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Abstract From January 1999 until December 2003 we used a plate fixator with multidirectional blocked screws (TiFix) for internal fixation of the proximal tibia in 42 patients. In 23 cases this was used to stabilise fractures: in 11 cases for primary fracture management, in a further 11 after initial management with an external fixator and in 1 after initial fixation with a conventional plate. We also used the TiFix plate in 13 operations for pseudarthrosis and 6 for axis deviation after bone healing. In 34 (80.9%) of the total of 42 cases it was possible to implant the plate in a minimally invasive procedure. At the time of clinical follow up the treatment was complete in 39 (92.9%) cases. Fracture consolidation has been achieved in all cases; no implant failures have been observed. One patient developed a deep wound infection around the plate after revision for pseudarthrosis; in this patient swabs taken intraoperatively had proved positive for staphylococci. Our results underline the high effectiveness of this internal fixator system with multidirectional angular stability in osteosynthesis for proximal tibial fractures. This implant together with the minimally invasive operation technique achieves superior results and low morbidity in the primary treatment of proximal tibial fractures and in treatment of nonunion after such fractures sustained earlier.

Abstract From September 1997 to December 2000, 25 fractures and 20 psaeudarthroses in 44 patients were treated by fixed-angle plating; in 92% of these cases a minimally invasive tunneling technique was used. Fifteen fractures had initially been stabilized by means of an external fixator, the internal fixator being implanted as a second step once consolidation of the soft tissue had been achieved. Revision of a pseudarthrosis was always combined with autologous bone grafting. Follow-up examinations were possible in all 44 patients after an average of 22 (range 9–48) months, and all fractures and pseudarthroses were found to have healed. No secondary loss of reduction or implant failure was seen. In 4 patients deep infection at the plate occurred, but was successfully treated by early implant removal. Full weight-bearing was possible after a mean of 15.2 (range 8–26) weeks for the fracture patients and of 17.1 (mean; range 8–52) weeks for the pseudarthrosis patients. These results show that the multidirectional fixed-angle internal plate fixator implanted by a minimally invasive technique has proved very reliable in the treatment of fractures and pseudarthroses of the distal tibia.