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1Principles of hybrid external fixation

By bridging from the epiphysis to the diaphysis, the fixator stabilizes the metadiaphyseal region.

Intraarticular fractures should be anatomically reduced and held with lag screws or reduction wires.

More complex fracture patterns, with articular fragment displacement, may require a separate open reduction. Interfragmentary fixation, typically with lag screws, should be added in a way that also permits wire placement.

A ring fixator may be useful to hold complex proximal fractures, and attached to the tibial shaft with pins and rods (hybrid fixation).

Details of external fixation are described in the basic technique for application of modular external fixator.

Specific considerations for hybrid external fixation and the proximal tibia are given below.