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Periarticular fractures treated with external fixation offer unique challenges for the orthopedic surgeon. External fixation has two indications in these injuries: (1) temporary stabilization, allowing for soft tissue healing prior to definitive internal fixation, and (2) definitive fracture fixation. The techniques are more challenging in these injuries because the short articular segment yields limited fixation options. In most cases when external fixation is used for temporary stability, the joint is completely spanned. This leaves the articular block without fixation resulting in some instability. When external fixation is used for definitive treatment, specific treatment strategies such as ring external fixation with thin tensioned wires provide more options for stabilization of the articular block. Typically, a short period of joint-spanning fixation allows for adequate healing so that the spanning portion of the frame can be removed and joint motion can begin. Periarticular fractures closer to the joint may require definitive spanning external fixation that requires longer joint immobilization. Improved stability of these constructs can be achieved by multiple techniques. This chapter discusses principles of external fixation and strategies to improve stability and improve clinical outcomes after periarticular fractures. Overall, goals of external fixation are to restore length and alignment of the limb, allow for patient mobilization, and provide easy access to soft tissue injuries in these typically high-energy fractures.
KeywordsPeriarticular fractures Biomechanics External fixation Ring or Ilizarov external fixation Pilon or plafond fracture Tibia plateau fracture Fracture healing Fracture stability Surgical site infection Joint-spanning external fixation Monolateral external fixation Articulated external fixation
- 34.von Knoch F, Marsh JL, Steyers C, McKinley T, O’Rourke M, Bottlang M. A new articulated elbow external fixation technique for difficult elbow trauma. Iowa Orthop J. 2001;21:13–9.Google Scholar