High energy tibial plateau fractures treated with hybrid external fixation.

Management of high energy intra-articular fractures of the proximal tibia, associated with marked soft-tissue trauma, can be challenging, requiring the combination of accurate reduction and minimal invasive techniques. The purpose of this study was to evaluate whether minimal intervention and hybrid external fixation of such fractures using the Orthofix system provide an acceptable treatment outcome with less complications. Between 2002 and 2006, 33 patients with a median ISS of 14.3 were admitted to our hospital, a level I trauma centre, with a bicondylar tibial plateau fracture. Five of them sustained an open fracture. All patients were treated with a hybrid external fixator. In 19 of them, minimal open reduction and stabilization, by means of cannulated screws, was performed. Mean follow-up was 27 months (range 24 to 36 months). Radiographic evidence of union was observed at 3.4 months (range 3 to 7 months). Time for union was different in patients with closed and grade I open fractures compared to patients with grade II and III open fractures. One non-union (septic) was observed (3.0%), requiring revision surgery. Pin track infection was observed in 3 patients (9.1%).Compared to previously reported series of conventional open reduction and internal fixation, hybrid external fixation with or without open reduction and minimal internal fixation with the Orthofix system, was associated with satisfactory clinical and radiographic results and limited complications.

Symptomatic intracranial abscess after treating lower cervical spine fracture with halo vest: a case report and review of literature.

We present the case of a nineteen year old male, who sustained a fracture of anterior-superior surface of C7, combined with anterior subluxation at the level of C6-C7 vertebrae. After x-ray and CT examination, he was treated conservatively by a Halo-vest. After mobilization, the patient was discharged from the hospital with instructions to visit the outpatient's clinic at regular bases.Despite of our instructions, he did not attend the regular follow-up and, three months later, he visited the emergencies complaining of pin loosening and serious headaches. He was admitted to the clinic in order to perform blood tests and new radiological control. During the first day, high fever (over 38,5 degrees C) was added to his symptoms. Blood exams were indicative of inflammation. Further investigation with CT-scan revealed the presence of a subdural abscess. After consulting the neurosurgeon, the patient was treated conservatively with antimicrobial drugs. Three weeks later he returned home without any symptoms. Since then, he is visiting regularly our clinic and no problems occurred during follow-up.