Retrospective clinical outcomes in the definitive treatment of high-energy tibial diaphyseal fractures using hexapod external fixator versus monolateral external fixator

Abstract

Background External fixation, which can preserve the biomechanical microenvironment of fracture healing, plays an important role in managing the high-energy fractures with poor surrounding soft tissues. The purpose of this study was to determine the differences of clinical outcomes, if any, between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures. Methods A total of 53 patients with high-energy tibial diaphyseal fractures and definitively treated by the hexapod external fixator (HEF) or monolateral external fixator (MEF) were retrospectively collected and analyzed, from March 2015 to June 2019. There were 31 patients in the HEF treatment, and the other 22 patients were managed by the MEF. The demographic data, surgical duration, external fixation time, final radiological results, complications, and clinical outcomes were documented and analyzed. Difficulties that occurred during the treatment were classified according to Paley. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit. Results The mean surgical duration in the HEF group (62.4 ± 8.3 min) was shorter than that in the MEF group (91.4 ± 6.9 min) (P < 0.05). All patients acquired complete bone union finally. Patients in the HEF group (24.2 ± 3.1 weeks) underwent a shorter average external fixation time than that in the MEF group (26.3 ± 3.8 weeks) (P < 0.05). Satisfactory alignment was achieved in all patients without the need for remanipulation. The residual sagittal plane deformities in the HEF group were all less than that in the MEF group (P < 0.05). The complication rate was 35.5% in the HEF group, while 45.5% in the MEF group. There was no statistically significant difference between the two groups in ASAMI scores (P > 0.05). Conclusion There is no statistically significant difference in finally clinical outcomes between hexapod external fixator and monolateral external fixator in the definitive treatment of high-energy tibial diaphyseal fractures. The hexapod external fixation treatment is a superior effective method, including advantages of stable fixation, less surgical duration, postoperatively satisfactory fracture reduction, and fewer complications.

Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study

“…Therefore, based on the situation of both groups of patients, HEF has the following advantages: (1) HEF can use complete closed reduction with computer assistance, without the need to open and expose the fracture site, with minimal damage to the surrounding blood supply and only minimally invasive percutaneous insertion of xation wires, and therefore causes minimal trauma. In this study, HEF group achieved closed reduction of fractures without any cases of cutting the fracture site, protecting the blood supply around the fracture site and providing a good biological environment for fracture healing [12,13]. (2) HEF can achieve stable xation of the entire segment of the tibia, and the fracture site can be xed through multi-plane penetrating xation wires.…”

“…In this study, HEF group had earlier complete weight-bearing time and shorter bone union time compared to IMN group. (3) HEF group signi cantly improved the accuracy of fracture reduction [9], the residual fracture displacement can be adjusted by measuring the AP and lateral radiographs with the aid of computer-based software postoperatively [12]. Effective xation of proximal 1/3 and distal 1/3 of the tibia is a di cult point in the treatment of segmental fractures, and the incidence of malunion of fractures in this area treated with intramedullary nails is as high as 84% [10].…”

“…The spatial con guration can be changed by adjusting the length of the 6 universal adjustment rods, thereby achieving reduction and correction of the fracture site [9,10]. In recent years, the application of HEF in fracture reduction, limb correction, and functional reconstruction of patients in China has gradually increased [11][12][13]. However, there is currently a lack of comparative research on the e cacy of HEF and IMN in the treatment of STFs.…”

Treating tibial fracture with supra-cutaneous locking plate osteosynthesis: personalized therapy for special patient;A case series study

“…xation with plate and screws was between 2.3 percent and 2.5 percent [9][10] Debridement was the initial step in the traditional way of treating open tibial fractures, followed by the placement of a large external xator or, where soft tissue injury and contamination were not severe, one stage debridement and internal xation [11][12]. However, due to instability or inconveniency brought on by bulky external xators, internal xation with a plate or intramedullary locking nail may occasionally be required [13]. The risk of infection was considerable with one stage debridement and internal xation for an open tibial fracture [14].…”