HYBRID EXTERNAL FIXATION OF COMMINUTED TIBIAL PLATEAU FRACTURES

Comminuted tibial plateau fractures present a surgical challenge to th e orthopaedic surgeon, Over the years, treatment has ranged from tract ion to cast immobilization to open reduction and internal fixation, Mo re recently, indirect reduction techniques with external fixation have been used. At the authors' institution, from 1990 to 1992, 18 Schatzk er Types V and VI tibial plateau fractures were treated in 18 patients with indirect reduction and application of a Monticelli-Spinelli hybr id external fixation system, Two patients had additional internal fixa tion and were excluded from this review, All 16 patients were availabl e for followup evaluation, The mean time to union was 4.5 months, Ther e were no nonunions, Three patients developed a varus deformity, Fifte en had radiographic evidence of early degenerative changes at 1 year f ollowup, There were 11 superficial pin tract infections in 4 patients; all resolved with local pin care and a short course of oral antibioti cs, There were no deep infections. With the added advantages of minima l to no soft tissue stripping and early knee range of motion, this tec hnique is recommended for treatment of these difficult fractures.