SUPPORTIVE COMPOSITE HYBRID FIXATION OF P ERCUTANEOUS SCREW FIXATION OF TIBIAL FRACTURES

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.