Reosteosynthesis of the tibial shaft. Part I. Changement of procedure after external fixation.

A series of 38 patients with 38 fractures of the tibial shaft, primarily treated with an external fixator, is presented. In all of them, a second osteosynthesis is performed. More than 80% of these fractures were open and more than 80% were of the type B or C of the AO-classification. A pseudarthrosis was responsible for the reosteosynthesis in 24 fractures and a deep infection in 10. The day before the second intervention averaged 8.4 months. In 22 patients a plate osteosynthesis, in 11 an intramedullary nailing and in 4 a second external fixation was carried out. In one patient a transposition of a free osteomyocutaneous flap was performed. The functional end results were excellent or good in 75% of the patients. In fractures with a high risk of bone healing problems, a changing of procedure should be planned from the beginning of the treatment. The second procedure significantly shortens the time of fracture healing. The most appropriate stabilization should be performed secondarily, depending on the fracture form and the situation of the soft tissues of the lower leg.