title: Ball-joint versus single monolateral external fixators for definitive treatment of tibial shaft fractures.
abstract: OBJECTIVE
  To compare modular monolateral external fixators with single monolateral external fixators for the treatment of open and complex tibial shaft fractures, to determine the optimal construct for fracture union.
  
  
  METHODS
  A total of 223 tibial shaft fractures in 212 patients were treated with a monolateral external fixator from 2005 to 2011; 112 fractures were treated with a modular external fixator with ball-joints (group A), and 111 fractures were treated with a single external fixator without ball-joints (group B). The mean follow-up was 2.9 years. We retrospectively evaluated the operative time for fracture reduction with the external fixator, pain and range of motion of the knee and ankle joints, time to union, rate of malunion, reoperations and revisions of the external fixators, and complications.
  
  
  RESULTS
  The time for fracture reduction was statistically higher in group B; the rate of union was statistically higher in group B; the rate of nonunion was statistically higher in group A; the mean time to union was statistically higher in group A; the rate of reoperations was statistically higher in group A; and the rate of revision of the external fixator was statistically higher in group A. Pain, range of motion of the knee and ankle joints, rates of delayed union, malunion and complications were similar.
  
  
  CONCLUSIONS
  Although modular external fixators are associated with faster intraoperative fracture reduction with the external fixator, single external fixators are associated with significantly better rates of union and reoperations; the rates of delayed union, malunion and complications are similar.
authors.affiliation: Department of Orthopaedics, Thriasion Hospital, Elefsis, Greece.
authors.forename: Michail
authors.initials: M
authors.lastname: Beltsios
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Mavrogenis
authors.forename: Olga D
authors.initials: OD
authors.lastname: Savvidou
authors.forename: Eirineos
authors.initials: E
authors.lastname: Karamanis
authors.forename: Zinon T
authors.initials: ZT
authors.lastname: Kokkalis
authors.forename: Panayiotis J
authors.initials: PJ
authors.lastname: Papagelopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation*; D005596:Fractures, Closed / Q000601:surgery; D017759:Fractures, Malunited / Q000209:etiology; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult