Staged correction trajectory with hexapod external fixator for the satisfactory reduction of acute long bone shaft fracture

Abstract

Abstract Backgroud: When deformity correction and fracture reduction are conducted in acute long bone shaft fracture using the hexapod external fixator, the collision and interference between the irregular bony end in the reduction process often result in an incomplete reduction and a time-consuming procedure. The purpose of this study was to present and determine the clinical effectiveness of staged correction trajectory with hexapod external fixator for the satisfactory reduction of acute long bone shaft fracture. Methods A total of 57 patients with acute tibial shaft fractures consented to hexapod external fixator treatment in our institution were retrospectively analyzed from June 2016 to February 2020. Thirty-one cases (Group Ⅰ) underwent a conventional one-step reduction trajectory from June 2016 to July 2018. Starting in September 2018, the other twenty-six patients (Group Ⅱ) all underwent staged correction trajectory (three key points reduction trajectory of “extension-rotation-reduction”). The demographic data, residual deformities before and after correction, number of repeated radiographs after the first postoperative radiograph, duration of deformity correction, and external fixation time were documented and analyzed. At the last clinical visit, the Johner-Wruhs criteria were used to evaluate the final clinical outcomes. Results All the 57 patients achieved satisfactory fracture reduction and bone union. There were no statistically significant differences between the two groups in demographic data, residual deformities before and after correction, external fixation time, and final clinical outcomes (P > 0.05). The average number of repeated radiographs after the first postoperative radiograph and mean duration of deformity correction in Group Ⅱ (1.3 times, 2.9 days) were all less than those in Group Ⅰ (2.3 times, 5.1 days) (P < 0.05). Conclusion Compared with the conventional one-step reduction trajectory, there are no statistically significant differences in the final clinical outcomes, but the staged correction trajectory is a superior method with the advantages of less repeated radiographs and reduction duration.

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