Use of the Hoffmann apparatus in the treatment of unstable tibial fractures.

The Hoffmann apparatus was employed in the treatment of thirty-four complex tibial fractures that we considered to have a poor prognosis with more conventional forms of treatment. Complications were minimum. The time to union for all of the fractures averaged 5.8 months and appeared to be directly related to the accuracy of the reduction. In twenty-five fractures in which it was possible to achieve an anatomical reduction and to apply compression through the apparatus, the time to union averaged 5.1 months. In six fractures that could not be anatomically reduced and compressed, the time to union averaged 8.2 months. Shortening or significant angulation of the fractures did not occur. The accessibility of the wound for serial débridement and the stabilization of the fracture as well as the traumatized soft tissue were thought to be of great value in preventing deep wound infection. A retrospective evaluation of many of the healed fractures revealed roentgenographic evidence of primary bone-healing without visible callus. Knowledgeable application of the principles and biomechanics of primary bone-healing are essential for successful treatment by this method.