Combination of a Plate and an External Fixator for Biological Osteosynthesis of Comminuted Fractures

Abstract

In a comminuted fracture, a unilateral plate doesn't always give enough stability because the contralateral cortex cannot be used as a buttress. New plate systems as the Locking Compression Plate (LCP) may solve this problem. Another method to stabilize the contralateral cortex is by using an External Fixator (EF) in addition to a conventional platte either on the opposite side of the plate or on the ipsilateral side over the plate. By doing so, a half frame of an EF acts as a substitute for the damaged cortex. This method is easily available and may also be considered when a conventional plate osteosynthesis must be mechanically improved after the conventional plate is already put in place. With this combination of a plate with a EF we treated twelve patients with comminuted fractures of the tibia, the humerus and the femur. Eleven fractures healed without further operations or complications. In one case, there was a superficial wound infection with Staph. epidermidis that lead to an early metal removal, but healing of the fracture was not impaired. We also tested this set-up in a model and found, that the additional EF increased the stiffness of the plate by 73% for axial load. The combination of a plate and a contralateral EP is a useful way to treat comminuted fractures biologically achieving enough stability to allow early motion of the adjacent joints and fast healing of the fracture. Especially for fractures adjacent to a joint, this method is an alternative to an intramedullary nail.

Changing the treatment to reduce complication rate in open tibial fractures

“…The consideration of the soft tissue management is almost uniform [7,23], but nowadays there is a considerable difference concerning the stabilising methods of the fractures [2,3,8,19,20,21,22,24]. Therapeutic tactics are changing constantly.…”

“…Therapeutic tactics are changing constantly. Initially plating and later the external fixator played the most important role in the treatment of open tibial fractures; nowadays unreamed nailing dominates the therapy [3,16,21,22]. Nailing for tibial shaft fractures is a simple and effective method, especially in the treatment of middle-third fractures.…”

Ist die Fixateur-externe-Osteosynthese an der proximalen Tibia noch zeitgemäß?

“…Stattgehabte Tibiafrakturen mit metaphysärer Trümmer-zone weisen bei unilateraler Plattenosteosynthese oft nicht die erforderliche Stabilität zur definitiven Versorgung auf; in diesen Fällen können externe Fixateure zusätzlich zur konventionellen Platte oder zum winkelstabilen Plattensystem auf der kontralateralen Seite im Bezug auf das Plattensystem oder auf der ipsilateralen Seite über der Platte angebracht werden. Mit dieser Kombinationsosteosynthese aus winkelstabilen oder nicht winkelstabilen Plattensystemen (monolateral) sowie zusätzlichen Fixateur-externe-Anlagen kontralateral oder ipsilateral werden bei geringer Weichteilaffektion gute radiologische wie klinische Ergebnisse erzielt[10].Der überragende Vorteil des Fixateur externe liegt in der Weichteilprotektion. Der wiederholt von unterschiedlichen Autoren behauptete Nachteil der Fixateur-externe-Anlage nach stattgehabten proximalen Tibiafrakturen wird in einer mangelnden Rigidität gesehen.…”