HIGH ENERGY TIBIAL CONDYLAR FRACTURES TREATED BY HYBRID FIXATOR - A CLINICAL STUDY

The high energy tibialcondylar fractures are difficult to treat because of comminution and injury to soft tissue envelop. With the advent of external fixators, fractures with overlying soft tissue compromise were amicable to surgical treatment. Hybrid External Fixator seemed suitable for such fractures as they combine the advantages of monolateral and circular fixators. Tensioned k-wires provide improved fixation in the cancellousmetaphysealperiarticular fragments & threaded half pins gave good purchase in the cortical bone of the shaft. It allows early mobilization of the knee joint and also early weight bearing. forty three consecutive patients with high energy proximal tibialcondylar fractures with comminution were treated with hybrid fixator from June 2009 to June 2012 in our institution out of which two were lost to follow-up remaining forty-one were followed up for a minimum period of 12 months. 41 fractures were assessed for bony union, range of motion of knee and associated complications of the treatment. Out of 41 fractures studied, 39 united at an average period of 15.5 weeks. Two (type 3B) fractures resulted in non-union (treated with bone grafting and plate fixation). 8 patients developed superficial pin tract infections which resolved with regular dressings and oral antibiotics. 3 patients had stiffness of the knee joint which was corrected partially by aggressive physiotherapy.3 developed angular deformity (2varus angulation of <15°and one valgus of 20°) .Results according to the IOWA score showed excellent out come in 6 patients (15.3%), good out come in 28 patients (71.7%) & fair in 5 patient (13%). Hybrid external fixator is very useful in the management of high energy tibialcondylar fractures. It can be rapidly applied, is minimally invasive, least blood loss and adjustable to correct alignment post operatively. Allows soft tissue care and early weight bearing and early joint mobilization .It has negligible complications and resulted in good outcome for this type of injuries.