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External fixation of segmental tibial shaft fractures

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Tibial shaft fractures are the most common type of large long-bone fractures. Segmental tibial shaft fractures are severe injuries and its treatment can be followed by a high incidence of complications, nonunion, delayed union, malunion, infection or compartment syndrome. The most common treatment strategy is intramedullary fixation. Results of the unilateral external fixation treatment for segmental tibial shaft injuries are presented in this paper.

Methods

Patients with segmental tibial shaft fractures, AO/OTA 42-C2 were treated as urgent cases by unilateral external fixation. Mitkovic-type external fixator was used in all of these fractures.

Results

There were 32 patients with segmental tibial shaft fractures (AO/OTA 42-C2), 20 males and 12 females, average age of 43.5 years. Average time of union was 5.9 (4.1–7.4) months for closed and 6.2 (5.1–7.9) months for open fractures. Average follow-up was 18 (26–60) months. Nine patients (28.12%) had open segmental tibial shaft fracture (2 Grade I, 2 Grade II, 1 Grade IIIA, 4 Grade IIIB). Union rate was 81.25% (26 cases). Nonunion rate was 18.75% (6 cases) and malunion 3.12% (1 case). Nonunion was higher in patients with open fractures (4). Compartment syndrome had been diagnosed in 6 cases (18.75%) with closed fracture and fasciotomy was performed when external fixator was applied. There were no deep infections. Pin tract infection was present in 7 cases (21.85%).

Conclusion

Treatment of segmented tibial shaft fractures can be followed by a number of complications. Unilateral external fixation with convergent orientation of pins provides three-dimensional stability of the fracture and good biomechanical conditions for fracture healing, with lower complications rate.

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Acknowledgements

This work was supported by the Ministry for science and education, Republic of Serbia, project III41017 “Virtual human osteoarticular system and its application in preclinical and clinical practice”.

Funding

No financial support was received for this study.

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Authors and Affiliations

  1. Medical Faculty, Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre Nis, University of Nis, Nis, Serbia

    Sasa Milenkovic, Milan Mitkovic & Milorad Mitkovic

Authors
  1. Sasa Milenkovic
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  2. Milan Mitkovic
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  3. Milorad Mitkovic
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Corresponding author

Correspondence to Sasa Milenkovic.

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Conflict of interest

Sasa Milenkovic and Milan Mitkovic declare that they have no conflict of interest. The author Milorad Mitkovic, has at this moment agreement with Ortokon, producer of External Fixator, on temporary assignment to the use of patent.

Compliance with ethical requirements

This study was approved by the appropriate ethics committee.

Informed consent

Informed consent was not necessary for this study with its retrospective design and anonymised data and thus not requested from our patients.

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Milenkovic, S., Mitkovic, M. & Mitkovic, M. External fixation of segmental tibial shaft fractures. Eur J Trauma Emerg Surg 46, 1123–1127 (2020). https://doi.org/10.1007/s00068-018-1041-5

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  • DOI: https://doi.org/10.1007/s00068-018-1041-5

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