[Supportive composite-hybrid fixation of percutaneous screw fixation of tibial head fractures]

Recent operative techniques with percutaneous screw fixation of the tibial plateau require a high level of patient compliance. Geriatric, non-cooperative patients and fractures with severe soft tissue injury have had to be excluded so far from this therapeutic regimen. Since September 1993, composite hybrid fixation, as a combination of ring fixation of the epimetaphyseal tibia with monolateral AO fixation of the tibial shaft, has been performed in 12 patients. The data were collected prospectively. Fractures were classified according to the AO and Moore classification; soft tissue damage was classified according to Tscherne and Gustilio. Fixation was performed with the cannulated AO system, 2.0 mm titanium K wires and 5.0 mm AO Schanz screws. In five patients, additional arthroscopic control of the reposition was performed. Average removal of the external fixator was 16 weeks postoperatively. Pin-tract infections occurred in all patients, mainly in the metaphyseal region. In one patient, a knee infection resulted from a subchondral intra-articular pin, which was treated by repetitive arthroscopic synovectomy. In two patients, a secondary loss of reposition (5-7 degrees varus) occurred. Despite a high rate of soft tissue damage (8/12), no osteitis or non-union occurred. As an alternative to extensive methods of ORIF, supportive composite hybrid fixation offers a new perspective of early functional treatment, weight bearing and a rare loss of reposition. It is favored in geriatric, non-cooperative patients and in fractures with severe soft tissue damage.