[Application of individualized controllable stress external fixation in open tibial fractures].

OBJECTIVE: To study the clinical effect of individualized controllable stress external fixator in the treatment of open tibial fractures. METHODS: From December 2018 to July 2020, 60 patients with open tibial fractures were treated, including 35 males and 25 females;The age ranged from 23 to 58 years;The course of disease was 1.2 to 10.0 h. According to the stress stimulation on the fracture end after operation, all patients were divided into 4 groups, including non stress group (15 cases) and 3 groups with different stress stimulation(15 cases in each group). All patients with open tibial fractures were treated with controllable stress external fixator. Four weeks after operation, the stress group adjusted the elastic external fixator to apply axial stress of 1/6, 2/6 and 3/6 of their own weight to the fracture end based on the patient's weight. The wound healing of all patients after operation was observed, the plain CT images of fracture ends at 4, 6, 8, 10 and 12 weeks after operation were followed up, the average valueof callus area per 10 scanning planes was calculated, and the differences between the groups were compared. The fracture healing was observed and statistically analyzed. RESULTS: The wounds of all patients healed well, of which 7 patients underwent secondary free skin grafting and transferred myocutaneous flap. All patients were followed up for 12 to 24 months, with an average of 16.5 months. The final follow-up results showed that the fracture healing of stress groups and non stress group had significant difference(P<0.05). After axial stress stimulation at the fracture end, CT examination was performed on the fracture end of all patients at 4, 6, 8, 10 and 12 weeks. The average values of callus area in 10 plain scanning planes were calculated as follows:no stress group (0.275±0.092) mm2, (0.383±0.051) mm2, (0.412±0.048) mm2, (0.472± 0.019) mm2, (0.548±0.036) mm2, the area of callus growth in the stress group was significantly higher than that in the non stress group. There was significant difference among these groups(P<0.05). CONCLUSION: When the controllable stress external fixation technique is used to treat open tibial fractures, the elastic external fixator is adjusted according to the patient's own weight after 4 weeks, and a certain axial stress is applied to the fracture end, which is conducive to the fracture healing of patients, and can reduce the incidence of delayed union or nonunion of open fractures, which has a certain application value.