F. Dujardin et al., ANATOMICAL AND FUNCTIONAL RESULTS OF EXTE RNAL FIXATION OF UPPER TIBIAL METAPHYSEAL FRACTURES, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 82(6), 1996, pp. 490-499
Purpose of the study This study aimed to evaluate a method for the tre
atment of upper tibial metaphyseal fractures using an external epiphys
odiaphyseal fixation with the double-frame Hoffmann device. Materials
and methods The study included 48 patients (37 men and 11 women) aged
16 to 82 years. The tibial fracture was simple in 15 cases, included a
metaphyseal comminution, partial in 3 cases and total in 30. In 13 pa
tients, there was also a simple articular fracture. The fracture was o
pened in 24 cases (type I in 10, type II in 7 and type III in 7 cases)
. Methods The gap and displacement evaluation between the fragments af
ter reduction was made on postsurgical roentgenograms its was consider
ed as complete when all fragments were in contact with each other, wit
hout frontal or anteroposterior translation above 5 mm. Heating was de
fined as a complete bone continuity providing a painless toad bearing.
The patients were clinically and radiologically reexamined with a mea
n follow-up of 15.45 months (5 to 62 months). Results After healing, t
here were 2 cases of angular deformities in patients whose autonomy wa
s otherwise already reduced. Twenty-three patients had a minor pin tra
ct infection. There was 3 cases of secondary osteitis after a type-III
open fractures and 3 other deep septic complications without function
al consequences. Forty-one fractures healed without bone graft in a me
an time of 18 +/- 7.6 weeks, Heating did not seem to statiscally depen
d on the opening nor on the type of fracture, but rather on the associ
ation with a peroneal fracture and the loss of cohesion between the fr
agments. The duration of professional invalidity evaluated in 20 cases
, Varied between 4 to 21 months (means : 11.3 months), and none of the
patients had to modify his activity because of the tibial fracture. A
t follow-up, no patient complained of invalidating pain. Thirty-two pa
tients recovered a satisfactory knee joint mobility and among the 16 o
thers, in only 3 no particular reason was found to explain the deficit
. Discussion While good anatomic and functional results lead us to kee
p the principle of external fixation, it seems however necessary to mo
dify the modalities of the treatment in order to improve healing condi
tions, especially by improving the cohesion of the fragments through s
econdary minimal internal fixation. The use of dynamic axial fixation
devices could therefore bring a theoretical advantage, but it must be
proven that they produce in this site a primary stabilization which is
a good as that obtained with Hoffmann's device.