TREATMENT OF PROXIMAL TIBIA FRACTURE WITH HYBRID EXTERNAL FIXATOR

Park, Tae Woo; Cho, Sung Do; Cho, Youg Sun; Kim, Bum Soo; Lew, Sogu; Hwang, Su Yeon

Abstract

PURPOSE: To evaluate the results and usefulness of hybrid external fixator in the treatment of proximal tibia fracture. MATERIAL AND METHOD: From Jan. 1997 to Jan. 2000, 19 proximal tibia fracture were treated with hybrid external fixator with or without limited internal fixation to stabilize the articular surface. All fractures were classified according to the AO classification. The results were analyzed by ROM(range of motion), bony union time, fracture reduction with MPTA(medial proximal tibial angle) and joint congruency. RESULT: There were 1 A2, 7 A3, 1 C1, 8 C2, 2 C3 proximal tibial fractures according to the AO classification. Open fractures were 10 patients. The mean bony union time was 13 wks(range 8-36wks) and the mean length of time in the external fixator was 14wks(range 8-36wks). At last follow up, the MPTA of the proximal tibia was 87.9 degree. 2 patients developed varus(82 degree) and valgus(92 degree) deformity respectively. Complications were intermittent pin drainage in 6 patients(31.6%), deep infection in 1 patient(5.3%) and nonunion in 4 patients(21%) required bone graft and internal fixation with plate at 6 months postoperatively. Four nonunions were 3 C2 and 1 C3 according to the AO classification and three were open fracture(1 type I, 1 type IIIb, 1 type IIIc : Gustilo type)
CONCLUSION
Hybrid external fixation is a good treatment option for proximal tibial fractures. However, nonunion and angular deformity would occur in severe metaphyseal comminution and soft tissue injury. Accurate fracture reduction and careful soft tissue management is prerequisite and if necessory early bone graft should be considered in such cases.