Abstract
Objective: Complex tibial plateau fractures are caused by variety of mechanisms and have different fracture patterns, may be associated with soft tissue injuries, compartment syndrome, blistrations. Restoration of joint congruity, limb alignment, early range of motion, with a stable knee is difficult at times. We studied efficacy of JESS (Joshi’s External Stabilizing System) with or without limited fixations in these complex tibial plateau fractures. Material and Methods: 32 patients of complex tibial plateau fractures (Schatzker type V and VI) associated with severe soft tissue injury, crushing , compartment syndrome were studied. All cases were treated by Joshi’s External Stabilizing System with or without limited fixation by cannulated cancellous screws. Progress and complaints of the patients were recorded in accordance with Rick/Delamertier and Meason Hohl scoring system. Follow up of patients was at regular interval of 4 weeks for 6 months and thereafter 6 monthly. Results: Out of 32 patients of complex tibial plateau fractures ( 23 Schatzker Type VI and 9 Type V) with mean age 37.47 (range 20-68) years had right knee injury (n=20) more than left knee (n=12). Mean interval period between injury and the surgery was 6.44 (range 3-16) days. Mean duration of hospital stay was 9.03 (range 525) days. Mean range of flexion was 112.19 0 (range 75 0 -130 0 ), Extensor lag of 5 0 -10 0 seen in 4 cases. 26 patients have no limitation in activity. Post operative complications like superficial / Pin tract infection in 7, deep infection in 1 and non-union in 1 case were observed. Excellent in 26, good in 4 and satisfactory results in 2 patients were observed in this study. Conclusion: JESS (Joshi’s External Stabilizing System) combined with limited fixation is a good alternative technique in management of complex tibial plateau fractures. This technique works on the principle of ligamentotaxis. JESS construct helps to take care of wound and dressings and permits early physiotherapy and
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