[Anatomical and functional results of the external fixation of upper metaphyseal tibial fractures].
OBJECTIVE
This study aimed to evaluate a method for the treatment of upper tibial metaphyseal fractures using an external epiphysodiaphyseal fixation with the double-frame Hoffmann device.


METHODS
The study included 48 patients (37 men and 11 women) aged 16 to 82 years. The tibial fracture was simple in 15 cases, included a metaphyseal comminution, partial in 3 cases and total in 30. In 13 patients, there was also a simple articular fracture. The fracture was opened in 24 cases (type I in 10, type II in 7 and type III in 7 cases).


METHODS
The gap and displacement evaluation between the fragments after reduction was made on postsurgical roentgenograms; its was considered as complete when all fragments were in contact with each other, without frontal or anteroposterior translation above 5 mm. Healing was defined as a complete bone continuity providing a painless load bearing. The patients were clinically and radiologically reexamined with a mean follow-up of 15.45 months (5 to 62 months).


RESULTS
After healing, there were 2 cases of angular deformities in patients whose autonomy was otherwise already reduced. Twenty-three patients had a minor pin tract infection. There was 3 cases of secondary osteitis after a type-III open fractures and 3 other deep septic complications without functional consequences. Forty-one fractures healed without bone graft in a mean time of 18 +/- 7.6 weeks. Healing did not seem to statistically depend on the opening nor on the type of fracture, but rather on the association with a peroneal fracture and the loss of cohesion between the fragments. The duration of professional invalidity evaluated in 20 cases, varied between 4 to 21 months (means: 11.3 months), and none of the patients had to modify his activity because of the tibial fracture. At follow-up, no patient complained of invalidating pain. Thirty-two patients recovered a satisfactory knee joint mobility and among the 16 others, in only 3 no particular reason was found to explain the deficit.


CONCLUSIONS
While good anatomic and functional results lead us to keep the principle of external fixation, it seems however necessary to modify the modalities of the treatment in order to improve healing conditions, especially by improving the cohesion of the fragments through secondary minimal internal fixation. The use of dynamic axial fixation devices could therefore bring a theoretical advantage, but it must be proven that they produce in this site a primary stabilization which is a good as that obtained with Hoffmann's device.
Dujardin
F
F
Service de Chirurgie Orthopédique, Hôpital Charles Nicolle, CHU de Rouen.
Ennedam
J
J
Guiffaut
P
P
Duparc
F
F
Biga
N
N
Thomine
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D013978:Tibial Fractures / Q000601:surgery*