OTA 1998 Posters

Use of Small Wires through Cannulated Screws in Periarticular Fracture Management with Limited Internal Fixation and Hybrid External Fixators

R. Harris, MD; D. Jones, MD; M. Frisch, MD; A. Jones, MD; C. Reinert, MD, US Army Institute of Surgical Research, Brooke Army Medical Center Orthopaedic Surgery Service, San Antonio, TX; University of Texas Southwestern Medical School Department of Orthopaedic Surgery, Dallas, TX

Purpose (hypothesis): Lower extremity periarticular fractures can be difficult to manage with formal open reduction and internal fixation (ORIF) techniques. Indirect reduction followed by limited internal fixation and hybrid external fixation with small wires around the joint is a technique which allows for stabilization of the fractures with minimal disruption of the surrounding soft tissues. Complications of small wires include pin tract infection, wire breakage, and pin cutout and loss of reduction. The purpose of this study is to describe the use of small wire hybrid external fixators for the treatment of periarticular fractures with placement of the wires through cannulated screws.

Methods: A retrospective review was performed of the patients whose fractures were treated using this technique. The records, radiographs, and latest follow-up data were analyzed for accuracy of reduction, fracture outcome, and complications. We specifically focused on complications related to the use of small wire external fixators including pin tract infection, loss of reduction, and wire failure.

Results: We identified 15 patients who were treated for periarticular fractures about the knee using this technique. Ten patients had tibial plateau fractures and 5 patients had comminuted supracondylar/intercondylar fractures of the distal femur. Adequate reduction was obtained and was able to be maintained with this method of fixation. There were no pin tract problems identified. There was no incidence of wire cutout, wire failure, or loss of reduction.

Discussion and Conclusion: Hybrid external fixation using small wire fixation has been advocated for the treatment of complex periarticular fractures to avoid the soft -tissue stripping involved in formal ORIF. With comminution in the periarticular region, achieving fixation with small wires can, in some cases, lead to loss of reduction due to wire failure and cutout. Initial stabilization of the articular surface reduction with cannulated screws can decrease the risk of wire failure. There does not appear to be an increased risk of infection with this method of treatment.