The significance of soft tissue trauma for fracture healing: a prospective study on 70 tibial shaft fractures.

In a prospective study, the significance of the fracture type, the dynamization of the external fixator, the soft tissue damage and the second osteosynthesis was evaluated for the fracture healing of 70 tibial shaft fractures. All fractures, included in the study, had a second or third degree closed or open soft tissue damage. In all fractures, a careful debridement was performed primarily. All fractures were stabilised with the Monofixator, and the fracture site was covered with vital soft tissues. If there was any sign of a delayed fracture healing after healing of the soft tissues, a secondary internal osteosynthesis was carried out as quick as possible. The mean hospital stay of the 70 patients was 32 days, the fixator was dynamized after an average of 9 weeks and removed after 18.4 weeks. Consolidation was registered after an average of 26.5 weeks. In 30% a secondary internal osteosynthesis was carried out after an average of 19.6 weeks. After this second osteosynthesis, no late problems were seen. In the statistical evaluation of the results, the paramount importance of the soft tissue damage for fracture healing became 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 the re-osteosynthesis. There was also an indirect influence on the functional end results: the quicker the fracture healing, the better the end results. A thorough clinical examination of the soft tissue damage in the early posttraumatic phase is of great importance to become a correct idea of the prognosis of a tibial shaft fracture. The more severe the soft tissue trauma, the more difficult the fracture healing will be.(ABSTRACT TRUNCATED AT 250 WORDS)