[Combination of direct and indirect reduction techniques in periarticular complex knee fractures]

We evaluated the efficiency of treatment of comminuted intraarticular fractures of the knee, involving direct reduction and rigid fixation for articular components, and indirect reduction and biological fixation for metaphyseal-diaphyseal components.

Twelve patients (9 males, 3 females; mean age 46 years; range 22 to 71 years) with distal femoral (n=6) and proximal tibial (n=6) intraarticular fractures were included. There were seven closed and five open fractures. Intraarticular fractures were fixed directly through a lateral parapatellar incision; while comminuted metaphyseal-diaphyseal fractures were indirectly reduced and internally fixed with biological fixation methods. The patients were evaluated clinically and radiographically. Intraarticular bone and soft tissue changes were evaluated by conventional and three-dimensional computed tomography. The results were assessed according to the HSS (Hospital for Special Surgery) criteria. The mean follow-up was 43 months (range 15 to 78 months).

All fractures healed without any refractures, implant failures, or infections. The mean time to full weight-bearing was 25.5 weeks for tibial, and 24 weeks for femoral fractures. Leg length discrepancy occurred in all the patients with femoral fractures (1-2 cm), and in two patients with tibial fractures (1 cm). One patient with a femoral fracture had a valgus deformity of 10 degrees. According to the HSS criteria, the results were good in five cases, and moderate in one case for tibial fractures; good in one case, moderate in four cases, and poor in one case for femoral fractures. Tomographic evaluations showed articular congruity in all the cases without any signs of loose bodies.

Combination of indirect and direct reduction techniques is an effective method for the treatment of comminuted intraarticular knee fractures.