Hybrid External Fixation for Proximal Tibial Fractures

Abstract

Introduction: Intraarticular fractures of the tibial plateau and periarticular fractures of the proximal tibia, caused by high energy trauma pose a therapeutic dilemma. Such fractures are associated with extensive soft tissue damage with or without compound injury. The management of such high velocity injuries become a challenge to the trauma surgeons. The goals of these periarticular fractures management are 1. Restoration of joint congruity by anatomic reduction 2. Stable fixation of fractures thus allowing early movements 3. Proper care of injured soft tissues. In earlier days uniplanar external fixation were used with various complications like pin track infections and decreased stability. In this study we present the use of hybrid external fixation system which includes Ilizarov ring fixator and AO rod external fixator connected with indigenously manufactured connecting clamps and short shafts augmented with or without minimal internal fixation. The purpose of this study is to assess the utility of this hybrid external fixation system and to analyse the functional outcome, soft tissue healing and fracture union. Aim and Objectives: To assess the performance of the Hybrid External Fixator in the treatment of different types of proximal tibial fractures, to evaluate the functional outcome, soft tissue healing and fracture union and radiological outcome, to evaluate the biomechanical and biological advantage of hybrid external fixator, to assess the utility of the indigenously made connecting clamps. Material and Method: The study included 21 cases of periarticular fractures of the proximal tibia which were treated by use of 5/8th Ilizarov ring, AO tubular external fixator and with indigenously manufactured connecting clamps & short shaft in a hybrid mode. All cases were prospectively followed up and studied. Results: Almost all the cases (99%) had sustained Road traffic Accidents (high velocity injuries) except one case which had sustained injury by fall of cement wall over her leg. Minimum follow up–1.5 months, maximum follow up–12 months, mean follow up–6.42 months. All fractures were followed according to a protocol. All fractures were treated with either closed reduction and hybrid external fixation or with minimal open reduction and a hybrid system. The study group was consisted of 16 males (76%) and 5 females (24%) with an average age for males of 43.06 years (range 25 to 65) and for females of 53.4 years (range 41 to 59). All the patients were in the age group of 26 to 65 years, mean age is 43.09. Conclusion: In the present study of 21 cases, the use of Hybrid external fixation, as a definite treatment, for high – energy proximal tibia bicondylar fractures proved to be beneficial.