Intrinsic problems with the external fixation device of Hoffmann-Vidal-Adrey: a critical evaluation of 117 patients with complex tibial shaft fractures.

In the 1978-1986 period, 117 patients with 119 fresh and complex fractures of the lower leg were secured primarily with a Hoffmann-Vidal-Adrey external fixation device. Ninety-five fractures could be followed until bony consolidation. In 12 fractures (12.7%) a pseudarthrosis developed, and a deep infection in four (4.2%). The external fixation device was attached for an average time of 25.0 weeks. Pin loosening was seen in seven patients (7.3%), minor pin-tract infection in nine (9.4%), and major pin-tract infection in three patients (3.1%). Fourteen fractures needed a secondary internal fixation; in 17 other fractures a secondary transplantation of cancellous bone autografts without internal fixation was carried out. After healing of the soft tissues, the tibial fracture can be regarded as a closed one and other therapeutic procedures to accelerate bony consolidation should be taken into account. The advantages and disadvantages of a second internal stabilization should be evaluated for every fracture with bone healing problems. The alteration from external to internal fixation makes an early removal of the external fixator possible and prevents in this way the intrinsic problems combined with this fixation type such as delayed union, nonunion, pin loosening, or pin-tract infection.