Abstract
Background
High energy open tibial fractures are complex injuries with no consensus on the optimal
method of fixation. Treatment outcomes are often reported with union and re-operation
rates, often without specific definitions being provided. We sought to describe union,
reoperation rates, and patient reported outcomes, using the validated EQ-VAS and Disability
Rating Index (DRI) scores, following stabilisation with a Taylor Spatial Frame (TSF)
and a combined orthoplastic approach for the management of soft tissues. A literature
review is also provided.
Method
A prospective cross-sectional follow up of open tibial fractures, treated at a level
1 major trauma centre, managed with a TSF using a one ring per segment technique between
January 2014 and December 2019 were identified. Demographic, injury and operative
data were recorded, along with Patient Reported Outcome Measures (PROM) scores, specifically
the EQ-VAS and Disability Rating Index (DRI). Union rates, defined by radiographic
union scale in tibia (RUST) scores, and re-operation rates were recorded. Appropriate
statistical analyses were performed, with a p<0.05 considered statistically significant.
Results
Overall, 51 patients were included. Mean age was 51.2 ± 17.4 years, with a 4:1 male
preponderance. Diaphyseal and distal fractures accounted for 76% of cases. Mean time
in frame was 206.7 ± 149.4 days. Union was defined and was achieved in 41/51 (80.4%)
patients. Deep infection occurred in 6/51 (11.8%) patients. Amputation was performed
in 1 case (1.9%). Overall re-operation rate was 33%. Time to union were significantly
longer if re-operation was required for any reason (uncomplicated 204±189 vs complicated
304±155 days; p = 0.0017) . EQ-VAS and DRI scores significantly deteriorated at 1 year follow-up
(EQVAS 87.5 ± 11.7 vs 66.5 ± 20.4;p<0.0001 and DRI 11.9 ± 17.8 vs 39.3 ± 23.3;p<0.0001). At 1 year post op, 23/51(45.1%) required a walking aid, and 17/29 (58.6%)
of those working pre-injury had returned to work.
Conclusion
Open tibial fracture have significant morbidity and long recovery periods as determined
by EQVAS and DRI outcome measures. We report the largest series of open tibial feature
treated primarily with a TSF construct, which has similar outcomes to other techniques,
and should therefore be considered as a useful technique for managing these injuries.
Keywords
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Article Info
Publication History
Published online: October 20, 2022
Accepted:
October 17,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
