Indirect reduction and composite fixation of extraarticular proximal tibial fractures

Forty-one extraarticular comminuted proximal tibial fractures were treated during a 7-year period. The fractures were proximal tibial metaphyseal injuries or metaphyseal-diaphyseal junction injuries with extension proximally and distally but not involving the knee joint. All fractures were treated surgically with open reduction and internal fixation using an indirect reduction technique with a lateral plate, and a medial substitution external fixator concomitantly. All fractures were seen for followup until they healed (average healing time, 12.1 weeks). The timing of internal fixation was based on the status of the soft tissue (average time to surgery, 8.5 days after injury). A temporary spanning external fixator was used in 17 (41.5%) fractures to allow for further assessment, demarcation, and improvement of the anterior soft tissues. There were 3 (7%) delayed unions, 1 (2%) malunion, and no nonunions. There were 2 (5%) wound infections and 5 (12%) pin track problems. One postsurgical soft tissue problem was encountered. Through this technique, reliable healing and alignment were achieved in this often difficult fracture pattern, particularly for fractures that were difficult or impossible to treat with an intermedullary nail.