Suksathien Yingyong, Suksathien Rachawan
Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
J Med Assoc Thai. 2011 Sep;94(9):1084-8.
The tibial shaft is one of the most common sites of open fracture. External fixators emerged as the treatment of choice for high energy open tibial fractures because they were easy to apply, allow sufficient access for wound care and provide sufficient mechanical fixation for patient mobilization and bone healing. Based on the advantages of dynamization in increased union rate and the simplicity of monolateral frame, a new design dynamic external fixator system was developed for definite treatment in open tibial fracture.
To evaluate the clinical results of open tibial fractures treated with a new design dynamic external fixator system until healing.
The case series of 60 patients with open tibial fracture treated with the new design dynamic external fixator system for acute and definitive-treatment frame between 2005 and 2009. According to the system of Gustilo and Anderson, 14 fractures were classified as type II, 43 as type IIIA, and three as type IIIB. Partial weight bearing with crutches was instructed when tolerable for dynamization. When there were evidences of fracture healing in both clinical and radiographic, external fixator was removed.
All fractures united. The median union time was 12 weeks (range, 10-15) in type 11, 16 weeks (range, 10-24) in type IIIA, and 20 weeks (range, 20-21) in type IIIB. Iliac bone grafting was performed in six cases at a mean time of 3.8 weeks to enhance bone union. Seven cases (12%) developed pintract infections. No deep infection was found in the present study. Ninety-five percent of fractures united with less than 10 degrees angulation in any plane. No instrument failure was found. The external fixator frame could be reused.
The new design dynamic external fixator system successfully treated open tibial fractures with a good result and low complication rate. It is simple, safe, and easy to use.
胫骨干是开放性骨折最常见的部位之一。外固定器成为高能开放性胫骨骨折的首选治疗方法，因为其应用简便，便于充分进行伤口护理，并为患者活动和骨折愈合提供足够的机械固定。基于动力化在提高愈合率方面的优势以及单侧框架的简易性，开发了一种新型设计的动态外固定器系统用于开放性胫骨骨折的确定性治疗。
评估采用新型设计的动态外固定器系统治疗开放性胫骨骨折直至愈合的临床效果。
本病例系列研究纳入了2005年至2009年间采用新型设计的动态外固定器系统进行急性和确定性治疗的60例开放性胫骨骨折患者。根据Gustilo和Anderson分类系统，14例骨折为II型，43例为IIIA型，3例为IIIB型。当可以耐受动力化时，指导患者使用拐杖进行部分负重。当临床和影像学检查均有骨折愈合迹象时，拆除外固定器。
所有骨折均愈合。II型骨折的中位愈合时间为12周（范围10 - 15周），IIIA型为16周（范围10 - 24周），IIIB型为20周（范围20 - 21周）。6例患者平均在3.8周时进行了髂骨植骨以促进骨愈合。7例（12%）发生针道感染。本研究中未发现深部感染。95%的骨折在任何平面的成角小于10度时愈合。未发现器械故障。外固定器框架可重复使用。
新型设计的动态外固定器系统成功治疗了开放性胫骨骨折，效果良好且并发症发生率低。它简单、安全且易于使用。
