Fixator-assisted Percutaneous Plate Fixation of Complex Diaphyseal Tibial Fractures

Aim: The purpose of this study is to evaluate the results of indirect reduction and fixation of comminuted diaphyseal tibial fractures using temporary simplified external fixator and plate osteosynthesis through a limited incision approach with special consideration of the duration of surgery and rate of complications. Materials and methods: In this prospective case series study, 41 cases of comminuted diaphyseal tibial fractures were included. Twenty-two were closed fractures, 15 grade I open fractures, and four were grade II open fractures. Patients were evaluated clinically according to the lower extremity functional scale (LEFS). Results: Of the 41 cases, 38 were followed up for at least 1 year. Using the LEFS, final scores ranged from 67-80 (mean 75). Union was achieved in all cases except one which united after bone grafting. The mean time to radiological healing was 12 weeks. Operative time from skin incision to closure ranged between 65 minutes and 100 minutes (mean of 80 minutes). There were four cases of superficial infection. Conclusion: Treatment of comminuted tibial fractures through use the of a simplified external fixator to aid and maintain the reduction of comminuted tibial fractures whilst limited incisions are then used for minimally-invasive plate osteosynthesis in an effective and time-saving method with a low complication rate.