External fixation in proximal metaphyseal tibial fractures

Purpose of the study This study was a retrospective analysis of 39 proximal metaphyseal tibia fractures treated by Orthofix (R) fixator in two trauma departments. Material and method There were 28 men and 10 women with a mean age of 49,5 years. 13 pedestrians were stroked by a car and 18 had a trafic accident on a motorcycle. In 27 cases, the fracture was open with following Cauchoix grading : 15 types 2, 6 types 1 and 6 types 3, All fractures were partially or totally included in the proximal epiphyseal square of the AO system. 14 fractures were metaphyseal, 13 diaphyso-metaphyseal and 12 had an articular irradiation. All external fixations were performed using the Orthofix,(R) device, with image intensification. A partial weight bearing was allowed for 2,4 months as an average and full weight bearing at mean 3,7 months. 7 skin grafts, 2 micro surgical (latissimus dorsi) and 2 local flaps were necessary. Results In 3 patients this technique failed. 3 patients had an autologous bone graft at the metaphyseal and 2 at the diaphyseal fracture site. 30 patients healed without other procedure after an average delay of 5,5 months. During the healing and weight bearing time, 6 frontal deformities appeared and 5 flexion contractures were not reoperated, With a minimum follow up of one year (mean 3 years) 22 fractures had no deformity, 8 had a valgus deformity (5 degrees to 10 degrees) and 3 a varus deformity (6 to 17 degrees). For the 25 patients with an isolated proximal tibial fracture, 11 (44 %) had an excellent functional result (no pain, full range knee motion, normal daily activity), 12 (48 %) had a good result (episodic pain, minimaly knee disconfort, flexion limitation). Discussion Orthofix (R) fixator appear to be a good solution for comminuted fractures, These fractures have anatomical and epidemiological particularities. AO classification system is not useful; a new one is proposed. External fixator must be placed meticulously after closed fracture reduction.