ANATOMICAL AND FUNCTIONAL RESULTS OF EXTE RNAL FIXATION OF UPPER TIBIAL METAPHYSEAL FRACTURES

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.