External Fixation in the Management of Closed Segmental Tibial Fractures

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 Nis, 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 Mitkovic 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.