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The Anterior T-Frame External Fixator for High-Energy Proximal Tibial Fractures

The authors’ experience using anterior T-frame external fixation combined with percutaneous internal fixation for treatment of high-energy proximal tibial fractures is reported. Thirty-six patients (38 fractures) were reviewed who were treated during a consecutive 42-month period. Three patients died and one patient had an amputation for a Type IIIC open injury, leaving 20 males and 12 females with 21 closed and 13 open fractures (two Type II, seven Type IIIA, three Type IIIB, and one Type IIIC). The average followup was 26 months. Fractures united at a mean of 20 weeks. Ten secondary surgical procedures were planned, including seven antibiotic bead removals with autogenous bone grafting and three soft tissue coverage procedures. Nine (26%) complications were found, including one deep infection (septic arthritis) and three pin tract infections, and one each malunion, nonunion, refracture, knee stiffness requiring manipulation under anesthesia, and deep venous thrombosis. The average Knee Society score was 85 for pain and 83 for function. All patients achieved full knee extension and mean flexion was 125°. The anterior T-frame external fixator with percutaneous internal fixation is a reliable method to stabilize these injuries. It is simple, inexpensive, and effective.