title: Using external and internal locking plates in a two-stage protocol for treatment of segmental tibial fractures.
abstract: BACKGROUND
  The tibial segmental fractures usually follow high-energy trauma and are often associated with many complications. We designed a two-stage protocol for these complex injuries. The aim of this study was to assess the outcome of tibial segmental fractures treated according to this protocol.
  
  
  METHODS
  A prospective series of 25 consecutive segmental tibial fractures were treated using a two-stage procedure. In the first stage, a low-profile locking plate was applied as an external fixator to temporarily immobilize the fractures after anatomic reduction had been achieved followed by soft-tissue reconstruction. The second stage involved definitive internal fixation with a locking plate using a minimally invasive percutaneous plate osteosynthesis technique. The median follow-up was 32 months (range, 20-44 months).
  
  
  RESULTS
  All fractures achieved union. The median time for the proximal fracture union was 23 weeks (range, 12-30 weeks) and that for distal fracture union was 27 weeks (range, 12-46 weeks; p = 0.08). Functional results were excellent in 21 patients and good in 4 patients. There were three cases of delayed union of distal fracture. Valgus malunion >5 degrees occurred in two patients, and length discrepancy >1 cm was observed in two patients. Pin tract infection occurred in three patients.
  
  
  CONCLUSIONS
  Use of the two-stage procedure for treatment of segmental tibial fractures is recommended. Surgeons can achieve good reduction with stable temporary fixation, soft-tissue reconstruction, ease of subsequent definitive fixation, and high union rates. Our patients obtained excellent knee and ankle joint motion, good functional outcomes, and a comfortable clinical course.
authors.affiliation: Department of Orthopedics, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
authors.forename: Ching-Hou
authors.initials: CH
authors.lastname: Ma
authors.forename: Yuan-Kun
authors.initials: YK
authors.lastname: Tu
authors.forename: Jih-Hsi
authors.initials: JH
authors.lastname: Yeh
authors.forename: Shih-Chieh
authors.initials: SC
authors.lastname: Yang
authors.forename: Chin-Hsien
authors.initials: CH
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D002985:Clinical Protocols; D015331:Cohort Studies; D016267:External Fixators; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult