Hexapod Circular Externalfixation in the Treatment of Displacer and Comminuted Tibial Shaft Fractures

Several treatment options currently exist for tibial shaft fractures. Unfortunately, the majority of those methods have limitations when used for unstable, displaced or comminuted
fractures. The purpose of this study was to review the initial experience with a novel hexapod circular external fixator in the treatment of displaced or comminuted tibial shaft fractures.

Materials and Methods: Charts and radiographs of 15 patients with displaced or comminuted tibial shaft fractures treated with the TL-Hex circular external fixation since December 2012 were retrospectively reviewed. The average age of the patients was 25.5 years old. Four patients were under 14 years of age and the other 11 patients were adults. There were 13 males and 2 females. Five patients suffered from the open tibial fractures while the other 10 patients had displaced closed fractures.
All patients underwent the application of TL-Hex circular external fixator followed by reduction and stabilization. Initial intraoperative reduction was followed by fine tuning of bone segment position using the gradual adjustment mode of the struts. In all cases, partial weight bearing was permitted immediately postoperatively while full weight bearing was permitted during the first two weeks. After the appearance of progressive callus, frame dynamization was performed. Usually, two weeks after dynamization, the external fixation was removed.

Results: Complete anatomical reduction of fracture was achieved in all cases. Superior frame stability and reduced rate of superficial pin tract infection was noticed in the majority of patients. No major complications were observed. Frame fixation time was the same as that when using other standard circular frames.

Conclusions: Patients with midshaft tibial fractures can be successfully treated using the novel hexapod circular external fixation device. The frame is characterized by simplicity of assembly and application, shortening the surgery time as well as significantly improved stability.