Role of Joshi's external stabilization system with percutaneous screw fixation in high-energy tibial condylar fractures associated with severe soft tissue injuries

Abstract

PurposeThe treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries. MethodsBetween June 2008 and June 2010, 25 consecutive patients who were 17–71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade I & II). The injury mechanisms were motor vehicle accidents (n = 19), fall from a height (n = 2) and assault (n = 1). The fractures were classified according to Schatzker classification system. ResultsThere were 7 type-V, 14 type-VI and 1 type-lV Schatzker's tibial plateau fractures. The average interval between the injury and surgery was 6.8 days (range 2–13). The average hospital stay was 13 days (range, 7–22). The average interval between the surgery and full weight bearing was 13.6 weeks (range 11–20). The average range of knee flexion was 121° (range 105º–135°). The normal extension of the knee was observed in 20 patients, and an extensor lag of 5º–8º was noted in 2 patients. The complications included superficial pin tract infections (n = 4) with no knee stiffness. ConclusionJESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high-energy tibial condylar fractures associated with severe soft tissue injuries.