ABSTRACT
Objective To report the therapeutic results of Hybrid external fixator in treatment of open metaphyseal fractures of the tibia.Methods From March 2000 to July 2004,19 cases of proximal tibial meta- physeal fractures and six cases of Pilon fractures were treated with Hybrid external fixators.By Gustilo classification, eight cases were of typeⅡ,10 typeⅢA,five typeⅢB and two typeⅢC.The wounds were closed directly after thorough debridement in 21 cases,and closed by pedicled flap transposition or free flap transplantation in four. Fasciotomy was performed in three.Closed indirect reduction of the fractures was done in 11 cases,while open reduction was carried out through an extended wound or a limited incision in 14.Anatomical reduction was done for the articular fractures,if any,and Hybrid external fixators were employed to stabilize fractures in all the cases in this series.Results All the patients had a mean follow-up of 15.7 months (ranging from 9 to 26 months) which re- vealed bone union of the fracture in all cases with a mean healing time of 8.8 months.Two patients had their external fixators replaced with plates and iliac bone graft to get fracture union.The fixators were removed 2.9 to 21 months (mean,9.4 months) after operation.Except for two cases of secondary healing,all the wounds healed primarily without serious complication,such as infection.The final follow-up revealed a knee motion range of more than 90?in 15 cases,less than 70?in four,whose knee motion range was improved to more than 90?after knee release performed one year later.In all the six cases of Pilon fractures,the ankle joint recovered normal range of motion.Traumatic arthritis occurred in two cases of Piion fracture 11 months after operation.Evaluation by Rasmussen's functional and radiological scoring system demonstrated excellent knee function in 13 cases,good in three,fair in two and poor in one,with a good to excellent rate of 84.2%.The ankle function was excellent in three cases,good in two and poor in one,with a good to excellent rate of 83.3%.Conclusions In treatment of open tibial metaphyseal fractures, the Hybrid external fixator can well maintain the stability of the fragments with a low incidence of soft tissue com- plications and insignificant interference with the knee motion.However the bone healing time can be prolonged with a definite rate of nonunion.