External Fixation as Primary and Definitive Treatment for Tibial Diaphyseal Fractures: Experience from Misurata Central Hospital, Libya

Abstract

This retrospective study evaluates the effectiveness of unilateral external fixators as a primary and definitive treatment for complex tibial diaphyseal fractures (TDFs) at Misurata Central Hospital, Libya. The study included 56 patients with TDFs, specifically focusing on open fractures (Gustilo type III), fractures with severe soft tissue injuries, and those in multiply injured patients. Our findings indicate that unilateral external fixation provides a viable and effective solution for these challenging cases. Union was achieved in open fractures within an average of 27 weeks and in closed fractures within 22 weeks. While complications such as nonunions (8 cases), delayed unions (5 cases), malunions (1 case), pin track infections (13 cases), and osteomyelitis (1 case) were observed, the external fixator served as a definitive treatment in 82.14% of cases. Reoperations were necessary in 17 patients. This study supports the use of unilateral external fixators as a primary and definitive treatment option for complicated tibial shaft fractures, emphasizing that reoperation or a change in fixation method should be considered primarily in instances of delayed callus formation