Experience with the pinless fixator in the treatment of fractures of the lower leg.

This is a report of the experience we have gathered in the application of the pinless fixator in cases of tibial fracture with soft tissue damage. In the Berufsgenossenschaftlichen Unfallklinik Ludwigshafen (Clinic for Trauma Surgery) 12 diaphyseal fractures of the tibia were stabilized with the pinless fixator in 1991. In all cases, conversion to an intramedullary nail was intended from the very beginning and was performed in 11 cases. In one case, a conventional external fixator had to be selected instead. The injuries included first and second degree open and closed fractures, mostly from group A of the AO classification. At conversion four bacteriological smear tests from the medullary cavity proved positive. In four cases, transitory peroneal deficiencies were diagnosed. When investigating their cause, it seemed that the present geometry of the pinless arms might be responsible for pressure damage to the soft tissues. Possibly this difficulty could be solved by altering the configuration of these arms. The pinless external fixator has definitely proved its usefulness when later conversion to an intramedullary nail is intended since the final fixation can be performed with the pinless device still in place.