DOI: https://doi.org/10.53350/pjmhs22161624 ORIGINAL ARTICLE 624 P J M H S Vol. 16, No.01, JAN 2022 External Fixation as a Primary and Definitive Treatment for Tibial Diaphyseal Fractures: a Retrospective Longitudinal Study ASFANDYAR KHAN 1 , SAYED NAJMUL HASSAN 2 , MUHAMMAD FARHAN FARHAT 3 , ARSALAN RIAZ 4 , BASIT MUKHTAR 5 , AKBAR ALI 6 1 Assistant professor Orthopaedics, Pakistan Institute of Medical Sciences (PIMS) Islamabad Pakistan. 2 District Specialist Orthopaedics, Type C Hospital Ghazi Harripor, Pakistan. 3 Medical Officer Orthopaedics, Pakistan Institute of Medical Sciences Islamabad, Pakistan. 4 Medical Officer Orthopaedics, Federal Government Polyclinic Islamabad, Pakistan. 5 Post Graduate Resident Orthopaedics, Pakistan Institute of Medical Sciences Islamabad, Pakistan. 6 Post Graduate Resident Orthopaedics, Shaheed Zulifqar Ali Bhutto Medical University/PIMS Islamabad Pakistan. Corresponding author: Asfandyar Khan, Email: asfandyar.pims@gmail.com ABSTRACT Aim:To assess the potency of unilateral external fixation as a proper cure for tibial fractures. Study design: A retrospective longitudinal study Place and duration: This study was conducted at Pakistan Institute of Medical Sciences (PIMS) Islamabad Pakistan from August 2020 to August 2021. Methodology:Treatment of 225 tibial shaft fractures was done, in which closed fractures took 22 weeks and open 26 weeks for complete fusion. All fractures were fixed with AO fixator Results:Data of 210 patients was evaluated. Treatment of 225 tibial shaft fractures was done, in which closed fractures took 22 weeks and open 26 weeks for complete fusion. A total of 17 nonunion patients were observed while there were 22 delayed fusions, 5 malunion, 59 pin infections, and 4 osteomyelitis, 43 patients went through the re-operation process. Conclusion:Four patients had fat embolism while pulmonary embolism was present in six and venous thrombosis in 15 patients. The ultimate treatment in 88.0% of patients was external fixation. If there is a no formation of callus formation, reoperation should be carried out so unilateral external fixation is the preferred treatment for tibial fractures. Keywords: External Fixation, Tibial Diaphyseal Fractures, treatment INTRODUCTION For closed tibial fractures, IM that is intramedullary fixation is the preferred method. But other studies have doubts about IM fixation for the treatment of soft tissues injuries, compartment syndrome, and multiple injured patients [1]. So, the discussion is still being made whether to choose these treatments (IM fixation, unilateral external fixation) for tibial fractures or not [2]. New internal fixation devices have replaced or made less use of external fixation. External fixation was famous in the 1980s but there were also some associated problems with it [3]. Biomechanical properties and optical frame design of these different fixation techniques were also discussed over a long time to know about the efficacy of unilateral external fixation treatment. The Current study was done to assess the potency of unilateral external fixation as a proper cure for tibial fractures METHODOLOGY This retrospective longitudinal study was conducted at Pakistan Institute of Medical Sciences (PIMS) Islamabad Pakistan from August 2020 to August 2021. Permission was taken from the ethical review committee of the institute. With the use of a steel half pin, the AO external fixators were used. The incorporation criteria for external factors are Twenty-five fractures with soft tissues injuries. In 138 cases Gustilo type 3 open fractures. Twenty-six fractures in many injured patients. Bone defects, intraarticular fractures, and fracture of the femur were excluded from study. At the time of injury, the mean age of patients was 35 years. There were 41 female and 169 male patients. Forty- nine patients fell from height and one hundred and sixty- one patients got injured through motor vehicle accidents. The average time of surgery from injury to end was 11 hours. The patterns of fractures were classified into AO/ASIF: type A fractures were 109, type B 76, and type C 35. Fluoroscopy and the radiolucent table were used to check the fracture. To enhance reduction traction table was used. Nerves, tendons, bones, and soft tissue cover of vessels managed open fractures. Muscular exercises were mandatory for patients at an early stage. Loading and axial dynamization was done on patients. In transverse and short oblique fractures only early dynamization was allowed. Within 2.5 months full weight-bearing and partial weight-bearing were allowed in 5 weeks. Patients were examined every month. The use of external fixators over other treatments is based on the healing of fracture followed by the formation of callus. Fusion or union was confirmed by radiography and pins were left at the fracture site while the device was removed after this patient is allowed to bear the weight. If there were no infections pins were removed after a few days. RESULTS Data of 210 patients were evaluated. Due to pulmonary embolism 4 patients died and were not included in the study. The average investigation time was 2.5 years. The operation time was 30 minutes. Assessment of results was done using 6 criteria. If the fusion takes place for six months it is normal healing and if it doesn't take place even after 8 months it indicates the absence of healing. The