Intra- And Extramedullary Fixation Combined With Vacuum Sealing Drainage For Selective Treatment Of Open Tibial Fractures: A Retrospective Case Series

The objective of this study was to introduce a novel method of percutaneous titanium elastic nails augmented by unilateral external fixator (BioEF-TENs system) combined with vacuum sealing drainage (VSD) technique and evaluate the effects in the management of open fractures of tibia. From January 2011 to June 2013, 15 patients (11M/4F) with a mean age of 41.6 years (16-60 years) were treated with this method. According to the Anderson-Gustilo classification, there were 3 cases defined as Gustilo I, 5 as Gustilo II, 3 as Gustilo IIIA, 2 as Gustilo IIIB and 2 as Gustilo IIIC. Follow-up was done at 1, 2, 3 months postoperatively, and then at 2 months intervals, to conduct clinical and radiographic examinations. The mean follow-up period of 15 patients was 18 months. After the VSD was removed, 3 patients needed skin-grafting and 2 case needed flap coverage. The external fixator was removed with a mean time of 23.3 weeks (18-45 weeks), the average union time is 29.8 weeks (21-56 weeks). Delayed union was observed in 3 patients and there was no case with mal-union. There were 3 cases with pin track infection which were treated after external fixator removal. Superficial wound infection was existed in one patient and was cured by intravenous sensitive antibiotics and VSD. No case was observed with decrease ROM or pain of the knee. And only one patient's ankle joint range of movement (ROM) was decreased by 20-25%. The results indicated that the BioEF-TENs system combined with VSD can achieve bone stability at one stage fixation operation, which not only avoids converting fixation but also obtains effective soft tissue protection, which is a novel technique for open fractures of tibia with certain indications and worthy for further research.