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Locking plate as a definitive external fixator for treating tibial fractures with compromised soft tissue envelop

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tibial fractures with compromised soft tissue envelop may lead to significant complications. The optimal management of these injuries remains controversial. Recently, locking plate used as a definitive external fixator is attractive because it not only minimizes trauma to the soft tissues, but also overcomes the shortcomings of standard external fixators. The objective of this study was to evaluate the outcome of using locking plate as a definitive external fixator for treating tibial fractures with compromised soft tissue envelop.

Patients and methods

A prospective series of 12 consecutive tibial fractures with compromised soft tissue envelop were treated using locking plate as a definitive external fixator. Of these patients, six were Gustilo and Anderson type IIIA, three were type II and three were closed fractures (AO/ASIF soft tissue injury classification IC4: 2, IC5: 1). Time to union, nonunion, malunion, leg shortening, range of motion and function for the knee and ankle, deep infection, pin tract infections were evaluated.

Results

The mean bone healing time was 37.8 weeks (range 20–56 weeks). Eventually, all of the fractures united. Most of the fractures healed in acceptable positions. There were no cases of deep infection. Pin tract infection was seen in 1 (8.3 %) patient, no loosening or failure of the external fixator was seen. At the most recent follow-up, the mean range of motion at the knee was extension 0° to flexion 135°, and the mean ankle range of motion was dorsi flexion 12° to plantar flexion 32°. All patients had excellent or good functional results and were fully weight bearing with a well-healed tibia at the final follow-up.

Conclusion

The locking plate used as a definitive external fixator provided a high rate of union. The patients experienced a comfortable clinical course, excellent knee and ankle joint motion, satisfactory functional results and an acceptable complication rate. However, the stiffness of external locked plating is not clear, therefore, clinical recommendation on its practical use to reduce the risk of implant failure still need to be determined.

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Acknowledgments

This study has received financial support from the Peak Talents Foundation in Jiangsu Province (#2012-WS-092), Key Project of Department of Health, Nanjing, China (JQX12005), and the Key Program of Science and Technique Development Foundation in Jiangsu Province (BE20116004). We acknowledge Dr. Hong-fei Shi, Dr. Jun Jiang, Dr. Xiao-xiao Xie, and Dr. Chang-jun Wang for their assistance during the data collection. The authors would also like to thank Ms. Xiao-xia Zhong for her help in patient follow-up.

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Authors and Affiliations

  1. Department of Orthopaedics, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China

    Xu-sheng Qiu, Han Yuan, Xin Zheng, Jun-fei Wang, Jin Xiong & Yi-xin Chen

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  1. Xu-sheng Qiu
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  2. Han Yuan
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  3. Xin Zheng
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  4. Jun-fei Wang
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  5. Jin Xiong
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Correspondence to Yi-xin Chen.

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Qiu, Xs., Yuan, H., Zheng, X. et al. Locking plate as a definitive external fixator for treating tibial fractures with compromised soft tissue envelop. Arch Orthop Trauma Surg 134, 383–388 (2014). https://doi.org/10.1007/s00402-013-1916-1

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  • DOI: https://doi.org/10.1007/s00402-013-1916-1

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