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Osteosynthesis and Trauma Care 2004; 12(4): 208-214
DOI: 10.1055/s-2004-832298
Original Article

© Georg Thieme Verlag Stuttgart · New York

Treatment of Open Tibial Fractures with External Fixation and Secondary Intramedullary Nailing by Polytraumatized Patients

D. Koulalis1 , 2 , G. Gouvas1 , G. Koulalis1
  • 1Orthopaedic Department of the General Hospital “Agios Dimitrios” Thessaloniki, Greece
  • 21st Orthopaedic Department of Hygeia Hospital, Athens, Greece
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Publikationsverlauf

Publikationsdatum:
30. November 2004 (online)

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Abstract

62 polytrauma patients with open tibial fractures were initially treated with primary external fixation followed by secondary intramedullary nailing with reaming. 28 open fractures were Gustilo Type I, 27 Type II and 7 Type III (3 III a, 3 III b,1 III c). The external fixator pin insertion sites were twice daily cleaned and disinfected. Average time between the application of the two methods was 5.2 days. The average time for initial callus appearance was 2.5 months. Superficial infection appeared in 7.1 % of Type I fractures and 7.4 % of Type II fractures. Deep infection appeared in 14.2 % of Type III fractures and non-union in 11.1 % of Type II fractures. In cases where immediate, minimally invasive stabilization is needed, secondary interlocking intramedullary nailing after initial treatment with external fixation is employed in polytrauma patients. This treatment regime provides rapid stabilization, mobilization and secures fracture healing in the treatment of open tibial fractures. It can be viewed as an alternative solution to unreamed interlocking intramedullary nailing when this is not possible.

Key words

Open tibial fractures - interlocking intramedullary nailing - external fixation - polytrauma

References

  • 1 Bach A W, Hansen S T. Delayed union, nonunion, and malunion of the tibial shaft. In: Evarts CM (ed). Surgery of the Musculoskeletal System. Vol. 3. Churchill Livingstone, New York 1983; pp 868-872
  • 2 Behrens F, Searls K. External fixation of the tibia. Basic concepts and prospective evaluation.  J Bone Joint Surg [Br]. 1986;  68 246-254
    PubMedSuche in Google Scholar
  • 3 Bonatus T, Olson S A, Lee S, Chapman M W. Non-reamed intramedullary nailing for open fractures of the tibia.  Clin Orthop. 1997;  339 58-64
    PubMedSuche in Google Scholar
  • 4 Chapman M W. The role of intramedullary fixation in open fractures.  Clin Orthop. 1986;  212 26-34
    PubMedSuche in Google Scholar
  • 5 Bone L B, Johnson K D. Treatment of tibial fractures by reaming and intramedullary nailing.  J Bone Joint Surg [Am]. 1986;  68 877-887
    PubMedSuche in Google Scholar
  • 6 Court-Brown C M, Cristie J, McQueen M M. Closed intramedullary nailing. Its use in closed and type I open fractures.  J Bone Joint Surg [Br]. 1990;  72 605-611
    PubMedSuche in Google Scholar
  • 7 Court-Brown C M, McQueen M M, Quaba A A, Cristie J. Locked intramedullary nailing of open tibial fractures.  J Bone Joint Surg [Br]. 1991;  73 959-964
    PubMedSuche in Google Scholar
  • 8 Dobozi W R, Pankovich A M, Segal D, Saltzman M, Wiss D. Flexible intramedullary nailing of tibial shaft fractures. Scientific Exhibit at the Annual Meeting of The American Academy of Orthopaedic Surgeons, Atlanta, Georgia 1984; Feb. 9-14
  • 9 Gustilo R, Merkow R L, Templeman D. Current concepts review. The management of open fractures.  J Bone Joint Surg [Am]. 1990;  72 299-304
    PubMedSuche in Google Scholar
  • 10 Gustilo R, Mentoza R M, Williams D N. Problems in the management of type III (severe) open fractures. A new classification of type III open tibial fractures.  J Trauma. 1984;  24 742-746
    CrossrefPubMedSuche in Google Scholar
  • 11 Holbrook J L, Swiontkowski M F, Santers R. Treatment of open fractures of the tibia shaft: Ender's nailing versus external fixation. A randomized, prospective comparison.  J Bone Joint Surg [Am]. 1989;  71 1231-1238
    PubMedSuche in Google Scholar
  • 12 Karlstrom G, Orelud S. External fixation of severe open tibial fractures with the Hoffmann frame.  Clin Orthop. 1983;  180 68-77
    PubMedSuche in Google Scholar
  • 13 Klemm K W, Borner M. Interlocking nailing of complex fractures of the femur and tibia.  Clin Orthop. 1986;  212 89-100
    PubMedSuche in Google Scholar
  • 14 Kimmel R B. Results of treatment using the Hoffmann external fixator for fractures of the tibia diaphysis.  J Trauma. 1982;  22 960-965
    PubMedSuche in Google Scholar
  • 15 Kropfl A, Berger U, Neureiter H, Hertz H. Intramedullary pressure and bone marrow fat intravasation in unreamed intramedullary femoral nailing.  J Trauma. 1997;  42 946-954
    PubMedSuche in Google Scholar
  • 16 Merle D'Aubigne R, Maurer P, Zuchman J, Masse Y. Blind intramedullary nailing for tibial fractures.  Clin Orthop. 1974;  105 267-275
    PubMedSuche in Google Scholar
  • 17 Mc Graw J M, Lim E VA. Treatment of open tibial shaft fractures. External fixation and secondary intramedullary nailing.  J Bone Joint Surg [Am]. 1988;  70 900-911
    PubMedSuche in Google Scholar
  • 18 Melis G C, Sotgiu F, Le Pori M, Guido P. Intramedullary nailing in segmental tibial fractures.  J Bone Joint Surg [Am]. 1981;  63 1310-1318
    PubMedSuche in Google Scholar
  • 19 Olerud S, Karlstrom G. Secondary intramedullary nailing of tibial fractures.  J Bone Joint Surg [Am]. 1972;  54 1419-1428
    PubMedSuche in Google Scholar
  • 20 Puno R M, Teynor J T, Nagano J, Gustilo R B. Critical analysis of results of treatment of 201 tibial shafts.  Clin Orthop. 1986;  212 113-121
    PubMedSuche in Google Scholar
  • 21 Rosenthal R E, MacPhail J A, Ortiz J E. Non-union in open tibial fractures. Analysis of reasons for failure of treatment.  J Bone Joint Surg [Am]. 1977;  59 244-248
    PubMedSuche in Google Scholar
  • 22 Santoro M V, Benirschke K S, Henley M B, Mayo K A. Prospective comparison of unreamed interlocking intramedullary nails versus half-pin external fixation in open tibial fractures. AAOS 58th Annual Meeting, Paper No. 404, March 1991
  • 23 Whittle A P, Russell T A, Taylor J C, Lavelle D G. Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming.  J Bone Joint Surg [Am]. 1992;  74 1162-1171
    PubMedSuche in Google Scholar
  • 24 Winguist R A, Hansen S T, Clawson D K. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases.  J Bone Joint Surg [Am]. 1984;  66 529-539
    PubMedSuche in Google Scholar

Dr. D. Koulalis

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