Modified traveling traction a novel external fixator for provisional stabilization of tibial fractures

Abstract

External fixators have been used for temporary stabilization as a part of damage control orthopedics. Watson et al in 2000 described “traveling traction”, a simple external fixator for provisional stabilization of pilon fractures. We have tried to analyze the wide applicability of this simple external fixator and its modification (Ez-fix) for provisional stabilization of all tibial fractures: proximal, diaphyseal and distal tibial. This was a 18-month prospective hospital based study in which 91 skeletally mature patients with tibial fractures (proximal, middle, distal 1/3rdand pilon) provisionally stabilized with Ez-fix external fixator application were enrolled. Ez-fix, with one distal femoral/ proximal tibia pin and other calcaneal pin was applied. Posterior splint was given for added stability. The patients were followed up till a definitive fixation or trans-fixation cast was applied. Out of 91 fixators 56 were shaft, 28 proximal and 7 were distal tibial fractures. The average duration in the Ez-fix across all the fracture patterns was 22 days. 71 of the 91 fractures had associated fibula fractures too. 25 Ez-fixes were applied in the ER/ICU. Satisfactory initial reduction in the Ez-fix was achieved in 92% of the proximal, 71% distal and 57% shaft fractures. The place of external fixation did not affect the initial reduction as there were comparable rates of satisfactory reduction in Ez-fixes applied in OT and ER/ICU. There was a significant association between duration and loss of reduction with p-value of