Introduction

The optimal management of intra-articular tibial plateau fractures with metaphyseal-diaphyseal dissociation remains challenging and controversial. We report results using the technique of limited open reduction with external fixation using a fine wire circular frame.

INTRODUCTION – Tuberosity fractures of the calcaneum are rare injuries. The traditional operative treatment involves open reduction and internal fixation with a tension band wire construct. We have developed a new technique of fixing these fractures with internal fixation using cannulated screws and a figure of eight wire. This paper describes the new technique outlining its advantages and compares the 2 methods of fixation biomechanically to determine their properties with respect to fracture fixation.

METHOD – 20 sections of bovine bone were taken to act as an experimental model for the calcaneum. They were osteotomised to create the posterior process fracture model. 10 were fixed using a traditional tension band wire construct and 10 were fixed using the cannulated screw and wire construct. Each construct was subjected to biomechanical testing to identify the stiffness, energy to failure and load to failure.

RESULTS – During loading the cannulated screw and wire constructs showed a significant increase in stiffness and energy to failure compared to the tension band wire constructs

CONCLUSION – The increased stability of the cannulated screw construct demonstrated by the testing offers biomechanical benefit over the traditional tension band wire construct. This, as well as the improved technical aspects of the cannulated screw fixation, may be beneficial for clinical use.

17 patients have undergone 20 microdrilling procedures to stimulate bone union in cases of established non-union. This occurred at the docking site following completion of bone transport using a stacked Taylor Spatial Frame, non-union following arthrodesis or non-union in long bone fracture.

Additional bone grafting was performed in only one patient. Further stimulation of union via injection of Bone Morphogenetic Protein was undertaken with 3 microdrilling procedures.

Of the 20 microdrilling procedures, 8 were considered fully successful in terms of stimulation of union, 7 were partially successful and 5 were not felt to have been successful.

The mean time to fully successful union following microdrilling was 11.4 weeks, ranging from 6 to 19 weeks.

There were 2 complications, both acute infections at the microdrilling site. Both of these were in patients with previous significant pin site infections.

We present the use of a microdrilling technique as a safe and effective minimally invasive technique that promotes union in cases of refractory non-union, whilst avoiding the donor site morbidity associated with open bone grafting.

We present, as a pilot study, our experience in the use of this technique in patients treated with circular frames for acute fractures, at the docking site in cases of bone transport and in cases of non-union following arthrodesis.