Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2023 | External Fixator | Research

Comparative analysis of external locking plate and combined frame external fixator for open distal tibial fractures: a comprehensive assessment of clinical outcomes and financial implications

Authors: Mohamed Lamin Bangura, Huasong Luo, Teng Zeng, Minglu Wang, Shangce Lin, Liang Chunli

Published in: BMC Musculoskeletal Disorders | Issue 1/2023

Abstract

Background

Open distal tibial fractures pose significant challenges regarding treatment options and patient outcomes. This retrospective single-centre study aimed to compare the stability, clinical outcomes, complications, and financial implications of two surgical interventions, namely the external locking plate and the combined frame external fixator, to manage open distal tibial fractures.

Methods

Forty-four patients with distal open tibial (metaphyseal extraarticular) fractures treated between 2020 and 2022 were selected and formed into two main groups, Group A and Group B. Group A (19 patients) are patients that underwent treatment using the external locking plate technique, while Group B (25 patients) received the combined frame external fixator approach. Age, gender, inpatient stay, re-operation rates, complications, functional recovery (measured by the Johner-Wrush score), pain ratings (measured by the Visual Analogue Scale [VAS]), and cost analyses were evaluated for each group. Statistical analyses using SPSS were conducted to compare the outcomes between the two groups.

Results

The research found significant variations in clinical outcomes, complications, and cost consequences between Group A and Group B. Group A had fewer hospitalisation periods (23.687.74) than Group B (33.5619.47). Re-operation rates were also considerably lower in Group A (26.3%) than in Group B (48%), owing to a greater prevalence of pin-tract infections and subsequent pin loosening in the combination frame external fixator group. The estimated cost of both techniques was recorded and analysed with the locking average of 26,619.69 ± 9,602.352 and the combined frame average of 39,095.64 ± 20,070.077.

Conclusion

This study suggests that although the two approaches effectively manage open distal tibia fractures, the locking compression plate approach (Group A) has an advantage in treating open distal tibia fractures. Shorter hospitalisation times, reduced re-operation rates, and fewer complications will benefit patients, healthcare systems, and budget allocation. Group A's functional recovery results demonstrate the locking plate technique's ability to improve recovery and patient quality of life. According to the cost analysis, the locking plate technique's economic viability and cost-effectiveness may optimise healthcare resources for open distal tibia fractures. These findings might improve patient outcomes and inform evidence-based orthopaedic surgery.

Available only for authorised users

Beltsios M, Savvidou O, Kovanis J, Alexandropoulos P, Papagelopoulos P. External fixation as a primary and definitive treatment for tibial diaphyseal fractures. Strategies Trauma Limb Reconstr. 2009;4(2):81–7. https://doi.org/10.1007/s11751-009-0062-3.CrossRefPubMedPubMedCentral

Meleppuram JJ, Ibrahim S. Experience in fixation of the infected non-union tibia by Ilizarov technique - a retrospective study of 42 cases. Rev Bras Ortop. 2016;52(6):670–5. https://doi.org/10.1016/j.rboe.2016.11.008. (Published 2016 Dec 30).CrossRefPubMedPubMedCentral

Rommens PM, Küchle R, Hofmann A, Hessmann MH. Intramedullary Nailing of Metaphyseal Fractures of the Lower Extremity. Acta Chir Orthop Traumatol Cech. 2017;84(5):330–40 (English. PMID: 29351533).CrossRefPubMed

Bakshi AS, Singh A, Kaur H, Kaur G, Singh J. A Comparative Study of Treatment With External Fixator Versus Antibiotic Coated Intramedullary Nail in Infected Non-union Long Bones. Cureus. 2022;14(9):e29659. https://doi.org/10.7759/cureus.29659. (PMID:36320998;PMCID:PMC9612901).CrossRefPubMedPubMedCentral

Broos PL, Miserez MJ, Rommens PM. The mono fixator in the primary stabilization of femoral shaft fractures in multiply-injured patients. Injury. 1992;23(8):525–8. https://doi.org/10.1016/0020-1383(92)90151-h.CrossRefPubMed

Tulner SA, Strackee SD, Kloen P. Metaphyseal locking compression plate as an external fixator for the distal tibia. Int Orthop. 2012;36(9):1923–7. https://doi.org/10.1007/s00264-012-1585-7. CrossRefPubMedPubMedCentral

Zhou Y, Wang Y, Liu L, Zhou Z, Cao X. Locking compression plate as an external fixator in treating closed distal tibial fractures. Int Orthop. 2015;39(11):2227–37. https://doi.org/10.1007/s00264-015-2903-7.CrossRefPubMed

Lerner A, Reis ND, Soudry M. Primary external fixation. In: Lerner A, Soudry M, editors. Armed Conflict Injuries to the Extremities: A Treatment Manual. Berlin Heidelberg: Springer-Verlag; 2011. p. 133–62.CrossRef

Zhang J, Ebraheim NA, Li M, He X, Liu J, Zhu L, Yu Y, Siddiqui S. External fixation using a locking plate: a reliable way in treating distal tibial fractures. J Orthop Trauma. 2015;29(11):e454–8. https://doi.org/10.1097/BOT.0000000000000377.CrossRefPubMed

10.

Bible JE, Mir HR. External Fixation: Principles and Applications. J Am Acad Orthop Surg. 2015;23(11):683–90. https://doi.org/10.5435/JAAOS-D-14-00281.CrossRefPubMed

11.

