Functional Outcome of Monorail Fixator as a Primary and Definitive Mode of Fixation in Open Fractures of Tibia- An Interventional Study

Abstract

Introduction: Open fractures of the tibia are associated with massive soft tissue injury and bone loss with high rates of infection and non union resulting in poor treatment outcome. The treatment goals include prevention of infection, soft tissue coverage, and fracture stabilisation with simultaneous mobilisation of nearby joints, enabling early return to function. The management in open fractures continues to be a topic of debate in orthopaedic traumatology with various treatment options, having their own set of complications. Aim: To assess the functional outcome of open tibial fractures with a monorail fixator using Radiographic Union Scale in Tibial fracture (RUST) score and modified Johner and Wruh’s criteria. Materials and Methods: This prospective interventional study of 30 cases was conducted from November 2018-October 2020 in Government Medical College, Patiala, Punjab, India. The patients of open tibial fractures of type 2, type 3A, 3B (male=27, female=3) as classified by Gustilo-Anderson were included in this study. Patients were operated for monorail system to assess the stability of monorail fixator, total time taken in fracture union and compliance with range of motion of joints. On follow-up patients were also assessed for pin track infection and postoperative surgical site infection by taking swab for culture and antibiotic sensitivity. Statistical analysis was performed using the statistical software Statistical Package for the Social Sciences (SPSS) 25.0 (SPSS 25.0). In this study, quantitative data was expressed as mean values with Standard Deviation (SD) and categorical data were expressed as frequencies with percentages. Results: Present study had shown excellent to good results in 27 cases (90%) with minimum surgery time of 52.17±14.24 minutes. Full weight bearing with fixator was allowed in 5.37 days and fracture union occurred at 31.8±5.8 weeks. RUST score of 2 was seen in 33.33% and score 3 in 63.33% of patients respectively. Only one patient (3.33%) had shown score 1, which was treated with removal of fixator, debridement, sequestrectromy and fracture fixation with ring fixator and bone grafting. The bacteriology positivity was seen in six cases (n=2 was positive for Escherichia coli and n=4 was positive for Staphylococcus aureus). Conclusion: Present study demonstrated the benefits of monorail fixator as a primary and definitive mode of fixation in open tibial fractures with early full weight bearing over a stable construct and minimal complications.