Management of comminuted tibial plateau fractures with external fixator using ligamentotaxis principle

Abstract

Background The treatment of proximal tibial fractures is often challenging, and internal fixation is occasionally associated with problems in wound healing due to frequently coexisting soft tissue injuries. Objective This study evaluated the performance of an external fixator in the treatment of different types of proximal tibial fractures by ligamentotaxis principle. Materials and methods Between March 2002 and June 2007, 50 proximal tibial fractures in 48 patients were treated with Ilizarov external fixator in Benha University and health insurance hospitals. The mean age was 39 years (range 19-57 years), and the mean follow-up period was 36.5 months (range 24-50 months). Fracture categorization was performed according to AO/ASIF; closed reduction was performed most often by closed means in 26% of cases or through miniopen incision in 74% of cases. Clinical and functional evaluation of patients in the tibial plateau group was performed using the Knee Society clinical rating score. Results The overall functional outcome of treatment of comminuted tibial plateau fractures treated by indirect reduction and ring fixator in this study was excellent in 18 cases, good in 22, fair in eight cases, and poor in two cases. All fractures in this series eventually healed. Conclusion Ring frames provide mechanical stability of the comminuted tibial plateau fracture. The excellent stabilization of fracture allows early ambulation of the patient with partial weight bearing; even in comminuted fractures, there is beneficial biologic influence of the early weight bearing on osseous healing.