Ang BFH, Chen JY, Yew AKS, et al. Externalized locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness. Bone Joint Res. 2017;6(4):216–23. https://doi.org/10.1302/2046-3758.64.2000470.CrossRefPubMedPubMedCentral

12.

Bliven EK, Greinwald M, Hackl S, Augat P. External fixation of the lower extremities: Biomechanical perspective and recent innovations. Injury. 2019;50(Suppl 1):S10–7. https://doi.org/10.1016/j.injury.2019.03.041.CrossRefPubMed

13.

Ma X, Wang Z, Wang J. Clinical analysis of accelerated rehabilitation surgery for Gustilo type IIIA/B open tibiofibular fracture [published online ahead of print, 2022 Nov 12]. Eur J Trauma Emerg Surg. 2022;https://doi.org/10.1007/s00068-022-02164-x.

14.

Kang Y, Wu Y, Ma Y, et al. “Primary free-flap tibial open fracture reconstruction with the Masquelet technique” and internal fixation. Injury. 2020;51(12):2970–4. https://doi.org/10.1016/j.injury.2020.10.039.CrossRefPubMed

15.

Girard PJ, Kuhn KM, Bailey JR, Lynott JA, Mazurek MT. Bone Transport Combined with Locking Bridge Plate Fixation for the Treatment of Tibial Segmental Defects: A Report of 2 Cases. J Orthop Trauma. 2013;27(9):220–6. https://doi.org/10.1097/BOT.0b013e31827069b9.CrossRef

16.

Liang H, Li L, Yang J, Du Y, Peng W. Treatment of open and comminuted mid-distal tibial fractures by bilateral external fixation combined with limited-internal fixation. Acta Orthop Belg. 2021;87(4):745–50. https://doi.org/10.52628/87.4.20.CrossRefPubMed

17.

Luo P, Xu D, Wu J, Chen YH. Locked plating as an external fixator in treating tibial fractures: A PRISMA-compliant systematic review. Medicine (Baltimore). 2017;96(49):e9083. https://doi.org/10.1097/MD.0000000000009083.CrossRefPubMed

18.

Franz D, Raschke M, Giannoudis PV, Leliveld M, Metsemakers WJ, Verhofstad MHJ, Craig JA, Shore J, Smith A, Muehlendyck C, Kerstan M, Fuchs T. Use of antibiotic coated intramedullary nails in open tibia fractures: A European medical resource use and cost-effectiveness analysis. Injury. 2021;52(7):1951–8. https://doi.org/10.1016/j.injury.2021.04.053. (Epub 2021 May 5 PMID: 34001375).CrossRefPubMed

19.

Lageju N, Neupane D, Jaiswal LS, Phuyal U. Pin-tract myiasis after external bone fixation: A case report and review of literature. Int J Surg Case Rep. 2022;95:107247. https://doi.org/10.1016/j.ijscr.2022.107247.CrossRefPubMedPubMedCentral

20.

Rogers GP, Tan HB, Foster P, Harwood P. Complex Tibial Shaft Fractures in Children Involving the Distal Physis Managed with the Ilizarov Method. Strategies Trauma Limb Reconstr. 2019;14(1):20–4. https://doi.org/10.5005/jp-journals-10080-1421.CrossRefPubMedPubMedCentral

21.

Blažević D, Kodvanj J, Adamović P, Vidović D, Trobonjača Z, Sabalić S. Comparison between external locking plate fixation and conventional external fixation for extraarticular proximal tibial fractures: a finite element analysis. J Orthop Surg Res. 2022;17(1):16. https://doi.org/10.1186/s13018-021-02907-3. (Published 2022 Jan 11).CrossRefPubMedPubMedCentral

22.

Liu W, Yang L, Kong X, et al. Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures: a biomechanics study. BMC Musculoskelet Disord. 2017;18(1):26. https://doi.org/10.1186/s12891-016-1384-1. (Published 2017 Jan 19).CrossRefPubMedPubMedCentral

23.

Albright P, Only A, Parikh HR, et al. External Fixation Characteristics Drive Cost of Care for High-Energy Tibial Plateau Fractures. J Orthop Trauma. 2022;36(4):189–94. https://doi.org/10.1097/BOT.0000000000002254.CrossRefPubMed

Title: Comparative analysis of external locking plate and combined frame external fixator for open distal tibial fractures: a comprehensive assessment of clinical outcomes and financial implications
Authors: Mohamed Lamin Bangura
Huasong Luo
Teng Zeng
Minglu Wang
Shangce Lin
Liang Chunli
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: External Fixator
Distal Tibial Fracture
Tibia Fracture
Published in: BMC Musculoskeletal Disorders / Issue 1/2023
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-023-07097-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparative analysis of external locking plate and combined frame external fixator for open distal tibial fractures: a comprehensive assessment of clinical outcomes and financial implications

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

A single-center, open-label, randomized, parallel-group trial to pilot the effectiveness of a peer coach behavioral intervention versus an active control in reducing anxiety and depression in patients scheduled for total knee replacement

Elucidating the role of RBM5 in osteoclastogenesis: a novel potential therapeutic target for osteoporosis

Intact revision rotator cuff repair stabilizes muscle atrophy and fatty infiltration after minimum follow up of two years

Assessments of early patellofemoral joint osteoarthritis features after anterior cruciate ligament reconstruction: a cross-sectional study

Estimating individual health-related quality of life changes in low back pain patients

Influencing factors of hidden blood loss after primary total hip arthroplasty through the posterior approach: a retrospective study