Outcome Assessment of Hybrid External Fixation in the Treatment of Comminuted Distal Femur and Proximal Tibial Fractures

Abstract

Background: Treatment of comminuted fractures of the distal femur and proximal tibia is difficult, and a challenge in the field of orthopedic trauma. Objectives: The aim of this study was to assess the short-term results of hybrid external fixation in the treatment of these fractures. Patients and Methods: In a prospective study, 44 patients with comminuted fractures of the distal femur or proximal tibia, with an overlying soft tissue injury treated by closed reduction and hybrid external fixation, were included. Parameters such as pin-track infection, union, limb shortening, knee motion, and alignment were evaluated during a mean follow-up period of 14 months. Results: Forty-four patients with distal femoral (n = 23) and proximal tibial (n = 21) fractures were treated using hybrid external fixation. Bone union was seen in 35 (80%) of the patients. Pin tract infection was seen in three patients (6.8%), one case (4.6%) with a PTF and two cases (8%) with DFFs. Malunion was observed in 4 patients (9.1%); of these, three cases (13%) had DFF and one case (4.8%) of pain was detected in the DFF group. One case had malunion and three cases had union. Findings showed satisfactory results in more than 80% of patients. In general, lower postoperative complications were detected in the proximal tibial fractures than the distal femoral fractures. According to a chi-square test, the difference between the patients with PTFs and those with DFFs was not clinically significant. Conclusions: Closed reduction and hybrid external fixation can be used as a definitive treatment for severe comminuted fractures of the distal femur and proximal tibia, when the concomitant contusion of the skin and soft tissue damage prohibits safe open reduction and internal fixation.