92 THE JOURNAL OF BONE AND JOINT SURGERY EXTERNAL FIXATION FOR COMPLICATED TIBIAL FRACTURES

An account is given of 38 patients with complicated tibial fractures who were treated by the Portsmouth method ofexternal fixation. Twenty-one patients had multiple injuries and 30 had compound fractures of the tibia. Eighteen fracture wounds were infected, 17 cases required bone grafts and 13 had skin grafts. Thirty-four fractures united in an average time of six months; three patients underwent below-knee amputations; one with neurofibromatosis remains ununited. Those treated primarily by external fixation did better than those in whom external fixation was used after failure of another method. Most fresh fractures united with external callus; and the significance of this in relation to the rigidity offixation is discussed. The method is easy to use, effective and economical. Improvements to permit adjustment of position and testing for union are suggested. We advise the use of this method ofexternal fixation as the primary treatment for complicated tibial fractures where there is a significant risk of infection or non-union. Fractures of the tibia frequently occur in association with severe damage to the soft tissues and with injuries elsewhere. Open wounds are common because the tibia has a subcutaneous anteromedial surface; it is precisely this anatomical feature which makes external fixation easy. In complicated tibial fractures external fixation is successful and has definite advantages over conven-tional methods. The fracture can be reduced and stabilised without sacrificing access to the injured soft tissues and without burying foreign material next to the fracture or under damaged skin