Which external fixation method is better for the treatment of tibial shaft fractures due to gunshot injury? - 08/05/21

Doi : 10.1016/j.otsr.2021.102948

Alkan Bayrak ^a,⁎ , Ömer Polat ^b, Hüseyin Tamer Ursavaş ^c, Kadir Gözügül ^d, Vedat Öztürk ^e, Altuğ Duramaz ^a
^a Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Orthopedics and Traumatology, Tevfik Sağlam St. Number 11, 34147 Bakırköy/Istanbul, Turkey
^b Ümraniye Training and Research Hospital, Department of Orthopedics and Traumatology, Elmalıkent Adem Yavuz St, Number 1, 34764 Ümraniye/Istanbul, Turkey
^c Silifke State Hospital, Orthopedics and Traumatology, Koyuncu Sok. No:434, 33960 Mersin, Turkey
^d Iğdır State Hospital, Orthopedics and Traumatology, Melekli Yolu Str, 76000 Merkez/Iğdır, Turkey
^e Sultangazi Haseki Training and Research Hospital, Department of Orthopedics and Traumatology, Uğur Mumcu Mah. Hastane St. Number 1, 34265 Sultangazi/Istanbul, Turkey

^⁎Corresponding author.

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Highlights

•	Open tibial fractures after LVGI are dirty injuries and are treated with different methods.
•	In the case of emergency intervention, first external fixator is applied and after soft tissue is recovered, permanent fixation can be applied.
•	This present study emphasized that permanent treatment can also be performed with AO type monoplanar external fixator or Ilizarov type external fixator.

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Abstract

Introduction

The present study aimed to evaluate the functional and radiological outcomes of AO type monolateral external fixator (AO-EF) and Ilizarov type external fixator (I-EF) in definitive fixation of tibial shaft fractures due to gunshot injury.

Hypothesis

Patients undergoing I-EF would have faster fracture healing with the help of early weight-bearing and the functional scores would be better compared to AO-EF.

Material and methods

The study consisted of 76 (67M, 9F) patients who underwent surgery between 2010 and 2016 for tibial shaft fracture due to low-velocity gunshot injury (LVGI). The patients were divided into two groups according to the fixation method (AO-EF and I-EF) which was discussed by the surgeon team due to their experience. The average age at the time of injury was 37.8±9.8 (20 to 59 years). Groups are compared according to LEFS score, coronal-sagittal-rotational angle, Johner-Rush score, and complications such as nonunion, malunion, osteomyelitis, and pin-tract infection. The mean follow-up time 31.61±3.83 months (between 24 and 44 months).

Results

No statistical difference was found between groups in terms of demographic characteristics. There was no statistical difference between groups regarding body mass index (BMI). LEFS score and operation duration were higher in the I-EF group (p=0.000 and p=0.006 respectively, p˂0.05). In the I-EF group, hospitalization period, full weight-bearing time, and healing time was shorter than the AO-EF group (p=0.001, p=0.000, and p=0.025 respectively, p˂0.05).

Discussion

Although AO-EF has advantages such as ease of application and short surgery time in the definitive fixation of LVGI tibia shaft fractures, I-EF is a superior technique in terms of functional scores. However, I-EF is a surgical approach that requires relatively more experience. Therefore, the choice of fixator should be determined according to the surgeon's experience in the permanent treatment of LVGI tibial shaft fractures.