Abstract
Periarticular fractures of the proximal tibia are some of the most difficult fractures to manage as open reduction and internal fixation of the fractures is plagued with complications such as non-union, delayed union, infection and post-traumatic osteoarthritis.
We evaluated the results of 16 consecutive periarticular tibial fractures stabilised with the AO hybrid fixator using the Oxford Knee Score, American Orthopaedic Foot and Ankle Score (AOFAS) and X-rays of the tibia. Two patients were lost to follow up and 1 patient refused to take part in the study whose latest radiographs showed grade 4 degenerative changes.
The mean follow up was 34 months (range 12 to 57 months) and the mean age was 50 years. All fractures were closed and were graded as either Schatzker 5 or 6. The fixator was applied for an average of 12 weeks. The mean Oxford Knee score was 27.2/60 (mild to moderate knee arthritis) and the mean AOFAS was 71.9/100. There was no significant malunion however 37.5% had developed radiological evidence of grade 3 or 4 post-traumatic osteoarthritis with one requiring a total knee replacement. Forty four percent of patients developed a complication with pin site infection being the commonest complication and 25% required further surgery. There were 2 nonunions with one requiring a fibular osteotomy, which subsequently united.
Eighty eight percent of patients were satisfied with the procedure while 80% would recommend the procedure if required in future.
From our study we feel that hybrid fixation of proximal periarticular tibial fractures is satisfactory however preoperative counselling regarding complications and the possible need for further surgery must be emphasised to the patient prior to embarking on this type of fixation.
Correspondence should be addressed to Roger Smith, Honorary Secretary, BASK c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London WC2A 3PN
