OTA 2005 Posters

Scientific Poster #18 Polytrauma/Injury Prevention

Treatment of Distal Femur and Proximal Tibia Fractures with External Fixation followed by Planned Conversion to Internal Fixation

Selina Silva, MS, IV; Anand Parekh, MD; Juan F. Agudelo, MD;

Wade R. Smith, MD; Steven Morgan, MD; Allison Williams, MD, PhD

(n-all authors);

Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado, USA

Purpose: This study was conducted to evaluate healing rates and complications in patients treated with temporary external fixation and subsequent open reduction and internal fixation (ORIF) for high-energy distal femur or proximal tibia fractures.

Methods: In this retrospective analysis of prospectively collected data at a level 1 trauma center from 1998 to 2004, demographic data and injury severity score were obtained from medical records. Outcome measures included: perioperative complications, time to radiographic and clinical union, nonunion, malunion, postoperative infection, loss of fixation, unplanned secondary surgeries, and range of knee motion.

Results: 34 patients with 12 distal femur and 23 proximal tibia fractures were treated by 3 surgeons using acute, temporary external fixation. Patients subsequently underwent ORIF (mean = 5 days, range 1 to 26 days). There were 35 fractures24 open (Gustilo I=6, II=3, IIIA=3, IIIB=8, IIIC=4) and 11 closed. Mean follow-up was 15 months. 33 fractures healed (94%), with 8 requiring bone grafting (1 closed and 7 open fractures). Six (17%) deep infections occurred, all in open fractures (Gustilo I=1, IIIB=2, IIIC=3). Other complications included one hematoma (3%), one chronic draining sinus (3%), one death from stroke (3%), one above-knee amputation secondary to infection (3%), and two malunions (6%). Both malunions occurred in proximal tibias, one with 14° and the other with 15° degrees of valgus. There were no fixation failures or pin site infections. The postoperative mean range of knee extension was 3° (-12 to 15) and flexion was 100° (35 to 130).

Conclusions/Significance: Temporary external fixation provides the advantage of early soft-tissue and bone stabilization with minimal operative burden. Adequate resuscitation and initial wound care can be effectuated; subsequent ORIF can then be safely performed once the patient is hemodynamically stable. We found a union rate of 94%, an infection rate of 17% and no fixation failures. All the infections occurred in open fractures, of which 83% were Gustilo grade III. The infection rate in this study falls within the reported range for grade III open fractures (15 to 20%). We conclude that the initial treatment of high-energy periarticular knee fractures with external fixation, followed by planned conversion to internal fixation, is a safe option in patients who are unsuitable for initial definitive surgery.