Tibial Frx: comparison of IM nailing vs external fixation
- Discussion:
- based on available data, the results of external fixation is comparable to IM nailing when the frx ends can be keyed together (maximal bone loading),
in which case there will be minimal loss of reduction and minimal frx site motion w/ wt bearing;
- proximal tibial frx: (see IM nailing of proximal tibial frx)
- in the case of proximal fourth tibial frx, external fixation should be chosen over IM nailing when the
frx can be keyed together w/ maximal bone loading;
- Henley et al 1998.
- 104 frx in IM nailing group vs. 70 frx in the external fixation group;
- satisfactory alignment: 92% vs 69% (p=0.00005); (malalignment);
- infection:
- infection at frx site: 13% vs 21% (no sig difference);
- in the EF group, 50% had at least one pin tract infection;
- frx healing: (see non union and prognosis for healing);
- time to healing between the groups was not significant;
- only the Gustillo classification had a significant correlation on healing;
- number of procedures after index procedure: 1.7 vs 2.7
