Combined internal and external osteosynthesis a biological approach to the treatment of complex fractures of the proximal tibia.

Lateral plating was combined with external fixation to treat 18 complex, proximal, tibial fractures with severe soft tissue injury. All patients were followed up until functional restoration of the limb had been achieved. In 15 cases, bone healing was uneventful. One deep infection without knee joint arthritis, one delayed union and one malunion necessitated revision. Pin track complications were negligible and soft tissue breakdown was not observed. The short-term results regarding the functional outcome showed a painless condition and good function in all patients. The method of fixation described is more invasive than the currently proposed minimally invasive combined fixation techniques, but can be regarded as an optimization of the mechanical and biological advantages of the implants.