Ajmal Khan Seelro, Kashif Mahmood Khan, Anisuddin Bhatti, Khurram Rasheed.
Outcome of external fixator in management of open tibial fracture.
J Pak Orthop Assoc Jan ;24(2):84-90.

Objective: To determine the outcome of external fixator in management of open tibial fracture Study Design: Quasi experimental study Place and Duration of Study: Department of Orthopedics, Jinnah Postgraduate Medical Centre, Karachi, from April 2007 to May 2008. Patients and Methods: Patients with Gustilo and Anderson Type 1, 2 and 3a & b traumatic open tibial diaphyseal fractures irrespective of the age and sex were selected. Children, older than 70 years age, Gustilo type 3c injuries and immuno compromised patients were excluded. The protocol of treatment was based on early wound debridement, fracture stabilization and bone coverage. All the cases were dealt in accident & emergency operating room under general/spinal anesthesia. The unilateral uni-planer external fixator was used as the first choice. Measurements of pin location, pin length and external bar location were done per operatively. Patients were followed up during admission and after discharge on weekly basis till 6 months. Outcome of external fixator was measured in terms of pin tract infection, delayed union, angular deformities, shortening, muscle atrophy, frame loosening, wound infection, range of motion and stiffness of joints. The data was then analyzed using SPSS software version 13 and presented in the form of tables and charts. Results: 60 patients, 54 males and 6 females with age range of 18 to 68 years. Injuries were most commonly in 20-30 years age group. 49 cases were road traffic injuries, rest were workplace or domestic fall. Common fractures were comminuted fracture in 20 cases and the type of wound commonly found in 40 cases was Gustilo and Anderson type 3a & b. Postoperative complications found as an outcome were pin tract infection 15%, delay union 38.3% wound infection 15%, shortening of 19mm or 1.97cm found in 29 cases found in segmental fracture, which was mostly in segmental and comminuted fractures, and angular malunion 21.7% delay union 38.3% frame loosening 12.5%. There were 9 cases of late osteomyelitis, and limb length discrepancy of <2cm found mostly in segmental fracture. Conclusion: External fixation is the best initial treatment and definite treatment of open tibial fracture with complex injuries of tibia and open contaminated wound. Comparable is Pin and Plaster technique in which treatment of wound through the window, that leads to poor results in term or care and alignment.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com