Anoop Kumar
BACKGROUND Compound fracture of tibia has been a debatable issue since ages. In the past, infection and infected non-union were the common complications making patient non-ambulatory for longer periods and permanently disabling him and also leading to fatal complications.1 In pre antibiotic era, the main methods of treatment were dressings, splintage and early amputation to save life.2 First true and workable external fixator was introduced by Clayan Paekill of Denver in 18973,4 and modified gradually to a versatile multirole fixation devices by virtue of which many limbs are now a days are saved which otherwise would have been amputated. MATERIALS AND METHODS Total of 40 patients of various grades of compound injuries were studied where only external fixator was used till union of fracture. In our study, 36 (90%) patients were males and majority of patient (60%) were of 20-30 years age group. Right extremity was involved in 23 (57.5%) of cases and middle third of shaft of tibia was involved in 28 (70%) patients. Average time of union was 25.1 weeks (11-40 weeks) whereas in 18 (45%) of patients fracture united earlier at 11-15 weeks majority of them belonged to Grade-II injury. Minimum surgeries were 3 (30%) whereas 1 (2.5%) patient underwent 10 surgeries. Union time in 3 patients was delayed because infected non-union and soft tissue and skin loss, these patients were managed by bone clearance, free flap coverage and bone transportation. All patients were followed for two years before concluding the study. RESULTS Among 40 patients under study, 36 (90%) were males and both sides were involved equally. 24 (60%) patients were of age group 20-30 years and middle third fracture was in 28 (70%) of cases. Union time was 11-15 weeks in 28 (70%) of cases where as 2 (5%) cases took as long as 35- 40 weeks because of multiple procedures to salvage limbs which earlier used to be amputated because such infected non-unions were considered dangerous for patients. Minimum three surgeries were undertaken in 13 (30%) cases; whereas maximum of 8-10 surgeries were undertaken in 3 (7.5%) of cases. Excellent results were reported in Grade-II (50%); whereas 3 (7.5%) cases had acceptable results. None of cases in our study had poor results. CONCLUSION After two years of analysis of said study, it was concluded that external fixator is a wonderful fixation device in treatment of compound injuries of tibia and results are even comparable to interlocking nailing of closed fracture tibia with Gustilo???s grade II injuries. External fixator has advantage of minor adjustments of fracture alignment if required, early weight bearing, management of soft-tissue coverage, rotation of flap and even free flap coverage keeping bones in proper alignment. There is no need of converting to interlocking nailing following skin healing as union can be achieved on external fixator and also brace may be used following final removal of fixator. Only Ilizarov fixation system and Hoffman external fixation system can salvage limbs with infected gap non-union, by infected bone clearance and distraction osteoneogenesis (bone transportation).
