Comparative analysis of open and closed method of external fixation in the treatment of closed fractures of tibial diaphysis

The tibial diaphysis fractures rank among the commonest fractures of long bones encountered in orthopedic practice. Making of the right indication for the proper treatment is one of the most crucial moments in the treatment process. The prospective analysis involved 30 patients with closed tibial diaphysis fractures treated by the external fixation method in the period from January 1, 2000 - December 31, 2004 in the Orthopedic - Traumatologic Department of the Health Care Center Cuprija and the Clinic of Orthopedics and Traumatology of the Clinical Center Nis. In half of the patients - 15, the closed method of external fixation was applied, while in the other half - 15 patients, we used the open method of external fixation. In the treatment of all patients, a Mitkovic external fixator with convergent pins' orientation was used. By the analysis of the obtained results, it was ascertained that the fracture healing attained with the application of this method occurred in 28 patients (95.7%). The time interval during which the tibial diaphysis fracture healed was 3.5-5.5 months. In 2 patients (6.6%), one from each group, aseptic pseudoarthrosis developed. The examinees suffering from pseudoarthrosis were treated by Mitkovic CD apparatus and spongioplastics, after which good final results were obtained. Postoperative osteitis, as the most severe complication in the management of closed tibial diaphysis fractures, was not registered in any of the patients. In the management of tibial diaphysis fractures, external fixation with the Mitkovic external fixator provides good biochemical conditions for the fracture healing.