External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients

Bråten, Martinus; Helland, Per; Grøntvedt, Torbjørn; Aamodt, Arild; Benum, Pål; Mølster, Anders
February 2005
Archives of Orthopaedic & Trauma Surgery;Feb2005, Vol. 125 Issue 1, p21
Academic Journal
Introduction We performed a prospective, randomised study to compare the Ex-fi-re external fixator (EF) with locked intramedullary (IM) nailing in tibial fractures. Only fractures without soft-tissue problems of importance were included. Materials and methods Ex-fi-re is a unilateral, dynamic axial fixator with fracture reduction capabilities. The Grosse-Kempf nail was used for nailing. A total of 78 patients with 79 fractures were entered in the study (41 Ex-fi-re, 38 IM nails). Results Time to radiographic union and full weight-bearing did not differ significantly, but unprotected weight-bearing was achieved earlier in the IM group (12 vs 20 weeks; p<0.001). There were more reoperations due to secondary dislocation in the EF group. There were no differences in final angulation or shortening. After 6 months and 1 year there were no differences in knee motion, ankle motion, fracture site pain or ankle pain. Some 64% of the nailed patients complained of anterior knee pain after 1 year. Conclusion The results were comparable in most respects. Unprotected weightbearing was achieved earlier after IM nailing. Anterior knee pain was frequent after nailing.


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