THE USE OF COMBINATION INTERNAL-FIXATION AND HYBRID EXTERNAL FIXATIONIN SEVERE PROXIMAL TIBIA FRACTURES

Forty-eight patients with 50 severe fractures of the proximal tibia we re followed prospectively for 2-4 years (mean 2.7 years) to evaluate t he use of limited internal fixation combined with external fixation in the treatment of these injuries. There were 27 men and 21 women rangi ng in age from 20 to 74 years. Fractures were classified according to the AO system (Mast J, Ganz R, Jacob R: Planning and reduction techniq ue in fracture surgery. Berlin, Springer-Verlag, 1989), which included 5 A3, 6 C1, 16 C2, and 23 C3 fractures. All patients in this series h ealed; 48 fractures healed in an average of 12 weeks without subsequen t surgery. There were two (4%) nonunions requiring bone graft. The ave rage hospital special surgery knee score was 90 (68-100). Grading crit eria for anatomical outcome revealed there were 17 (34%) excellent res ults, 24 (48%) good results, 6 (12%) fair results, and 3 (6%) poor res ults. In conclusion, this treatment method is associated with a high p ercentage of good and excellent results. Combined internal and externa l fixation combines the advantages of anatomic, stable fixation with l ess soft-tissue dissection and eliminates the need for large implants.