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Objective: With the transportation industry, the development of the construction industry, more and more high-energy injury, severe soft tissue injury and fracture crushing damage to the other parts, and are often combined. The high-energy proximal tibia metaphyseal injury is more common in clinical practice, often multiple traumatic part of simple closed fractures are essentially different, and difficult to treat. We design selected the cross screw placement method dual unilateral external fixator static the tibial metaphysis high energy injury. This article mainly through biomechanical test this configuration external fixator fixation strength with several other devices compare, understand their stability; addition the holder as a terminal treatment of 26 cases of proximal tibial metaphyseal high energy injury patients follow-up, an objective analysis of the efficacy, summarizes the use of standard static cross-set nail method dual unilateral external fixator method explore effective methods of treatment of proximal tibial metaphyseal high-energy injury. Method: a cross set static nailing double unilateral external fixator fixed proximal tibia metaphyseal fracture fixation strength with several other instruments biomechanics 15 fresh frozen the donkey calf bone specimens into prepared AO4.1 . A3 fracture model, divided into 3 groups, respectively, followed by a single external fixator, cross-the screw placement method double unilateral external fixator static hybrid external fixator, single plate and dual plate fixation were performed axial compression test, reversing test, and record numerical and experimental data into the SPSS 11.5 statistical software, one way ANOVA test, SNK method for pairwise comparisons and statistical inference. Clinical applications since January 2006 to December 2007, we use cross home nailing double unilateral static force external fixation of the proximal tibia metaphyseal injury in 30 cases of high-energy, get follow-up and complete clinical data of 26 cases , 27 sides, 16 sides of open fractures, accounted for 59.3%, according to the Gustilo-Anderson typing Ⅱ type above 62.5%, closed fracture 11 cases of 11 side, according to Tscherne closed fractures and soft tissue damage classification phase Ⅱ injury 63.6 %. Which the combined popliteal artery injury in 2 cases, and two cases of peroneal nerve injury, the BDC of ipsilateral fork ligament fracture in 1, three cases of severe contusion tibialis anterior muscles. Soft tissue injury at the same time fracture crushed fractures according to the AO / ASIF classification type A2 side the A3 18 side, the C2 type 2 side. Combined with other injuries accounted for 85%, the combined 1 cases of splenic rupture in three cases, brain trauma and blood pneumothorax ipsilateral femur fracture in 10 cases, the ipsilateral acetabular fracture in 1, the ipsilateral foot injuries two cases, two cases of mandibular fractures. The follow-up record fracture healing time, range of motion, complications, patient satisfaction. Results: The a biomechanics test results in axial compression experiments, as the load increases, the displacement of the fracture is increasing, when loaded to 600N fracture displacement of each group were single plate group 0.397 ± 0.080mm, double plate group 0.144 ± 0.008mm, the external fixator group 2.035 ± 0.071mm, dual external fixator group 0.562 ± 0.082mm, hybrid external fixator group 3.797 ± 1.344mm. Torsion test, as the torque increases, the torsion angle is increasing, when twisted to 10Nm torsion angle of each group were single steel plate group 26.468 ± 0.420 °, 7.527 ± 0.120 ° double plate group, single external fixation rack group 26.720 ± 0.610 ° Dual external fixator group 18.382 ± 0.330 ° 26.528 ± 0.500 ° hybrid external fixator group. Dual external fixator group, double-plate group, single-plate group mean based on the the SNK method statistical results, the axial compression experiments, respectively 0.562,0.144,0.398, three groups are the probability of the number of comparisons to 0.529, in accordance with 0.05 testing standards, does not reject the null hypothesis that the three groups are the number of no significant difference in the external fixator group (mean 2.035), mixed external fixator group (mean 3.797) respectively as compared with a significant differences. Torsion loading experiments, the mean single fixation group, single-plate group, mixed external fixator group were 26.468,26.528,26.720, three groups were compared probability 0.629 0.05 standard inspection does not reject the null Assume that these three groups are the number of no significant difference with dual external fixator group (mean 18.382), dual plate group (mean 7.528) compared, respectively, with a significant difference. 2 clinical follow-up results of 26 patients were followed up for 6 to 20.5 months, an average of 12.5 months, 23 of which side of the fractures healed, three side cases the fracture the obvious healing signs line with autologous bone grafts review the bone defect after 3 months After healing. The cases were cases of delayed healing power after a month to heal. Fracture healing time of 3 to 9 months, with an average of five months; The external fixator Time 4.5 to 15 months, with an average of 7.2 months. 7 days to 3 months after surgery, the patient may crutches or abandoned Shui weight-bearing walking. Merchant and other composite score of the tibia and fibula fracture surgery score excellent in 17 side, the 7 good side, 2 side, poor side, good rate of 88.9%. The group of 26 cases, pin tract complications occurred in 20 cases, accounting for 76.9%. A total of 173 of the screw channel, pin tract for 41 holes, accounting for 23.7%, the majority were cured by pin tract care, 11 holes of pin tract infection, accounting for 6.4%, which screws loose five holes (2.9%), oral antibiotics change the screw position or to go other than the holder healing did not happen osteomyelitis and septic arthritis. 6 patients always pin tract infection did not occur. Not obvious complications in surgery, postoperative patients with functional exercise extensor hallucis longus tendon injury, lower extremity deep vein thrombosis symptoms did not occur compartment syndrome. The offset of the axis of the tibia are not found in the course of treatment. Conclusion: This configuration of external fixation in axial compression resistance and resistance to torsional strength is much larger than a single plate, single frame and ring frame, and there is a significant difference, although not as strong with two plates, but for the proximal tibia metaphyseal end fracture can be achieved sufficiently stable. This choice of high-energy injury fixation devices for proximal tibial metaphyseal provide a biomechanical basis, can also be of great value in guiding patients with early functional exercise. Due to high energy as a terminal treatment of 26 cases of cross-the law double unilateral pedicle screws static external fixator soft tissue injuries of the proximal tibia bone fracture in patients with clinical follow-up observation, that the application of this method, there is trauma, reset fixed firmly, functional exercise early fracture healing faster and less complication, can be recommended as a terminally choice of treatment.
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