Outcome analysis of surgical management of type 2, 3a and 3b open fractures of distal 2/3rd tibial diaphysis using external fixators
Keywords:Open fracture, Distal tibia, External fixation, Rust score
Background: There is confusion regarding ideal fixation method for intermediate grades of open fractures of tibia. In distal 2/3rd of tibia the blood supply is precarious and so it further increases the confusion. Purpose of this study is to evaluate effectiveness of external ﬁxator as deﬁnitive treatment in these fractures.
Methods: 55 patients with type2, 3A or 3B open fractures of distal 2/3rd tibia were studied. External fixator applied at the time of debridement is removed and cast applied once wound is healed. Follow up at 1, 3, 6 and 9 months recorded. Union assessed using rust scoring system. Functional outcome assessed using Modified Functional Evaluation System by Karlstrom- Olerud after patients are mobilized.
Results: Union rate was 74.5%.Functional outcome was satisfactory in 34%, moderate function in 32% and good function in 24.4%. In 7.3% the function was poor. Only one case gave excellent function.
Among diabetic patients 71.4% developed wound infection and all developed pin tract infection showing strong association between diabetes and infection.
Conclusion: Though external fixation followed by serial casting technique gave fare outcomes, there is scope for better results and so the option of other methods of treatment should not be excluded. There is a significant association between diabetes and infection and so special care and covigilance is advised in diabetic patients.
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