Fracture of the tibial diaphysis treated by external fixation and the axial alignment grid: a single surgeon's experience

The results of tibial fracture fixation for 50 unstable closed and open fractures, using the dynamic axial fixator (DAF) and the limb axial alignment grid have been assessed both clinically and radiologically. Each patient has been carefully followed up in a dedicated clinic and each procedure was conducted or directly supervised by the senior author. All patients achieved union, although 16 per cent required a further procedure such as bone grafting or fibula osteotomy to secure this and a further 6 per cent were revised to intramedullary nails. There was a malunion rate of 16 per cent, but no patients requested further treatment for functional problems. The incidence of pin-site infection was 10.4 per cent, each patient taking responsiblity for their own pin-site care. There were no deep infections. The results achieved in this series compare favourably with those of other treatment modalities for this fracture, which may often be difficult to manage. Given the stringent adherence to the important principles of fixator application and well supervised follow-up which are practised on this unit, sue believe that the results as presented here may well represent the limit achievable with this device. Furthermore, the authors would recommend that the technique remains an important option in tibial fracture management, particularly for the unstable closed and open fractures. (C) 1997 Elsevier Science Ltd.