Over a 6-year period ( 1977Over a 6-year period ( -1983))
, 59 patients with 61 tibial shaft fractures were treated by external fixation Of these patients, 42 with 42 fractures were followed up until solid union Thirty-seven fractures were caused by high-energy impact, mainly road accidents Seventeen fractures were closed and 25 were open In 33 patients an external quadrilateral frame system was applied primarily, and in the remaining nine within 1-2 weeks No predrilling was done, and in 16 patients nonthreaded connection rods were used throughout the period in the fixator. The process of union was monitored by repeated noninvasive measurements of stability Average time from injury to dismantling of the external fixation was 5 2 months (range 2-12 5 months) and time-tounion for the whole series was 10 0 5 5 months (range 4-31 months) Sixteen fractures failed to unite Compared with other published series treated by external fixation, the incidence of non-union in the present series is high On the basis of the present findings it is concluded that a compression device should be mounted either primarily or as soon as possible during the process of union, and that compression should be applied at regular intervals If an external fixator is used, the surgeon must bear in mind the possible complications It is probably safer to reduce rather than to prolong time-to-removal of the external fixation system.