Primary Bone Graft and External Fixation Versus External Fixation Alone in Treatment of Distal Tibial Fracture

Abstract

Background: The distal tibia has a precarious blood supply that renders the bone into delayed healing when fractured. This challenge makes the orthopedic surgeons to address it as unstable fracture that requires surgical intervention. Aim of Study: To evaluate the immediate bone graft with the use of external fixation of distaltibial fractures and compare it to non-grafted fixation. Patients and Methods: This is a prospective study conducted on 30 patients with distal tibia fracture that were dealt with in the orthopedic department,at Al-Kindy Teaching Hospital and Imamein Al-Kadhumein Teaching Hospital, during the period from October 2013 till June 2015. Included patients were those with closed tibial fracture of distal third grade 0 and grade 1 according to Oestern and Tscherneclassification,anddistal third tibial fracture with open grade I according to Gustillo classification. They were randomly divided into two groups in every other patient; these groups are allocated as followed: A-Group I: (8 males and 7 females) in this group of 4 patient had open Gustillo I fracture and 11 had closed distal third tibial fractures, that were prepared for external fixation with autogenous bone graft. B-Group II: (9 males and 6 females) in this group of 4 patients open Gustillo I fracture and 11 had closed distal third tibial fractures that were prepared for external fixation alone. Results: there were 6 patients in (3 patients in each group had complications of pin track infection,6 had delayed union (3 of group I and 3 in group II), none had malunion, and 2 patients of group II had nonunion. There was a significant difference both clinically and statistically in using the graft technique in the distaltibial shaft fracture treatment. Conclusion: Early autogenouscancellous bone grafting for any closed and grade I open low-energy open fracture is very effective