Treatment

Bintang Soetjahjo, Rieva Ermawan, Rhyan Darma Saputra, Udi Herunefi Hancoro, Bagus Jati Nugroho, Jiva Yori Anugra

Abstract

Background: Tibial shaft fractures including open tibial fractures grade III are one of the most common fractures of long bones. There are many methods of conservative and operative treatment, one of them is external fixation. External fixation is more common used temporary in polytraumatized patients with tibial shaft fractures. The study was undertaken to see if the patient can be treated with external fixation as the definitive treatment and evaluate the functional outcome after the treatment.

Subjects and Method: A retrospective review of a prospectively-collected database was performed. Data was taken from the Orthopaedic Department of RSUD Dr. Moewardi Hospital patients’ database. The study included all patients who underwent grade III open tibial fracture treatment from May 2018 to May 2019. A total of 8 patients who were included in our study were a patient with open tibial fractures grade III planned for external fixaton as definitive treatment. They were evaluated radiographically and clinically to determine the union rate. The data were reported descriptively.

Results: External fixator time ranged in this study around 240 days. In this study, there were a few patients whose progress were remain unknown due to loss of contact. Fractures studied 5 out of 8, no patient were union after 8 months of external fixator used. 4 out of 8 patients were reported non-union after 8 months based on their radiological examination (50%) and 1 out of 8 patients were reported has been performed Removal of External Fixation (ROEF) after 5 months of treatment. The rest of the 3 patients’ results were remain unknown.

Conclusion: Open tibial fractures grade III  of the leg can be managed with use of external fixator as a definitive treatment. However, the use of external fixation does not provide maximum results in grade III A tibial fractures.

Keywords: open tibial fractures, external fixation, union, malunion

Correspondence: Bintang Soetjahjo. Dr. Moewardi General Hospital. Jl. Kolonel Sutarto 132, Jebres, Surakarta, Central Java, Indonesia. 57126. Email: bjortho@yahoo.com. 

Indonesian Journal of Medicine (2021), 06(04): 452-459
https://doi.org/10.26911/­theijmed.2021.06.04.11

Full Text:

PDF

References

Beltsios M, Savvidou O, Kovanis J, Alexandropoulos P, Papagelopoulos P, (2009). External fixation as a primary and definitive treatment for tibial diaphyseal fractures. Strategies Trauma Limb Reconstr. 4(2): 8187. DOI 10.1007/s1175100900623


Bode G, Strohm PC, Südkamp NP, Hammer TO (2012). Tibial shaft fracturesmanagement and treatment options. A review of the current literature. Acta Chir Orthop Traumatol Cech. 79(6): 499505.


De Agostinis M (2018). Redesign of a uniplanar, monolateral external fixator. Proc Inst Mech Eng H P I MECH ENG H. 232(5): 446457. Doi:10.1177/0954411918762021


Fang X, Jiang L, Wang Y, Zhao L (2012). Treatment of Gustilo grade III tibial fractures with unrimed intramedullary nailing versus external fixator: a metaanalysis. Med. Sci. Monit: international medical journal of experimental and clinical research.18(4): RA49. Doi:10.12659/MSM.882610.


Foster PAL, Barton SB, Jones SCE, Morrison RJM, Britten S (2012). The treatment of complex tibial shaft fractures by the Ilizarov method. The J. Bone Jt. Surg. British volume, 94(12):16781683.Doi:10.1302/0301620X.94B12.29266


Fragomen AT, Rozbruch, SR (2007). The mechanics of external fixation. HSS Journal. 3(1): 1329.


Fu Q, Zhu L, Lu J, Ma J, Chen A (2018). External fixation versus unreamed tibial intramedullary nailing for open tibial fractures: a metaanalysis of randomized controlled trials. Sci. Rep. 8(1): 17. Doi:10.1038/s4159801830716y


Grubor P, Grubor M (2012). Results of application of external fixation with different types of fixators. Srpski arhiv za celokupno lekarstv. 140(56): 332338. Doi:10.2298/SARH1206332G


Jeudy J, Steiger V, Boyer P, Cronier P, Bizot P, Massin P (2012). Treatment of complex fractures of the distal radius: a prospective randomised comparison of external fixation ‘versus’ locked volar plating. Injury. 43(2): 174179. Doi:10.1016/j.injury.2011.05.021


Ma CH, Wu CH, Tu YK, Lin TS (2013). Metaphyseal locking plate as a definitive external fixator for treating open tibial fractures—clinical outcome and a finite element study. Injury. 44(8): 10971101. Doi:10.1016/j.injury.2013.04.023


Milenkovic S, Mitkovic M, Mitkovic M (2020). External fixation of segmental tibial shaft fractures. Eur J Trauma Emerg Surg. 46(5): 11231127. https://doi.org/10.1007/s0006801810415


Newman SDS, Mauffrey CPC, Krikler S, (2011). Distal metadiaphyseal tibial fractures. Injury. 42(10): 975984. Doi:10.1016/j.injury.2010.02.019


Pairon P, Ossendorf C, Kuhn S, Hofmann A, Rommens PM (2015). Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits. Eur J Trauma Emerg Surg. 41(1): 2538. Doi:10.1007/s000680140448x


Reddy VS, Anoop T, Ajayakumar S, Bindurani S, Rajiv S, Bifi J (2016). Study of clinical spectrum of pediatric dermatoses in patients attending a Tertiary Care Center in North Kerala. IJPD. 17(4): 267. Doi:10.4103/23197250.188424


Stojković B, Milenković S, Radenković M, Stanojković M, Kostić I (2006). Tibial shaft fractures treated by the external fixation method. Med Biol. (13)3: 145147


Walenkamp MM, Bentohami A, Beerekamp MSH, Peters RW, van der Heiden R, Goslings JC, Schep NW (2013). Functional outcome in patients with unstable distal radius fractures, volar locking plate versus external fixation: a metaanalysis. Strateg. Trauma Limb Reconstr. 8(2): 6775. DOI 10.1007/s1175101301694


Wani N, Baba A, Kangoo K, Mir M (2011). Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures. Int. Orthop. 35(6): 915923. Doi:10.1007/s0026401010237


Xu X, Li X, Liu L, Wu W (2015). A metaanalysis of external fixator versus intramedullary nails for open tibial fracture fixation (Retraction of vol 9, 75, 2014). J. Orthop. Surg. Res. 10. Doi:10.1186/s1301801400756

Refbacks

  • There are currently no refbacks.