Abstract
Hybrid fixation is now an established modality of treatment for articular fractures of the proximal and distal tibia. However, there is a lack of consensus over the management of non-articular metaphyseal fractures extending into the diaphysis. Despite sophisticated techniques, intramedullary nailing remains difficult and has relatively high rates of malunion and nonunion. Plate fixation may produce satisfactory results, but its use is limited where there is major extension into the diaphysis or where the soft tissues are compromised.
Since 1995, we have used hybrid external fixation in the treatment of such fractures in 24 male and 16 female patients of mean age 54 years (15 to 92). Mostly sustained in road traffic accidents, there were 26 closed and 14 open fractures, seven of which were Gustillo type IIIB. There were 26 distal tibial, seven proximal and seven tibial shaft fractures.
Metaphyseal fixation consisted of two rings with tension wires, diaphyseal fixation of screws. We used additional rings in segmental diaphyseal fractures or used olive compression wires across the fracture when additional stability was required. Hybrid fixation was the primary procedure in 25 patients and a secondary procedure, performed within eight weeks of injury, in 15. All patients went on to union in a mean of 45 weeks, but 10 required additional procedures such as bone-grafting, additional insertion of olive wire and soft-tissue procedures. Residual malunion in six patients required adjustment with frame fixation, with minimal clinical significance. We had three pin-tract infections and one deep infection, which resolved after sequestrectomy.
When choosing a fixation system, it must be taken into account that high-energy tibial fractures may be slow to unite and that deep infection is related to the degree of soft-tissue injury. We believe hybrid fixation is a safe and minimally invasive treatment option. Careful attention to reduction and soft-tissue management, followed by early functional rehabilitation, can reduce healing times.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
