Double Reverse Traction-Assisted Versus Traditional Freehand Closed Reduction With Hexapod External Fixator in Treating Open Tibial Shaft Fractures: A Retrospective Study.

OBJECTIVE

Open tibial shaft fractures (OTSFs) pose significant therapeutic challenges due to high-energy trauma, extensive soft tissue damage, and contamination risks, complicating fracture stabilization and increasing infection rates. Conventional freehand closed reduction often requires multiple attempts, exacerbating soft tissue injury and radiation exposure. To address these limitations, this study evaluates a double reverse traction-assisted technique, hypothesizing that it could improve reduction accuracy and reduce complications in OTSFs managed with hexapod external fixators (HEFs).

METHODS

This retrospective cohort study analyzed the records of 55 hospitalized patients with AO/OTA type 42-A or 42-B OTSFs treated with HEF between March 2020 and March 2023. Double reverse traction-assisted closed reduction was performed on 28 patients (DRTA group), while traditional freehand closed reduction was performed on 27 patients (Freehand group). We documented fracture reduction time, fluoroscopy time, external fixation time, radiographic results, electronic prescription count, and complications. Final clinical outcomes were assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at a mean follow-up of 15.3 months. Statistical analysis was performed using independent samples t-tests or the chi-square test.

RESULTS

DRTA group demonstrated significantly shorter fracture reduction time (12.13 ± 2.12 vs. 17.14 ± 3.43 min; p < 0.001) and fluoroscopy time (8.12 ± 1.78 vs. 13.75 ± 2.62; p < 0.001) compared to the Freehand group. External fixation time showed no significant difference (p > 0.05). DRTA group exhibited superior radiographic alignment, with significantly reduced residual translation and angulation on AP/lateral views (all p < 0.05). The electronic prescription count for postoperative correction was significantly lower in the DRTA group (0.9 ± 0.7 vs. 1.4 ± 1.0; p < 0.05). The complication rate was lower in the DRTA group (32.1%) than in the Freehand group (48.1%), but this difference was not statistically significant (p > 0.05). ASAMI scores were similar between both groups (p > 0.05). ASAMI bone and functional scores were similar between groups.

CONCLUSION

In this retrospective study, both reduction techniques achieved favorable therapeutic outcomes. However, the double reverse traction-assisted technique was associated with greater efficiency in fracture reduction, more accurate radiographic alignment, and a nonsignificant trend toward lower complications compared to traditional freehand reduction. These results indicate that the double reverse traction-assisted technique is a feasible and promising alternative, but its definitive advantages need to be confirmed by larger, prospective, randomized controlled trials.