Surgical techniques useful in the treatment of complex periarticular fractures of the lower extremity

Treatment of complex periarticular fractures of the lower extremity is guided by the principle of soft-tissue preservation. A skin incision through the subcutaneous tissue to incise the periosteum, followed by judicious application of implants will incur the least amount of iatrogenic damage. The concept of "sufficient stability" can replace the need for "rigid fixation" in many instances. Operative treatment should be considered a complementary extension to the well-founded principles of nonoperative treatment rather than the antithesis. In the final analysis, the approach of a biologist or gardener will yield better results than a strictly mechanical or saw bone laboratory approach.