The small pin circular fixator for proximal tibial fractures with soft tissue compromise.

We used a Monticelli-Spinelli small pin circular external fixator in five cases, in combination with closed reduction or limited open reduction internal fixation, to salvage a satisfactory result in juxtaarticular, intraarticular fractures of the proximal tibia, when associated soft tissue compromise prevented standard fixation with plates and screws. The small pin circular fixator allows juxtaarticular placement of the small pins, enhancing stabilization of the comminuted fractures, allowing early range of motion of the joint and early patient mobilization. The small diameter pins support the soft cancellous bone fragments. This technique attempts to combine the benefits of traction, external fixation, and limited internal fixation. We recommend this method as a salvage procedure when plates and screws are contraindicated because of poor bone and soft tissue conditions.