Hughes External Fixator in Treatment of Tibial Fractures

Abstract

Summary: The results of a prospective trial of the use of the Hughes unilateral external fixator in the management of 48 tibial diaphyseal fractures are presented. Good results were obtained in grade II and III fractures but not in closed and grade I fractures. The results and complication rates were comparable with those of other more complex external fixators. Good results were found to be dependent on the adequacy of the initial reduction and the duration of external fixation, but independent of alterations in pin angle, length and location as well as fixator location.

Nonunion of tibial fractures treated with external fixation

“…The importance of soft tissue damage is well known (Evans et al 1988, Green et al 1988). However, Court-Brown and Hughes (1985) We used 3 types of external fixator with the same nonunion rate supporting previous findings that nonunions occur irrespective of the type of fixator (Behrens and Searl 1986). We found that comminution in open fractures was another important factor for nonunion.…”

Early muscle-periosteal lesion inhibits fracture healing in rats

“…Muscle provides an important collateral source of blood to cortical bone in both clinical (Byrd et al 1981) and experimental studies (Richards and Schemitsch 1989). Reduction in the perfusion of muscle may result in delayed union of tibial fractures (Court-Brown and Hughes 1985). Our findings, indicating a marked reduction in mechanical properties after isolation of the muscle envelope, further show the important role played by muscle in the healing process.…”

“…In severe open fractures associated with high energy trauma, the surgical treatment of soft tissue is important for the clinical outcome (Gustilo et al 1984, Court-Brown et al 1991. Most authors recommend thorough debridement of soft tissue in the acute phase and soft tissue coverage with a muscle flap for exposed bone at an early stage when risk of infection is reduced.…”

“…Furthermore, fracture configuration, blood supply to the fragments and stability of fixation all have an effect on healing Anderson 1976, Court-Brown andHughes 1985). Soft tissues surrounding a diaphyseal fracture are thought to play a particular role in the healing process as a source of vascularity (Rhinelander 1974, Trueta 19741, and severe soft-tissue loss, with periosteal detachment and compromised vascularity, are major determinants of the compromised fracture healing (Gustilo et al 1984).…”

Effects of lesion between bone, periosteum and muscle on fracture healing in rats

“…It is well recognized that the healing of diaphyseal fractures is related to the seventy of damage to both bone and soft tissues at the time of injury (Oestem and Tscherne 1984). The fracture configuration, the presence of infection, the blood supply of the fragments and the stability of fixation all have an effect on healing Anderson 1976, Court-Brown andHughes 1985). Soft tissues surrounding a diaphyseal fracture are especially thought to play a role in the healing process as a vascular source (Rhinelander 1974.…”