Results of treatment using the Hoffmann external fixator for fractures of the tibial diaphysis.

External fixation via the Hoffmann apparatus was employed as primary treatment in 19 patients and as secondary treatment in eight patients. These were severe fractures: almost all were open, comminution was present in 66%, 50% were classified as Grade III, and 50% had other orthopedic injuries. The majority of patients had delayed unions. Overall, three nonunions (13%) resulted, yet the malunion rate was 39%. Forty-five per cent of patients required a bone graft for eventual union. Fifty per cent had drainage from their pin tracts yet only two required debridement and all eventually resolved. Almost one half of the patients had neurologic impairment, primarily because of severe compartment syndromes (all in open fractures, all treated with fasciotomies) and four major vascular injuries. The most common neurologic sequela was footdrop, found in eight patients. The Hoffmann fixator is valuable, but only in severe injuries, as complications do occur which might be avoided with simpler methods of treatment.