Results of open tibial fracture treatment using external fixation

Golubović, Ivan; Ristić, Branko; Stojiljković, Predrag; Ćirić, Miroslav; Golubović, Ivana; Radovanović, Zoran; Petrović, Sladjana; Djordjevic, Nina; Golubović, Zoran; Najman, Stevo

doi:10.2298/sarh1606293g

Cited by 10 publications

(17 citation statements)

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“…In addition to being cost-effective, the IMN approach to open diaphyseal tibial fractures also has a better union rate than EF. Previous studies have found various complications with EF ranging from delayed union to pin loosening and mal-union [14, 15]. Our results support these findings and encourage favoring IMN over EF in the management of these fractures.…”

Section: Discussionsupporting

confidence: 89%

Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute

Haonga

Areu

Challa

et al. 2019

SICOT-J

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Introduction: Open tibia fractures are some of the most common types of Orthopedics injuries in low- and middle-income countries (LMICs). In Tanzania, open tibia fractures are treated either conservatively by prolonged cast or surgically by external fixation (EF) or intramedullary nail (IMN) when available. The cost of treatment and amount of time patients spend away from work are major economic concerns with prolonged casting and EF. The goal of this study was to determine the cost effectiveness of IMN versus EF in the treatment of open diaphyseal tibia fractures at Muhimbili Orthopaedic Institute (Dar es Salaam, Tanzania). Methods: This is a prospective randomized control study conducted of patients with a closeable AO/OTA 42 open diaphyseal tibia fracture. The patients underwent surgical fixation with either IMN or EF at Muhimbili Orthopaedic Institute (MOI), and were followed up at 2, 6, and 12 weeks postoperatively. A micro-costing method was used to estimate the fixed and variable costs of IMN and EF of the open diaphyseal tibial fracture. Results: The mean total cost per patient was lower for the IMN group ($425.8 ± 38.4) compared to the EF group ($559.6 ± 70.5, p < 0.001), with savings of $133.80 per patient for the IMN group. The mean hospital stay was 2.72 ± 1.40 days for the IMN group and 2.44 ± 1.47 days for the EF group (p = 0.5). Quality-adjusted life years (QALYs) were 0.26 per patient for the IMN group and 0.24 in the EF group at 12 weeks (p = 0.8). Ninety-two percent of patients in the IMN group achieved fracture union versus 60% in the EF group at three months postoperatively (p = 0.03). Conclusion: IM nailing of a closeable open diaphyseal tibial fracture is more cost effective than EF. In addition, IM nailing has better union rates at three months compared to EF.

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Section: Discussionsupporting

confidence: 89%

Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute

Haonga

Areu

Challa

et al. 2019

SICOT-J

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“…In our study, the 10% incidence of non-union observed aligned with the 8% non-union incidence noted by Beltsios et al [29,32]. Nonetheless, these incidence rates were lower than those published by other authors in the literature, who reported non-union rates of 13%, 14.7%, 18.7%, and 28.3%, respectively [26,31,34,35]. While this non-union rate observed in our study can be explained by the biology and biomechanics of segmental fractures, it is not to be accounted for by disadvantages of the external…”

Section: Discussionsupporting

confidence: 85%

“…(Table 6) [7]. In addition, the union rate compares favorably with the outcomes reported by other authors [19,[26][27][28][29][30][31]. This positive outcome may be accounted for by the external xators' inherent stability, operative technique used, adherence to basic surgical principles, and efforts to achieve anatomical reduction including axial and side-to-side compression.…”

Section: Discussionmentioning

confidence: 53%

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Locally-developed External Fixators as Definitive Treatment of Open Tibia Diaphyseal Fractures: A Clinical Prospective Study Conducted in Ivory Coast

