Complication Rate and Pitfalls of Temporary Bridging External Fixator in Periarticular Communited Fractures

BACKGROUND: A second staged operation using temporary bridging external fixation (TBEF) has been widely used in patients with periarticular complex fracture, yet few papers have been published on the related complications. The purpose of this study was to report the complication rate and pitfalls directly related to TBEF through a retrospective study and to suggest some solutions. METHODS: Fifty-nine cases that were treated by using TBEF were studied among 195 periarticular complex fractures. We retrospectively collected the clinical and radiological data and then the study data was evaluated for 1) cases with unsatisfactory restoration of length, 2) cases with deep infection caused by half pins invading the zone of definitive fixation, and 3) neurovascular injuries related to half pins. RESULTS: Complications were observed in 7/59 cases (11%). Problems related to the achievement of length were observed in one case of distal tibia fracture and 2 cases of distal femur fracture. Half pin related infection was observed in 2 cases of distal femur fracture. Neurovascular injury (medial calcaneal nerve injury in a distal tibia fracture) was observed in 2 cases. Among 7 complications, four were related to using TBEF in distal femur fracture. This is because the abundant leg muscles have strong deforming force and infection might be increased due to frequent irritation by the half pins. CONCLUSIONS: TBEF is a simple procedure with several advantages. However, complications might be observed if certain principles are not followed. It is thought that many complications due to TBEF can be reduced if the half pins are not inserted in the zone of injury, restoration of length is fully achieved and the neurovascular characteristics are carefully considered. In particular, much more caution is needed in the distal femur, which has abundant muscles surrounding it.

Less invasive stabilization system(LISS)in treatment of periarticular fractures of the knee joint / 中华创伤骨科杂志

Objective To discuss the less invasive stabilization system(LISS)in treatment of fractures around the knee joint.Methods Between February 2002 and December 2005,103 cases of periarticular fractures of knee joint were treated with LISS in our department.There were 58 cases of comminuted distal femoral fracture and 45 cases of comminuted proximal tibia fracture.Follow-ups were conducted once per week during the first four weeks and once per month in the following months to observe whether such complications as loosening of internal fixators and nail breakage would occur.Results All the cases were followed up for a mean time of 16.5 months(range, 6 to 27 months).Loosening and breakage of internal fixation was found in only one case,while others obtained bony union.In fractures of types A and C,the knee range of motion varied from 95?to 145?(average,130?)and 85?to 140?(average,110?)in flexion respectively.HSS score:excellent in 84 cases(81.6%),good in 15 cases (14.6%),fair in three cases(2.9%),and poor in one case(0.9%).Conclusions The LISS can be the best choice for the treatment of periarticular fractures around the knee joint,but we should take care to implant the plate and screws in a proper position and direction and avoid early weight-bearing.In application of the 13-hole plate, large incision should be made to approach the distal tibia for fear of damaging the superficial peroneal nerve.

Minimally Invasive Plate Osteosynthesis for Periarticular Tibial Fractures / 대한정형외과학회잡지

PURPOSE: This study was designed to investigate the feasibility and advantages of minimally invasive plate osteosynthesis of periarticular tibial fractures. MATERIALS AND METHODS: Twenty-one patients with periarticular tibial fractures were treated, including 7 proximal and 14 distal fractures. According to the AO classification, 11 cases were A type. After fracture reduction with the traction or distractor, the pre-contoured narrow LC-DCP was inserted at the distant site to the fracture-site, and the screws were percutaneously fixed. RESULTS: Time to union averaged 15.0 weeks (range 10-24 weeks). There were 2 cases of delayed union (above 6 months), and 2 cases of malunion, one with >5 degrees of varus alignment and one with >10 degrees of external rotation. Two patients with failure had second operations, one to correct angulation and for bone graft due to comminution, and the other for early plate removal due to repeated superficial infection. CONCLUSION: The authors feel confident that this minimally invasive technique for plate osteosynthesis of tibial fractures will prove to be a feasible and worthwhile method of stabilization, which avoids the severe complications associated with conventional open plating.