The anterior T-frame external fixator for high-energy proximal tibial fractures

The authors' experience using anterior T-frame external fixation combined w ith percutaneous internal fixation for treatment of high-energy proximal ti bial fractures is reported. Thirty-six patients (38 fractures) were reviewe d who were treated during a consecutive 42-month period. Three patients die d and one patient had an amputation for a Type IIIC open injury, leaving 20 males and 12 females with 21 closed and 13 open fractures (two Type LT, se ven Type IIIA, three Type IIIB, and one Type IIIC), The average followup wa s 26 months. Fractures united at a mean of 20 weeks. Ten secondary surgical procedures were planned, including seven antibiotic bead removals with aut ogenous bone grafting and three soft tissue coverage procedures. Nine (26%) complications were found, including one deep infection (septic arthritis) and three pin tract infections, and one each malunion, nonunion, refracture , knee stiffness requiring manipulation under anesthesia, and deep venous t hrombosis. The average Knee Society score was 85 for pain and 83 for functi on. All patients achieved full knee extension and mean flexion was 125 degr ees. The anterior T-frame external fixator with percutaneous internal fixat ion is a reliable method to stabilize these injuries. It is simple, inexpen sive, and effective.