External Fixation as a Primary and Definitive Treatment for Complex Tibial Diaphyseal Fractures: An Underutilized and Efficacious Approach

Figures & data

Table 1 Patient Demographic Characteristics with Complicated Tibial Shaft Fractures

Variables	Subgroup	N (%)
Age (year)	Mean± SD	42.1±10.1
Gender	Male	102 (92.7%)
	Female	8 (7.3%)
Residency	Rural area	25 (22.7%)
	Urban area	85 (77.3%)
Comorbidities	Smoking history	30 (27.3%)
	Diabetes mellitus	33 (30.0%)
Main causes	Motor vehicle accidents	81 (73.6%)
	Gunshot injury	19 (17.3%)
	Fall from a height	10 (9.1%)
Type of fracture	Open fracture	92 (83.6%)
	Closed fracture	18 (16.4%)
Gustilo and Anderson fracture grad	C	45 (48.9%)
	B	36 (39.1%)
	A	11 (12.0%)

Table 2 Postoperative Characteristics and Outcome

Variables	Subgroups	N (%)
Orthopedic complications	Pin track infection	30 (27.3%)
	Osteomyelitis	2 (1.8%)
Checketts score	Minor (Grades I and II)	20 (18.2%)
	Major (Grades III and IV)	10 (9.1%)
General complications		11 (12.0%)
General complications types	Fat embolism	2 (1.8%)
	Pulmonary embolism	5 (4.5%)
	Deep venous thrombosis	4 (3.6%)
Time for union (week)	Mean± SD	23.1± 3.2
Union type	Normal healing	71 (64.5%)
	Delayed union	34 (30.9%)
	Nonunion	5 (4.5%)
	Malunion	3 (2.7%)
Follow-up time (weeks)	Mean± SD	34.8± 4.8

Figure 1 Open segmental tibial shaft fracture treated by external fixation method; (A) plain X-ray after injury (AP view and lateral views), (B) X-ray (AP view) 3 months after the injury, (C) X-ray (AP and lateral views) 6 months after the surgery.

Table 3 Factors Associated with Pin-Track Infections

Variables	Subgroups	Pin Tract Infection		P-value
		Yes (30)	No (80)
Age (year)	Mean ±SD	39.9±11.1	42.9 ±9.7	0.165
Gender	Female	4 (13.3)	4 (5.0)	0.277
	Male	26 (86.7)	76 (95.0)
Main cause	Gunshot injury	6 (20.0)	13 (16.2)	0.125
	Motor vehicle accidents	24 (80.0)	57 (71.2)
	Fall from a height	0 (0.0)	10 (12.5)
Residency	Rural	22 (73.3)	3 (3.8)	<0.001
	Urban	8 (26.7)	77 (96.2)
Smoking history	Yes	25 (83.3)	5 (6.2)	<0.001
	No	5 (16.7)	75 (93.8)
History of diabetes mellitus	Yes	26 (86.7)	7 (8.8)	<0.001
	No	4 (13.3)	73 (91.2)
Type of fracture	Closed	0 (0.0)	17 (21.2)	0.014
	Open fracture	30 (100.0)	63 (78.8)
Gustilo and Anderson fracture grade	C	22 (78.6)	24 (37.5)	0.001
	A	1 (3.6)	10 (15.6)
	B	5 (17.9)	30 (46.9)
General complications	No	20 (66.7)	79 (98.8)	<0.001
	Yes	10 (33.3)	1 (1.2)

Note: Boldface indicates a statistically significant result (P < 0.05).

Data Sharing Statement

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.