Functional outcome of 59 patients of bicondylar tibial plateau fractures treated with internal vs external fixation: Selection criteria

Abstract

Background: The purpose of this prospective study was to evaluate the Functional results of Internal versus External fixation of bicondylar tibial plateau fractures decided on specific selection criteria.Materials and Methods: Fifty nine patients with tibial condyle fractures (Schatzker type V and VI) were recruited in the study between Nov 2013 and Dec 2015 at our tertiary care hospital in Bengaluru, India. Open reduction and internal fixation with Dual Buttress plates, Buttress plate and CC screws was done in 38 patients (closed, Type I & II open with good skin conditions). Hybrid External fixation was done in 21 patients (closed, Type I & II open with bad skin conditions, Impending compartment syndrome). They were followed up at six weeks, six months and twelve months and was evaluated for the functional outcomes by Hospital for special surgery knee scoring system (HSS). Result: 86% of our patients had good to Excellent results according to HSS score. The outcomes between both modes of fixation were not significantly different at 1 year follow up. There was no difference in total arc of knee motion. Mean range of knee flexion in internal fixation was 115.79 + 21.290, External fixation was 115.24 + 13.370. Average HSS Score at final follow up for internal fixation was 78.87 + 10.94 and external fixation was 78.71 + 9.05. 2 patients needed flap surgery due to wound complications, 3 patients experienced infection following internal fixation compared to external fixator. 1 patient experienced non union following external fixation.Conclusion: Both methods of fixation in Bicondylar tibial plateau fractures gives a favourable functional outcome provided selection criteria is followed strictly. Level of Evidence: Level 3.