External Fixation in the Management of Closed Segmental Tibial Fractures

Summary Segmental fractures represent the interruption of bone integrity at two or more levels. In these fractures, a wide zone of injury (damage of all structures of the lower leg) creates very unsuitable biological conditions for healing of the fracture. Because of the damage of both intramedullary and periostal vascularization, segmental fractures are predisposed to slow healing and development of pseudoarthrosis. The aim of the paper was to present the results of treatment of patients with closed segmental tibial fractures treated by external fixation. Within the period between January 1, 1998 and June 31, 2012 in the Clinical Center Niš, 26 patients with closed segmental fractures of the tibia were treated. The assessment of outcomes of treatment of closed segmental tibial fractures by external fixation was performed on a series of 24 patients. The mean age was 43.57 years. All the patients were treated by Mitković unilateral external fixator produced by “Trafix” firm. Fracture healing occurred in 20 (83.33%) patients; four (16.67%) patients reported significant complications in the course of treatment that required further surgical treatment. By applying the method of external fixation in the treatment of closed segmental tibial fractures, reposition of fragments is achieved through a small incision, with pins of exteranal fixator placed outside the fracture zone to prevent further damage of intramedullary and periosteal bone vascularisation, which is very important for fracture healing. Sažetak Segmentni prelomi tibije predstavljaju prekid kontinuiteta koštanog tkiva dijafize tibije na dva ili više nivoa. Kod segmentnih preloma potkolenice dolazi do oštećenja svih anatomskih struktura, što stvara veoma nepovoljne biološke uslove za zarastanje preloma. Zbog oštećenja kako intramedularne tako i periostalne vaskularizacije, segmentni prelomi potkolenice predisponirani su za usporeno zarastanje i razvoj pseudoartroza. Cilj rada bio je da se prikažu rezultati lečenja zatvorenih segmentnih preloma potkolenice metodom spoljne skeletne fiksacije. U periodu od 01.01.1998. do 31.06.2012. godine u Kliničkom centru u Nišu lečeno je 26 bolesnika sa zatvorenim segmentnim prelomom potkolenice. Procena krajnjih rezultata lečenja izvršena je na seriji od 24 bolesnika. Prosečna starost ispitanika iznosi 43.57 godina. Svi bolesnici lečeni su spoljnim skeletnim fiksatorom Mitković. Zarastanje preloma bez težih komplikacija registrovali smo kod 20 (83,33%) ispitanika. Kod četiri (16,67%) ispitanika javile su se značajnije komplikacije u toku lečenja, koje su zahtevale dodatne hirurške intervencije. Prilikom primene metode spoljne skeletne fiksacije u lečenju zatvorenih segmentnih preloma potkolenice, repozicija fragmenta ostvaruje se kroz male rezove, a klinovi spoljnog skeletnog fiksatora plasiraju se van žarišta preloma, tako da se dodatno ne oštećuje ni intramedularna ni periostalna vaskularizacija kosti u zoni preloma, što je veoma važno za proces zarastanja preloma.