Surgical reconstruction of bicondylar tibial fractures with external fixation relies on indirect fracture reduction that could affect anatomical restoration. The aim of the present study is to evaluate the radiographic and clinical outcomes of tibial bicondylar fractures treated with circular external fixation. A total of 20 bicondylar fractures of the proximal tibia in 20 patients treated with circular external fixation were included in the study. Two fractures were open. Mean clinical and radiographic follow-up was 37.3 months after frame removal. Angular, translation, and length deformities were assessed on nonweight-bearing anteroposterior, lateral, and two 45 degrees oblique views. The medial proximal tibia (MPTA) and posterior proximal tibia angles (PPTA) were calculated in all cases. The condylar widening was calculated in relation to the width of the femoral condyles. Joint depressions or gaps of the articular surface were identified on the four views of the knee. The modified Hospital for Special Surgery (HSS) knee scoring system was used for clinical evaluation. The MPTA was good in 18 (90%) and fair in 2 patients (10%). The PPTA was good in 13 (65%), fair in 6 (30%), and poor in 1 patient (5%). The articular reduction was good in 12 (60%) and fair in 8 patients (40%). The condylar widening was good in 15 (75%) and fair in 5 patients (25%). Mechanical axis deviation was within the normal range in 11/12 patients (91.7%). All fractures consolidated. One deep infection was successfully treated with local debridement, the mean modified HSS knee score at the latest follow-up was 90.5 (range: 67-100). Articular reconstruction and tibia alignment based on radiographic evaluation in the present study, along with functional results compare favorably with those of external and internal fixation presented in the literature.

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

No abstract

CIRCULAR EXTERNAL FIXATION TECHNIQUE IN TIBIAL PLAFOND FRACTURES: DESCRIPTION AND OUTCOMES fractures of tibial plafond have been treated by the Authors with circular external fixation, adding minimally invasive internal fixation in selected cases. The surgical technique is described in detail and the quality of radiological and clinical outcomes is reported. This method is valuable in achieving stabilization and healing of pilon fractures with a minimum of soft tissue complications. Aggiornamenti IntroduzioneLa complessità del trattamento delle fratture del pilone tibiale deriva da molteplici fattori. In primo luogo sono da considerare la natura articolare di tali lesioni e la modestia dell'involucro tegumentario del terzo distale della gamba. Inoltre il rapido squilibrio tra i gruppi muscolari che controllano l'articolazione tibio-tarsica (con conseguente tendenza all'equinismo) e l'irrigidimento della pinza peroneo-tibiale possono determinare uno scadente risultato clinico anche in presenza di valide ricostruzioni dell'anatomia regionale. Condizioni di un recupero soddisfacente sono infatti, oltre al ripristino dell'allineamento e della congruenza, una escursione articolare che consenta un grado discreto di flessione dorsale e una elasticità residua della sindesmosi peroneo-tibiale distale. Nelle fratture scomposte solo il trattamento chirurgico può conseguire l'obiettivo del ritorno a una buona funzionalità della tibio-tarsica. Ampie esposizioni chirurgiche in questo distretto sono state tuttavia gravate, specie nel caso di "timing" inadeguato, da un'alta percentuale di complicanze legate a deiscenza dei tessuti molli e/o infezione [1,2]. Una minore aggressione tissutale associata a una adeguata ricostruzione è stata realizzata con placche a stabilità angolare e mediante la fissazione esterna [3,4]. Quest'ultima, associata o meno a tecniche di fissazione interna minimale, può utilizzare fissatori assiali, ibridi o circolari. Con la fissazione esterna l'incidenza di complicanze infettive e di pseudoartrosi è riportata come estremamente bassa o assente dalla maggioranza degli Autori [5]. L'utilizzo di fissazione assiale "a ponte" è stato tuttavia associato a una maggiore percentuale di malallineamento [5]. Le tecniche di fissazione differiscono inoltre in merito all'utilizzo di una trazione estrinseca o del fissatore medesimo al fine di realizzare la ligamentotassi. Riteniamo che i principali e peculiari vantaggi connessi alla fissazione circolare delle fratture del pilone tibiale possano essere individuati in:• ripristino e controllo della lunghezza della colonna esterna;

Background: Recent epidemiologic reports from national fracture registries demonstrate an increase in the incidence of tibia fractures in the elderlies. Objectives: the objective of this retrospective study is to evaluate Circular External Fixation (CEF) for primary and definitive fixation of tibia extra-articular fractures (TEF) in the elderly treated at a level I trauma center. Materials and Methods: we evaluated a subset of 31 elderly patients (over 70 years) with 31 TEF (mean age 76 years, range 70-89) of which six (19.4%) were open treated with CEF between 2010 and 2017. 29 (93.5%) fractures underwent definitive fixation with traditional Ilizarov, 2 were treated with Sheffield and Taylor Spatial frames and evaluated clinically and radiologically accordingly to ASAMI bone and functional scores. Results: All fractures consolidated without additional procedures at an average of 21.3 weeks (range 9-42). No deep infections were observed. Four malunions within 8° occurred. ASAMI bone results were excellent in 93.6% of patients and revealed an excellent result in 21 (67.7%) of patients, eight patients (25.8%) had a good result, and 2 (6.5%) a fair result. Conclusions: CEF gave excellent results in the treatment of a variety of tibial shaft fractures in an elderly population, in terms of early return to ambulation, with average time to union, rate of delayed union, and misalignment rate comparable or superior to intramedullary nail and plate osteosynthesis, that represent the options more frequently proposed in clinical practice and literature. Advantages of circular external fixation in osteosynthesis of extra-articular tibia fractures in these patients are the minimal impact on soft tissues and the stability of the construct, that allows immediate weight bearing and early return to ambulation.