Kouassi

Akobé

Kouassi

et al. 2020

Preprint

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Background: This study sought to evaluate the effectiveness of locally-developed external fixators (LDEF) as definitive treatment for open tibia diaphyseal fractures (OTDF) in Ivory Coast.Methods: Gustilo I, II and IIIA OTDFs of patients admitted within 24 hours of injury were prospectively included and treated with a locally-developed external fixator. The rates of union, mal-union, septic complications, as well as the functional results were assessed, in addition to the LDEF construct’s integrity. Predictive factors of failure or poor results were assessed.Results: Overall, 40 OTDF patients were admitted within 24 hours of injury. Gustilo I, II and IIIA fractures were observed in three, 13, and 24 patients, respectively. Uneventful fracture healing was obtained in 29 cases, with an average union time of 8.47 months. Mal-union and non-union were registered in three and four cases, respectively. Pin-track infection (PTI) was observed in 13 cases, and deep infection in seven. Infection resolved in all patients except four, who developed chronic osteomyelitis. None of the non-unions were associated with an infection. The overall functional result was satisfactory in 32 patients. PTI was the only predictive factor for chronic infection. Biplanar frames, when compared to monoplanar constructs, were associated with a significantly improved functional outcome.Conclusion: In comparison with the results obtained in the same environment without a locally-developed external fixator, the provision of such a device improved significantly the OTDF management, as it provided better stability and superior fracture healing rates. PTI remains an essential problem but with, hopefully, limited negative consequences. Trial registration: This study protocol was registered in Pan African Clinical Trial Registry under N°PACTR202009854874448. Date of registration 28 September 2020 ‘retrospectively registered’. www.pactr.org.

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“…In addition to these fundamental requirements [6,8], the external fixator must be inexpensive [4]. These constructs should also be compatible with patient care and allow the recovery of the softtissue envelope [19]. Ideal external fixation systems should be rigid enough to promote fracture healing without secondary loss of reduction, when used as a definitive treatment [8,20].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical study of a low-cost external fixator for diaphyseal fractures of long bones

et al. 2020

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Background: External fixation improves open fracture management in emerging countries. However, sophisticated models are often expensive and unavailable. We assessed the biomechanical properties of a low-cost external fixation system in comparison with the Hoffmann® 3 system, as a reference. Methods: Transversal, oblique, and comminuted fractures were created in the diaphysis of tibia sawbones. Six external fixators were tested in three modes of loading-axial compression, medio-lateral (ML) bending, and torsion-in order to determine construction stiffness. The fixator construct implies two uniplanar (UUEF1, UUEF2) depending the pin-rods fixation system and two biplanar (UBEF1, UBEF2) designs based on different bar to bar connections. The designed low-cost fixators were compared to a Hoffmann® 3 fixator single rod (H3-SR) and double rod (H3-DR). Twenty-seven constructs were stabilized with UUEF1, UUEF2, and H3-SR (nine constructs each). Nine constructs were stabilized with UBEF1, UBEF2, and H3-DR (three constructs each). Results: UUEF2 was significantly stiffer than H3-SR (p < 0.001) in axial compression for oblique fractures and UUEF1 was significantly stiffer than H3-SR (p = 0.009) in ML bending for transversal fractures. Both UUEFs were significantly stiffer than H3-SR in axial compression and torsion (p < 0.05), and inferior to H3-SR in ML bending, for comminuted fractures. In the same fracture pattern, UBEFs were significantly stiffer than H3-DR (p = 0.001) in axial compression and torsion, while only UBEF1 was significantly stiffer than H3-DR in ML bending (p = 0.013). Conclusions: The results demonstrated that the stiffness of the UUEF and UBEF device compares to the reference fixator and may be helpful in maintaining fracture reduction. Fatigue testing and clinical assessment must be conducted to ensure that the objective of bone healing is achievable with such low-cost devices.

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Results of open tibial fracture treatment using external fixation

Cited by 10 publications

References 0 publications

Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute

Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute

Locally-developed External Fixators as Definitive Treatment of Open Tibia Diaphyseal Fractures: A Clinical Prospective Study Conducted in Ivory Coast

Biomechanical study of a low-cost external fixator for diaphyseal fractures of long bones

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