Management Of Open Type IIIA And Type IIIB Fractures Tibia With LRS External Fixator

Abstract

Back ground: The specific method of skeletal fixation and soft tissue management in open fracture of tibia, one of the common fracture continues to be a topic of debate in orthopedic traumatology. The current study was done with an objective to assess the role of LRS external fixator in the management of open type IIIA and type IIIB fractures of the tibia.Materials and method: Out of the total 157 cases of open fractures of tibia encountered during the study period, 45 cases belonged to type IIIA and IIIB were treated by primary wound debridement and fracture stabilization with LRS external fixator. The surgery was aimed at achieving anatomical reduction, stable fixation and early soft tissue coverage to allow early mobilization. Average duration of the use of external fixator was 24 weeks. Using the principle of compression distraction osteogenesis, fracture union was enhanced by doing compression and distraction at the rate of 1 mm for every 10 days alternatively. Regular follow up done and the cases were assessed as per modified Andersons and Hutchins criteria. Additional procedures like bone grafting fibular osteotomy were performed for few patients.Results: Overall 90% of the fractures united well. While good to excellent results were seen in 28 cases amounting to 72%, moderate and poor results were observed in 18% and 10% of the cases respectively.Conclusion: The method of management using the LRS external fixator was found to be simple and effective for fracture stabilization in terms of easy access to soft tissue care, enable fracture union, early return to function and can be considered as an alternative choice fixation for type IIIA and type IIIB fracture both bone of leg with bone loss which lessens the economical burden and those patient not willing to undergo multiple procedures.