The treatment of tibial plafond fractures requires careful management of the soft tissue envelope, reconstruction of the articular surface and stable fixation with minimal additional damage. Thirty cases of AO type 43 C tibial fractures were treated by transosseous osteosynthesis (Ilizarov technique). The external fixator constructs used were Ilizarov (Transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue, Springer, Berlin, 1992) and Sheffield (Classification AO des fractures, Springer, Berlin, 1987) circular fixator systems. All tibial plafond fractures healed. Using radiological criteria for assessment of reduction of the articular fragments and the clinical scoring system described by Teeny and Wiss, there were excellent and good restoration of articular structure in 27 cases and good clinical results in 14. This treatment method compares well with previous published series and is to be recommended for this group of difficult fractures.

Treatment of segmental tibial bone defects after high-energy trauma or atrophic nonunion resection is challenging. In the last two decades, distraction osteogenesis Ilizarov bone transport has become a gold standard for the treatment of segmental tibial bone defects and lengthening in spite of the fact that frequent frame modifications and the need for sequential correction of deformities during bone transport are the main limitations of the device itself. The Taylor Spatial Frame applies the concept of the Stewart platform to the standard Ilizarov frame while applying the same principles of distraction osteogenesis postulated by Ilizarov. We report the case of a patient with two problems we could treat simultaneously: an ankle equinus contracture (a consequence of limb leg discrepancy) and infected tibial nonunion and soft-tissue damage complication after plating in a 41A3 type II Gustilo fracture of the left leg.

The timing of definitive fixation for major fractures in polytrauma patients is controversial. We investigated the outcome of the Sheffield hybrid system (SHF) as a solution in the role of primary and definitive fixator for patient with open femoral fractures in whom definitive osteosynthesis with intramedullary nail can be associated with higher rate of complications. Eleven patients (7 men and 4 women), mean age of 40.4 years (range 14-75 years) with previous injury severity score (ISS) greater than or equal to 16 were treated from a damage control orthopedics perspective. Time in the fixator averaged 28 weeks (range 10-64 weeks). Mean follow-up was 3 years (2-4.5). All fractures united. Paley functional and bone results in most cases were good to excellent. Final mean knee range of motion was 113 degrees. We found that SHF for complex fractures of the femur combine maximum support for the bone and preservation of soft tissues. SHF is an effective technique compared to internal nails and earlier external fixator devices, attributable to its advantages such as continuity of frame till union, preventing any second-hit phenomenon, early mobilization, and restoration of primary defect due to bone loss by differential distraction osteogenesis without additional surgery.