It is logical to define failure of fixation using the same measures considered as indications for reduction and fixation. Using these strict criteria, the incidence of radiologic failure was much higher than previous published series. In the elderly this was unacceptably high, and treatment goals should be limited to restoring stability and alignment.

ine-wire external fixation is accepted as a minimally invasive technique, which can provide better outcomes than traditional open methods in the management of complex fractures of the tibial plateau. Available fixators vary in their biomechanical stability, and we believe that a stable beam-loading system is essential for consistently good outcomes. We assessed, prospectively, the clinical, radiological and general health status of 20 of 21 consecutive patients with complex fractures of the tibial plateau who had been treated using a standard protocol, with percutaneous screw fixation and a neutralisation concept with a fine wire beam-loading fixator allowing early weightbearing.Bony union was achieved in all patients, with 85% having good or excellent results. Full weight-bearing started during the first six weeks in 60% of patients. The general health status assessment correlated well with the knee scores and reflected a satisfactory outcome. [Br] 2003;85-B:691-9. J Bone Joint Surg

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