Application of hybrid external fixation by the "joystick method" in bicondylar tibial plateau fractures: Technical note.

Abstract

This study aimed to present clinical outcomes in patients with tibial plateau fractures who were treated with hybrid external fixators and describe the details of our technique. Schanz screws were synchronously applied and used as a joystick for fracture reduction. The study population included 72 patients with bicondylar tibial plateau fractures classified as type 41-C2 according to the AO classification. Joint reduction was maintained using Schanz screws transmitted through tibial condyles as a joystick under fluoroscopy. The patients then underwent surgery with these Schanz screws and a hybrid external fixation system. The median age of the patients was 39 (21-67) years, and the median follow-up time was 21 (12-35) months. The mean knee flexion and extension were 105° (80°-125°) and 0° (-5°-7°), respectively. The mean varus laxity and valgus laxity were 4.30° (2°-7°) and 3.10° (2°-5°), respectively. Four patients had leg shortness of 0.4-1.1 cm. The external fixators were removed between 8 and 16 weeks (mean = 11 weeks) postoperatively. The KSS scores at the end of 1 year were "excellent" for 48 patients, "good" for 19 patients, and "inadequate" for 5 patients. With the synchronous application of the two Schanz screws of 6.5-mm thickness and the two-drill technique under fluoroscopic guidance, we obtained stable reductions over a short period. No patient experienced major complications, and this enabled early weight bearing and a return to daily living activities.