Syed Asif Ali, Usman Zafar Dar, Muhammad Ali, Salma Batool, Farrukh Siddique, Faridoon Siddique.
Complication of External Fixator and Related Factors; a Retrospective Cohort Analysis Tibial Nonunion patients.
Esculapio J Services Inst Med Sci Jan ;15(1):14-7.

Objective: To determine the different types of skin lesion in tibial nonunion patients and associations of type of fracture (in term of open versus closed) with various predictors or cofactors, at Mayo hospital, Lahore, Pakistan. Methodology: It was retrospective analysis conducted in the Department of Orthopedics, Mayo hospital, Lahore on the data of the tibial nonunion patients of all age groups who followed from July 2002 to June 2012. Fractures were typed into open and closed depending on skin involvement. Statistical analysis was done using SPSS version 25. Independent sample T test, chi-square test of independence, and binary logistic regression were performed to ascertain the likelihood relation of open/closed fractures with different associated cofactors. Results: Out of total of 144 patients, 79.2% had open tibial fractures while 20.8% had closed tibial fractures. Amongst open fractures, 26.3% were Gustilo type I, 31.6%) Gustilo type II, 18.4% Gustilo type IIIA, 21.1% Gustilo type IIIB, and 2.6% were Gustilo type IIIC. The mean age of the patients with open fractures was 15.11 years higher than that of patients with closed fractures (p<0.01). Bivariate analysis suggested that type of fracture had statistically significant association with side of lesion (p = 0.016), anatomic location of tibial lesion (p <0.01), comorbid systemic diseases (p = 0.012), and complications of external fixator (p<0.01).Binary logistic regression found that as compared to closed fractures, open fractures were involving2.673 times more right side, 8.583 times more at proximal/middle location, 12 times less among patients suffering comorbid systemic diseases, 10.669 times more associated with complications of external fixator, and 11.28 times more complicated with leg length discrepancy. Conclusion: Majority tibial nonunions were open fractures, especially Gustilo type III. Closed fractures were seen relatively among younger population. As compared to closed tibial fractures, open tibial fractures occurred significantly more in right tibia and at proximal / middle shaft location. Closed tibial fractures occurred significantly in patients with comorbid systemic diseases while open tibial fractures were more associated with subsequent complications of external fixator as well as leg length discrepancy.

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