Purpose: To evaluate the results of the treatment of tibia fractures with external fixation and subsequently exchanging it to intramedullary osteosynthesis

Material and Methods: This is a retrospective study of 25 tibia fractures which were treated in our institution between January 2002 and December 2005. There were 17 men and 8 women with an average age of 32 years (range, 19 to 70). According to AO-OTA there were 7 type B2, 12 type C1, 3 type C2 and 3 type C3. All fractures were open (Gustilo Anderson type I (2), type II (8), type III (15). The planned treatment protocol included provisional management with external fixation and sequential converse to a static intramedullary nailing. The mean duration of external fixation was 9 3 weeks (range, 2 to 7). In all cases nailing was preceded by a period in plaster lasting an average of 4 weeks.

Results: All patients were reviewed after an average time of 12 months (range 9–21). Bone union was noted in all fractures at an average of 19 weeks (range, 8 to 32) after the intramedullary nailing. There was one case with deep infection, without compromising the consolidation of the fracture. A leg shortening from 1.5 cm to 3 cm was recorded in 6 cases. Angular malalignment from 2° to 5° of tibia was recorded in 2 cases. 3 additional surgeries for leg lengthening were recorded but no further surgery due to the tibia malalignment was needed.

Conclusions: The management of open tibia fracture remain a challenging problem. Exchange of the external fixation to intramedullary nailin is a safe and effective treatment modality of managing of these difficult tibia fractures.

Purpose: To assess the function of the knee joint and the development of knee arthrosis, at seven years postoperatively, in patients in whom a high energy tibial plateau fracture had been treated with minimal internal fixation augmented by small wire external fixation frames.

Material and Methods: Between October 1989 and November 1999, one hundred twenty nine high energy tibial plateau fractures were treated with hybrid fixation including small wire circular or hybrid frames, minimum internal fixation and occasionally provisional extension of the external fixation to the distal femur. The average patient age was 39 years. There were 69 (53%) C1 fractures, 19 (15%) C2 and 41 (32%) C3 fractures and 49 (38%) fractures were open. Complex injury according to Tscherne-Lobenhoffer classification was recorded in 87 (67%) patients. Clinical, subjective, objective and radiographic results were evaluated after an average follow up of 84 months.

Results: Results were assessed according to the criteria of Honkonen–Jarvinen. Excellent or good functional result was recorded in 98 (76%) patients. However, only 74 (57.5%) patients retained an excellent or good radiographic result at the final follow up. Compared with the radiographic appearance of the post-traumatic arthritis after an average of 48 months, there was found no statistically significant deterioration of the knee arthrosis (p< 0,05). No reconstruction operations were performed after the completion of the index procedure.

Conclusion: A high percentage of radiographic post-traumatic arthritis should be expected, after high energy tibial plateau fractures had been treated with minimal internal fixation augmented by small wire external fixation frames. However, because all the objectives of the fracture treatment can be obtained, the functional results remain satisfactory over time.