Mj. Raschke et al., SUPPORTIVE COMPOSITE HYBRID FIXATION OF P ERCUTANEOUS SCREW FIXATION OF TIBIAL FRACTURES, Der Unfallchirurg, 99(11), 1996, pp. 855-860
Recent operative techniques with percutaneous screw fixation of the ti
bial plateau require a high level of patient compliance. Geriatric, no
n-cooperative patients and fractures with severe soft tissue injury ha
ve had to be excluded so far from this therapeutic regimen. Since Sept
ember 1993, composite hybrid fixation, as a combination of ring fixati
on of the epimetaphyseal tibia with monolateral AO fixation of the tib
ial shaft, has been performed in 12 patients. The data were collected
prospectively. Fractures were classified according to the AO and Moore
classification; soft tissue damage was classified according to Tscher
ne and Gustilio. Fixation was performed with the cannulated AO system,
2.0 mm titanium K wires and 5.0 mm AO Schanz screws. In five patients
, additional arthroscopic control of the reposition was performed. Ave
rage removal of the external fixator was 16 weeks postoperatively. Pin
-tract infections occurred in all patients, mainly in the metaphyseal
region. In one patient. a knee infection resulted from a subchondral i
ntra-articular pin, which was treated by repetitive arthroscopic synov
ectomy. In two patients, a secondary loss of reposition (5-7 degrees v
arus) occurred. Despite a high rate of soft tissue damage (8/12), no o
steitis or nonunion occurred. As an alternative to extensive methods o
f ORIF, supportive composite hybrid fixation offers a new perspective
of early functional treatment, weight bearing and a rare loss of repos
ition. It is favored in geriatric, non-cooperative patients and in fra
ctures with severe soft tissue damage.