SECONDARY INTERNAL-FIXATION AFTER EXTERNA L FIXATION FOR OPEN FRACTURE OF THE LOWER-LIMB

Purpose The purpose of our study is to analyse the indications, result s and limits of secondary internal fixation after external fixation fo r open fracture of the lower limb. Material Our series covered 21 pati ents treated between 1991 and 1994. There were 17 men and 4 women. Tib ia was affected 17 times and femur 5 times (one bifocal fracture). In Gustilo's classification, we had 1 case of type 1, 12 of type II and 8 of type III. Methods We used 15 times the FESSA External Fixator and 6 times a monotube external fixator in emergency. We have done seconda ry 11 intra medullary nailing and 11 patients were treated by plating (one patient had both) 13 patients had a bone graft (cortico-cancellou s graft). In the first group of patients (10 cases), the initial treat ment gave us good results for both skin and bone healing. The external fixation was replaced by an internal one in order to accelerate bone consolidation and to allow an early weight-bearing. Removal of the ext ernal fixation was made at an average of 4 months postoperative. In th e Second group (11 cases) the internal fixation was proposed because o f an insufficiency of the external fixation leading to complications a s : non union, mal union and bone defects. External fixation was remov ed in a mean time of 8 months. Internal fixation was completed by loca l bone autograft. Results 17 patients have been reviewed. Consolidatio n occurred with an average of 6 months after internal fixation 1 to 24 months. We had no deep infection but only 2 superficial ones. Discuss ion We chose 2 types of indication, and we called them programmed and for necessity. The first group of 10 patients whose stain was moderate and whose initial setting up had permited a perfect anatomic reductio n with a rapid wound healing. Internal fixation was performed after a short duration of external fixator. An early weight bearing was allowe d so that the functionnal recovery could be obtained quickly. The seco nd group is represented by patients whose internal fixation was done f or non union, malunion or bone defect. In such a case autogenous cance llous graft was used to fill the defect.