%0 Journal Article
%T External fixation as definitive treatment or external fixation followed by early fixation in open fractures of the tibial shaft: A descriptive study.
%A Le Baron M
%A Maman P
%A Volpi R
%A Flecher X
%J Injury
%V 55
%N 0
%D 2024 Jun
%M 39069345
%F 2.687
%R 10.1016/j.injury.2024.111477
%X <B>BACKGROUND: </B>Treatment options for open tibial shaft fractures include external fixation with or without early conversion to internal fixation.<BR><B>OBJECTIVE: </B>The aim of this study was to describe 1) early conversion to internal fixation and definitive external fixation and 2) in case of conversion, to identify risk factors for complications.<BR><B>METHODS: </B>Seventy-two external fixations of open fractures of the tibial shaft (Gustilo classification, 7 fractures (9.7 %) grade I, 25 fractures (34.7 %) grade II, 40 fractures (55.6 %) grade III (31 grade IIIA and 9 grade IIIB)) were included in a continuous non-randomised study. Thirty-three fractures without infection signs were converted to internal fixation at a mean time of 40.5 +/-15 days (IF group). External fixation was maintened in the remaining 39 fractures (EF group).<BR><B>RESULTS: </B>In the "IF" group, the union rate was 69.7 % at 6.3 +/-3.6 months (3-16). All patients had complete union at 16 months, requiring 2.8 +/-0.8 reoperations. Fixation with external fixation only ("EF" group) showed a union rate of 51.3 % at 8.9 +/-4 (5-22) months and 96 % at 16 months after 3.7 +/-0.9 reoperations. Superficial infection (12.1 %; p = 0.011) and numerous surgeries (2.76; p = 0.004) were found to be risk factors for deep infection. Time to wound closure >7 days (p = 0.049), time to reoperation >28 days (p = 0.00), numerous surgeries (2.76; p = 0.004) and deep infection (6.1 %; p = 0.027) were found to be union failure factors.<BR><B>CONCLUSIONS: </B>Early conversion of external fixation to internal fixation is an effective option to achieve bone union of open tibial fractures in selected patients.