The significance of soft tissue trauma for fracture healing. A prospective study on 70 tibial shaft fractures following primary treatment with the Monofixateur.

In a prospective study, the significance of the fracture type, the dynamization of the external fixator, the soft tissue damage and the second osteosynthesis for the fracture healing of 70 tibial shaft fractures was evaluated. All fractures included in the study involved second- or third-degree closed or open soft-tissue damage. In all fractures, a careful debridement was performed primarily. All fractures were stabilized with the Monofixateur, and the fracture site was covered with vital soft tissues. If there was any sign of delayed fracture healing after healing of the soft tissues, a secondary internal osteosynthesis was carried out as soon as possible. The mean hospital stay of the 70 patients was 32 days, while the fixator was dynamized after an average of 9 weeks and removed after 18.4 weeks. Consolidation was observed after an average of 26.5 weeks. In 30% of cases a secondary internal osteosynthesis was carried out after an average of 19.6 weeks. After second osteosyntheses, no late problems were seen. Statistical evaluation of the results made the paramount importance of the soft tissue damage for fracture healing very clear: soft tissue damage had a significant influence on the duration of the hospital stay, on the consolidation time and on the frequency of second osteosynthesis operations. There was also an indirect influence on the functional end-results: the quicker the fracture healing, the better the end-results. Thorough clinical examination of the soft tissue damage in the early posttraumatic phase is of great importance to allow correct assessment of the prognosis of a tibial shaft fracture.(ABSTRACT TRUNCATED AT 250 WORDS)