STABILIZATION PROCEDURES IN LARGE SOFT-TI SSUE AND BONE DEFECTS

When stabilizing fractures with large soft tissue and bone defects, th e primary concern is to avoid additional vascularization damage. There fore, external fixation is still the standard method. In metaphysial f ractures, joint transfixation should be avoided if possible. Concernin g closed comminuted fractures of femural and tibial shaft fractures, i nterlocking nailing shows the lowest complication rate. The introducti on of unreamed nailing of open fractures shows the same low infection rate as external fixation, so it can be considered an alternative meth od. Early plate fixation is applied for fractures of the upper extremi ties as well as the proximal and distal femur, if secure covering with vital tissue can be provided. As this is not guaranteed in the case o f the tibial shaft, plate fixation remains the absolute last resort. C oncerning distal and proximal fractures of the pilon tibiale and tibia head, plate fixation is very often applied for definitive stabilizati on. However, the secondary application represents a considerably lower infection and fracture-healing risk.