Abstract
Proximal juxta-articular leg fractures are often high-energy injuries, involving the tibial articular surface as well as diaphyseal segments. Young, active people are frequently affected, and optimal reduction, effective stabilization, early function and a rapid return to daily-life are the goals of treatment.
These fractures are, as well known, difficult to treat, because of the frequent articular involvement, fragment comminution and extension of the fracture rim: if not adequately treated, they might result in mal-union, non-union, articular stiffness and late arthrosis.
Mal-union, both angular and rotational, are, in many cases, very difficult lesions to treat, almost always requiring osteotomies, osteointegration and stable fixation: we present our experience in the treatment of these lesions, with the results obtained in 31 cases treated with a minimum of 1 year of follow-up. The same protocol was used in all patients: direct surgical approach to the lesion, removal of any implanted device, careful débridement of the mal-union site (mainly directed to complete interposed fibrous tissue removal), deformity correction, stable internal fixation and osteointegration, whenever necessary, by autologous or homologous bone. We evaluated all cases in terms of patient satisfaction, deformity correction, bone healing and functional recovery: one major complication occurred (nail failure); delayed skin healing was seen in three patients (one requiring re-operation), and one patient there was rupture of a distal locking screw. In conclusion, this method is effective in the treatment of these lesions.
