A’ Orthopaedic Department University of Athens, Attikon University Hospital, Athens, Greece.
J Orthop Surg Res. 2011 Jul 14;6:35. doi: 10.1186/1749-799X-6-35.
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.
对于伴有明显软组织创伤的高能关节内胫骨近端骨折的治疗具有挑战性，需要准确的复位和微创技术的结合。本研究的目的是评估 Orthofix 系统的微创干预和混合外固定治疗此类骨折是否能提供可接受的治疗效果，同时减少并发症。2002 年至 2006 年间，我院（一级创伤中心）收治了 33 例伴有 II 型胫骨平台双髁骨折、ISS 中位数为 14.3 的患者，其中 5 例为开放性骨折。所有患者均采用混合外固定器治疗。其中 19 例患者行微创切开复位和经皮螺钉固定。平均随访 27 个月（24-36 个月）。3.4 个月（3-7 个月）时可见影像学愈合。闭合性和 I 型开放性骨折患者的愈合时间与 II 型和 III 型开放性骨折患者不同。1 例（3.0%）患者发生非愈合（感染性），需要翻修手术。3 例（9.1%）患者出现钉道感染。与传统切开复位内固定的先前报道系列相比，Orthofix 系统的混合外固定加或不加微创切开复位和经皮螺钉内固定与满意的临床和影像学结果以及有限的并发症相关。
