No abstract

IntroductionStabilisation of the tibia with an external fixator, particularly when there is a severe injury of soft tissues, is a long established method [11,19,20].The external fixator allows the closed reduction and efficient stabilisation of fractures without periosteal loss and with minimal trauma to soft tissues when placing the pins. Rapidly applied in simple and complex fractures, its main advantage in emergency surgery is to avoid placement of a metallic device into the fracture site, lowering therefore the risk of infection (previously 10± 25 %) in the open fractures already contaminated during the accident [11, 14 ± 16, 30].Infection of pin tracts in the soft tissues which may spread to the bone is the classical difficulty attributed to external fixator. Frequency of this complication depends on surgical technique, on the quality of the pins, on the way they enter the bone and finally on postoperative care. Its incidence has diminished during the last few years [11,19,26].Non-union rates range from 2 to 36 percent according to various authors [8,11,19,20,24,27] with consolidation occurring within a mean time of 6 months. Late consolidation and re-fracture are more frequent after external fixator treatment than after internal osteosynthesis and occur in 2±26 % of the cases [17,27]. The frequency of re-fracture depends partly on how early external fixators are removed [11].Malunion attributed to external fixators is linked to a deformity appearing after too early removal of the external fixator rather than to a complication intrinsic to the method [11]. AbstractThe aim of the study is to analyse the results and the rate of consolidation of 65 tibia and fibula fractures in 62 patients (mean age 41 years) who have been stabilised between July 1995 and June 1998 by Hoffmann II external fixator. According to AO classification, the series included 21 type A, 15 type B, and 19 type C fractures. Eighty percent were open fractures according to Gustilo, of which 32 percent were grade III. A standard surgical protocol with debridement followed by an abundant irrigation was followed in 70 percent of the cases. Under systemic antibiotic coverage, the fractures were stabilised by an external fixator using a montage chosen according to the fracture type and the extent and location of lesions of the soft tissues. Soft tissue coverage for grade III B fractures was carried out after 13 days on average by a fasciocutaneous or muscular free flap. An early bone graft was placed in 25 percent of cases without waiting for delayed consolidation. Eighty-eight percent of fractures united after 23 weeks when using the standard protocol, allowing the removal of the external fixator after 17 weeks on average. In 13 percent of the cases a pin tract infection occurred but no deep infection was found. In 12 percent of patients a delay of consolidation or a pseudarthrosis was seen requiring a change of method in order to obtain the union. Use of a protocol which must be followed by the surgical team treating the open fractures of the ...