THE MANAGEMENT OF HIGH-ENERGY PROXIMAL TIBIAL FRACTURES BY COMBINED PERCUTANEOUS INTERNAL FIXATION AND CIRCULAR EXTERNAL FIXATION.

Abstract

31 cases of high-energy proximal tibial fractures were retrospectively analysed. The series included 22 cases of Schatzker VI and 9 cases of proximal tibial extraarticular fractures. There were 7 females and 24 males, with average age being 45years(26–94). There were 12 open fractures ( 1 Gustilo grade1, 10 grade 3b and one 3c); while 19 cases had Tcherne’s grade 2–3 injury. 4 patients developed compartment syndromes requiring fasciotomy. All fractures were treated with preliminary ligamentotaxis using a unilateral external fixator. In addition, Open fractures underwent radical debridement with the one case of 3c requiring vascular reconstruction. CT scan was then done to assess the joint incongruity ,anatomy of the fracture, and to aid in decision making. The fractures were then fixed using percutaneous techniques and a circular external fixator. Minimal open reduction was resorted to in cases with significant joint depression. In all, 26 cases were managed using percutaneous techniques alone while 5 required minimal open reduction and screw fixation. Bone grafting was done in 6 cases and 11 required a plastics procedure for soft tissue reconstruction. The results were assessed using the radiological Rasmussen’s criteria and the clinically using he IKSS knee score. At a mean follow-up of 31mths, the mean time to metaphyseal union was 18weeks (6–25weeks);. 28 patients had good to excellent clinical scores, while 3 had a fair result. The radiologic assessment graded 12 cases as excellent and 19 as good. Complications included 2 cases with flap edge necrosis, 2 with severe pin tract sepsis, 1 with proximal DVT and one case with septic arthritis.

We conclude that the above treatment protocol yields promising results, preserving good knee function without prejudicing future need for arthroplasty.