The Journal of Bone and Joint Surgery, Vol 73, Issue 6 893-897, Copyright © 1991 by Journal of Bone and Joint Surgery, Inc
The role of supplemental lag-screw fixation for open fractures of the tibial shaft treated with external fixation
C Krettek, N Haas and H Tscherne
Trauma Department, Hannover Medical School, Federal Republic of Germany.
Ninety-nine open fractures of the tibial shaft were treated with unilateral
external fixation with or without supplemental lag-screw fixation. We
compared the results in forty-four fractures in which only external
fixation was used (control group) with those in fifty-five fractures that
were stabilized with lag-screws and external fixation, and we found no
statistically significant differences between the two groups with respect
to the time to full weight-bearing, the time to union, or the rates of
delayed union, osteomyelitis, malunion, superficial or deep pin-track
infection, or loosening of the pins. The limbs in which the fracture was
treated with external fixation and supplemental lag-screws had more than
twice the rate of refracture of the control limbs (11 compared with 5 per
cent), and the percentage of fractures having supplemental lag-screw
fixation that needed bone-grafting to achieve union was more than twice
that in the group treated with external fixation alone. We concluded that
the routine use of supplemental lag-screw fixation is not indicated in
patients who have an open fracture of the tibial shaft that has been
stabilized with external fixation.
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