الفهرس Only 14 pages are availabe for public view
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Abstract
The tremendous energy release that occurs with such fractures injuries the vulnerable soft tissue in an area where there is no muscle cover and where the vascularity is marginal clue to limited anastomoses between the major vessels. Associated soft tissue injuries include contusions, fracture blisters, open wounds, compartment syndrome, and neuro-vascular injury. As a result of this past experience, treatment protocols have shifted over the years from non-operative management to open reduction and internal fixation (ORIF) to external fixation and limited internal fixation and even spanning external fixation. The most recent protocol of treatment is tow staged protocol. This is widely accepted. As an alternative to extensive open methods, external fixator + minimally invasive osteosythnthesis (MIO) offers a new perspective of early functional treatment, weight bearing and a rare loss of reposition for these difficult fractures. The fixator offers the possibility of indirect reduction and stabilization and accurate alignment without soft tissue stripping. These are very attractive features in this injury subset that made the external fixator the treatment of choice for these high - energy fractures. It is favored in geriatric non - cooperative patients and in fractures with severe soft tissue damage. Minimal exposure and limited internal fixation can still be done if needed. The advantages of using circular wire or hybrid external fixator compared to traditional external fixation, casts, or internal fixation are numerous, including stability, preservation of vascularity, immediate joint motion, minimal operative risk, and minimal blood loss with early patient ambulation, reduced hospital stay and decreased treatment costs. Tow staged protocol has the advantage of the external fixator and that of internal fixation with preservation of soft tissues which is the important factor in treatment