Treatment of open tibial fractures with the Orthofix fixator.

External fixation is considered the treatment of choice for severe open tibial fractures. A prospective study was designed to evaluate the use of the Orthofix Dynamic Axial Fixator (DAF) for the short- and long-term treatment of open tibial fractures. Forty-four patients with 45 open tibial fractures were enrolled in the study, which included a one-year follow-up period. Eighty-nine percent of the fractures were classified as Gustilo and Anderson's Type III. All fractures except one were united in a mean healing time of 22.6 weeks. The dynamization of the Orthofix in nonsegmental fractures occurred at an average of 8.1 weeks. Segmental fractures received a two-stage dynamization. The first stage consisted of removing the supplementary pins, once callus formation was seen at one of the fractures lines, plus the addition of a bone graft. This stage occurred at an average of 8.8 weeks. The second stage consisted of unlocking the telescoping rods and allowing dynamic axial loading of the consolidating graft. This stage occurred at an average of 19.0 weeks. The implementation of this one-plane unilateral frame, which is capable of converting from a rigid to a dynamic fixator, combined with a bone graft in 58% of the patients, contributed to a 98% success rate. Proper timing of dynamization is emphasized to avoid angulation, nonunion, or delayed union.