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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2012 February;63(1):1-7
External hybrid fixation for the treatment of high-energy complex and open fractures of the tibial plateau and pilon
Corina G. 1, Marsilio A. 1, Tartaglia N. 2, Rollo G. 1
1 Orthopedics and Traumatology Division, Vito Fazzi Hospital, Lecce, Italy;
2 Orthopedics and Traumatology Division, San Paolo Hospital, Bari, Italy
Aim. High-energy tibial fractures are difficult to treat because of comminution and severe soft tissue damage. Invasive procedures are associated with significant infection rates and morbidity. In the minimally invasive hybrid external fixation, monolateral fixators supporting diaphyseal fragments are attached to circular ring-wire constructs acting as a scaffold for metaphyseal fragments. These fixators are better tolerated than the bulky all-ring Ilizarov fixator. Dynamization of the monolateral component stimulates healing and combined with early weight bearing gives good functional outcomes. We describe our experience of using hybrid ring fixators in a large heterogeneous group of patients with complex and open, high-energy tibial fractures.
Methods. In this retrospective case series, 161 patients with complex and open tibial plateau and pilon fractures were treated with the Sheffield hybrid fixator or similar constructs comprising a Sheffield ring and different commercially available monolateral fixators, with optional diagonal bars for added stiffness. Passive physiotherapy was started immediately postoperatively, and fixator dynamization and gradual weight bearing was guided by radiographic evaluation.
Results. After a 7-month follow-up period (N.=149), 98% patients showed complete radiographic union, 66% returned to preinjury activity level, and 27% had light functional limitation without pain. The average hospital stay was 5 days, and the mean time to union was 16 weeks. Superficial pin track infections were noted in ~2% patients, and no patient suffered neurovascular damage.
Conclusion. Our excellent results with different constructs of hybrid ring fixators in a large, heterogenous patient population should prove useful to surgeons making fixator-related decisions in clinical situations.