High-energy open tibial fractures in children: Treatment with a programmable circular external fixator
Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK.The Bone & Joint Journal (Impact Factor: 3.31). 07/2012; 94(7):989-93. DOI: 10.1302/0301-620X.94B7.28333
Between 2005 and 2010 ten consecutive children with high-energy open diaphyseal tibial fractures were treated by early reduction and application of a programmable circular external fixator. They were all male with a mean age of 11.5 years (5.2 to 15.4), and they were followed for a mean of 34.5 months (6 to 77). Full weight-bearing was allowed immediately post-operatively. The mean time from application to removal of the frame was 16 weeks (12 to 21). The mean deformity following removal of the frame was 0.15° (0° to 1.5°) of coronal angulation, 0.2° (0° to 2°) sagittal angulation, 1.1 mm (0 to 10) coronal translation, and 0.5 mm (0 to 2) sagittal translation. All patients achieved consolidated bony union and satisfactory wound healing. There were no cases of delayed or nonunion, compartment syndrome or neurovascular injury. Four patients had a mild superficial pin site infection; all settled with a single course of oral antibiotics. No patient had a deep infection or re-fracture following removal of the frame. The time to union was comparable with, or better than, other published methods of stabilisation for these injuries. The stable fixator configuration not only facilitates management of the accompanying soft-tissue injury but enables anatomical post-injury alignment, which is important in view of the limited remodelling potential of the tibia in children aged > ten years. Where appropriate expertise exists, we recommend this technique for the management of high-energy open tibial fractures in children.
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ABSTRACT: The purpose of this study is to present and validate a hinge-fixator technique for the treatment of open tibial fractures, which has advantages in application and the follow up period. The technique was used in open tibia fractures of 14 adult patients. Using this method, initial anatomic reduction was achieved and temporary stability was obtained on the hinge-fixator after applications were completed. Patients' radiological and clinical results were analyzed using the Paley's criteria at the time of the last follow-up. Patients were brought in for followed up analysis over a 5.4 year period. According to Paley, two patients had 'good' and 12 patients had 'excellent' radiological results, while the functional result were excellent (n=13) and good (n=1), respectively. The hinge-fixator technique is a fast and easy method that contributes to shorter operation times, reduced radiation exposure, and more comfortable treatment periods.
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