title: Minimally invasive surgical technique: Percutaneous external fixation combined with titanium elastic nails for selective treatment of tibial fractures.
abstract: BACKGROUND
  Several techniques have been described to treat tibial fractures, which respectively remains defects. This article presents a novel intra- and extramedullary fixation technique: percutaneous external fixator combined with titanium elastic nails (EF-TENs system). The purpose of this study is to introduce this new minimally invasive surgical technique and selective treatment of tibial fractures, particularly in segmental fractures, diaphysis fractures accompanied with distal or proximal bone subfissure, or fractures with poor soft-tissue problems.
  
  
  METHODS
  Following ethical approval, thirty-two patients with tibial fractures were treated by the EF-TENs system between January 2010 and December 2012. The follow-up studies included clinical and radiographic examinations. All relevant outcomes were recorded during follow-up.
  
  
  RESULTS
  All thirty-two patients were achieved follow-ups. According to the AO classification, 3 Type A, 9 Type B and 20 Type C fractures were included respectively. According to the Anderson-Gustilo classification, there were 5 Type Grade II, 3 Type Grade IIIA and 2 Type Grade IIIB. Among 32 patients, 8 of them were segmental fractures. 12 fractures accompanied with bone subfissure. Results showed no nonunion case, with an average time of 23.7 weeks (range, 14-32 weeks). Among them, there were 3/32 delayed union patients and 0/32 malunion case. 4/32 patients developed a pin track infection and no patient suffered deep infection. The external fixator was removed with a mean time of 16.7 weeks (range, 10-26 weeks). Moreover, only 1/32 patient suffered with the restricted ROM of ankle, none with the restricted ROM of knee.
  
  
  CONCLUSIONS
  This preliminary study indicated that the EF-TENs system, as a novel intra- and extramedullary fixation technique, had substantial effects on selective treatment of tibial fractures.
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China. Electronic address: wzykdx_tu@hotmail.com.
authors.forename: Kai-Kai
authors.initials: KK
authors.lastname: Tu
authors.affiliation: Department of Orthopaedic Surgery, Ningbo Sixth Hospital, Ningbo, Zhejiang, China. Electronic address: zhouxianting1988@163.com.
authors.forename: Xian-Ting
authors.initials: XT
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China. Electronic address: 10455484@qq.com.
authors.forename: Zhou-Shan
authors.initials: ZS
authors.lastname: Tao
authors.affiliation: Department of Orthopaedic Surgery, Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou, Wenzhou, Zhejiang, China. Electronic address: 191944253@qq.com.
authors.forename: Wei-Kai
authors.initials: WK
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China. Electronic address: 645223319@qq.com.
authors.forename: Zheng-Liang
authors.initials: ZL
authors.lastname: Huang
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China. Electronic address: 235220585@qq.com.
authors.forename: Tao
authors.initials: T
authors.lastname: Sun
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China. Electronic address: 734797805@qq.com.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital of WenZhou Medical University, Wenzhou, Zhejiang, China. Electronic address: tzs19900327@163.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D002681:China; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D005597:Fractures, Open / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D017410:Practice Guidelines as Topic; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium
keywords: External fixation; Flexible intramedullary nailing; Operative indication; Surgical technique; Tibial fractures