Open tibial fractures. Treatment by uniplanar external fixation and early bone grafting.

Seventy-nine open tibial fractures were treated with unilateral uniplanar tubular external fixators. Excellent stability allowed early weight-bearing. All comminuted fractures, with or without bone loss, and some transverse or short oblique fractures with intermediate fragments were treated by early bone grafting through a posterolateral approach. The external fixator was dynamised as soon as periosteal callus was seen on the radiograph. Bone healing times ranged from 11 to 40 weeks (mean 20). Significant ankle stiffness occurred in 10.9% and leg shortening in 2.8%. Pin track infection was seen in 45.2% but was easily controlled with standard management. The external fixation frame allowed excellent functional freedom for Oriental patients to sit cross-legged and squat. Combined with early bone grafting, external fixation is an excellent method for the management of open tibial fractures.