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EXTERNAL FIXATOR IN MANAGEMENT OF OPEN DIAPHYSEAL FRACTURES OF TIBIA IN ADULT

Introduction

External fixation is a surgical treatment used to stabilize bone and soft tissues at a distance from the operative or injury focus. They provide unobstructed access to the relevant skeletal and soft tissue structures for their initial assessment and also for secondary interventions needed to restore bone continuity and a functional soft tissue cover.

Initial External fixator has been effective and can be one of the choice of fixation in open fractures of tibia especially in comminuted and severe Gustilo-Anderson type III injury, provides adequate stability as there were predictably moderate to good bone and functional results .

ANATOMY OF THE TIBIA

External fixators types and biomechanics

BIOLOGY OF BONE HEALING

The tibia is the medial and larger of the two bones within the leg and is the primary weight bearer. The shaft is triangular in cross-section and has three surfaces: medial, lateral and posterior, and three borders: medial, lateral, and and anterior. It has proximal and distal expansions for articulating with the knee and ankle joints

Classification of fixator devices

Biomechanics of the external fixator

Surface Anatomy

 

The anterior and medial surfaces of the tibia are subcutaneous and can be palpated throughout their length. The anterior border of the tibia forms the shin. The medial border continues distally to form the medial malleolus. On the anterior aspect of the proximal tibia is a bony prominence, the tibial tuberosity, which is the site of attachment for the patellar tendon.

Fracture healing is the creation of a bony bridge between the two fracture fragments initially and the subsequent consolidation and remodeling state.

2-RING FIXATORS:

1-PIN FIXATORS:

Simple fixator

Fracture Healing Patterns:

Clamp fixator

A. Primary fracture healing:

occur only when there is anatomic restoration of the fracture fragments and when the stability of fracture reduction is ensured by rigid internal fixation and a substantial decrease in inter fragmentary strain.

B. Secondary fracture healing:

Occur only when fractures are treated with a form of management that results in some degree of motion (sling immobilization, cast immobilization, external fixation, intramedullary fixation).

Occurs by formation of immature bone which is called callus, followed by mature, lamellar bone.

Secondary fracture healing consists of three stages: an inflammatory stage, a reparative stage, and a remodeling stage.

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