Secondary soft tissue surgery, if required is done by plastic surgeon in form of skin grafting or free or vascular flap. Secondary bony procedure, if required, is done in form of bone marrow injection or bone grafting. In some cases, secondary surgery in form of external fixator or intramedullary nailing is done. Follow up of every patient is done at weekly for 1 month, bimonthly for 3 months and monthly till 6-8 months or until union is achieved at fracture site.

Figure 1 and 2: Intra operative picture

Figure 3: Plate application

Table 1: Union time

Results: 8 cases united in 4 months, 8 cases united in 6 months, 9 cases united in 6-9 months and 5 cases went in non-union. Average duration of union was 5.6 months. Functional outcomes evaluated by AKSS score for proximal fractures & by AOFAS for distal fractures. 15 cases shown excellent results; with union, 11 cases shown good results; soft tissues reconstruction required, 4 cases had bad results; due to infection. Overall, 26 cases were had good to excellent results.

Discussion

In an observational study by Panda [1] et al of eight patients with compound injuries to distal femur and proximal tibia or both during a period of one year. Total 8 fractures were treated by external fixation i.e precontoured anatomical locking plate application. Out of 8 cases 7 had full range of motion (87.5%) and 1 had terminal lag of movements (12.5%). The final outcome of the study based on knee society score was, 4 excellent (50%), 3 good (37.5%) and 1 fair (12.5%).

Bansal [2] et al prospectively evaluated 30 cases of fresh compound tibial fractures. The mean fracture healing time was 14 week (range, 12-18 weeks) for proximal tibia, 24 weeks (range, 18-26 weeks) for tibial diaphysis / multi segmental fractures, 18 weeks (range, 14-20 weeks) for distal tibia. Once biplaner radiographic cortical bridging was observed, full weight bearing for 1 month before implant removal was advised. According to the Johner and Wruhs7 criteria results were excellent in 75%, good in 18% and poor in 7% cases.

In a study by Venkatesh [3] et al total of five (05) patients underwent “supracutaneous plating” of the tibia using a metaphyseal locking compression plate. In all five patients the plate was kept in place until there was complete consolidation both clinically and radiologically. At the latest follow-up (average 15 months). All patients were fully weight bearing with a fully healed tibia. In the study by Rajshekharan [4] et al, four patients with Grade II compound fractures of the tibia included. The average age of the patients was 52 years (range 45-60). The average time of presentation was 36 hours (range 10 h - 3 days). The plate was in situ for average 20 weeks. In all patients, plate was removed after radiological and clinical union. No screw tract infection found.
Results of our study are comparable to other studies.

Conclusion

We observed that external fixation in open fractures usually results in infection, delayed or non-union, requirement of further surgeries. Supracutaneous LCP as primary definite fixation can give excellent results in terms of stable & rigid fixation, early fracture union, less chances of second surgery, cost effective and better patient compliance & better functional outcomes.