[Use of a hybrid external fixator for treatment of tibial fractures].

PURPOSE OF THE STUDY: The study deals with treatment of the articular ends of the tibia, using a hybrid external fixator. A group of patients treated in the years 2001-2003 is retrospectively evaluated.

MATERIAL: Between 2001 and 2003, 21 patients (16 men and 5 women) with a fracture of either the distal or the proximal end of the tibia were treated, using a Synthes external hybrid fixator, at the Department of Orthopedics and Traumatology, Faculty of Medicine, Charles University, Plzen. The average age of the patients was 49.2 years. The fractures, evaluated by the AO classification, included five type A3 fractures and 16 type C1 or C2 fractures. In 14 patients the fracture was associated with multiple trauma or polytrauma and in seven it was a single injury. Open fractures were treated in five patients (grade 2 in two and grade 3 in three patients), closed fractures in 16 patients (Type CII in 12 and type CIII in four patients, as assessed by Tscherne's classification). Fifteen patients had fracture of the proximal tibia and six had distal tibial fracture. A hybrid external fixator was used alone in six patients, and in combination with miniosteosynthesis in 15 patients.

METHODS: The first aim was to perform closed reduction or reduction from a minimal approach with an intraoperative image intensifier. Subsequently, the fracture was temporarily stabilized with pelvic reduction forceps or Ki wires and, if indicated, the articular ends were stabilized by miniosteosynthesis. When the outer ankle was fractured, plate osteosynthesis was carried out. Finally, a hybrid external fixator was applied. In the case of an open fracture, this procedure was preceded by soft tissue debridement.

RESULTS: The evaluation, based on clinical and radiographic findings and subjective complaints of the patients, was made with the use of the Rasmussen and Bray scoring system. Nineteen patients were followed up, two failed to turn up. The results were excellent in five, very good in six, satisfactory in five and poor in three patients. Two repeat operations were necessary.

DISCUSSION: The treatment of injury to the articular ends of the tibia, with the use of a hybrid external fixator, is one of the options for stabilization of both open and closed fractures. This method enables us to stabilize fractures of the tibial metaphysis as well as intra-articular fractures. Application of a hybrid external fixator is indicated in type A and type C fractures (AO classification). The state of crural soft tissues must be taken into consideration. The advantage of this method is the use of Kirschner wires, as fixation components, stretched in a circular frame. The fixation components require only minimum space for insertion in the metaphysis or epiphysis, the implant is stable and permits easy treatment of soft tissues. Another advantage is the possibility of early rehabilitation of the adjacent joints and loading of the extremity. Relatively frequent "pin infection" and therefore more frequent visits to the outpatient department can be considered a disadvantage.

CONCLUSIONS: The method described here is, in addition to other options of fracture osteosynthesis, suitable for treatment of fractured ends of the tibia. External fixator application can be used with advantage for treatment of supra or infra-articular fractures of the tibia and fractures associated with marked swelling of soft tissues, for which internal osteosynthesis is not indicated, and in open fractures as well.