Treatment of complex tibial plateau and distal tibial fractures with Taylor spatial frame: experience in a district general hospital

Abstract

Complex tibial fractures especially intraarticular pilon and plateau fractures are difficult to manage. Literature shows poor results in the treatment of these fractures due to complexity of the fracture and involvement of articular surface. Taylor spatial frame (TSF) is a hybrid, multiplanar, external fixator, which uses the slow correction principles of Ilizarov system. Specialised centres around the world use these frames to treat various long bone fractures and to correct deformities. Very few district general hospitals and hospitals of similar set-up deal with these injuries. TSF was used to treat 26 complex intraarticular fracture of tibial plateau (Schatzkar type IV–VI) and pilon fractures (Rudi III) in a district general hospital. Seventeen were pilon and nine were plateau fractures. There were 21 male and 5 female patients. Average length of time patients had the frames on was 191 days. The average follow up was 14 months. The average operative time was 2 h 13 min for pilon fractures, 2 h 37 min for tibial plateau fractures. Fourteen patients did not have any complications. Twelve had 1–3 pin-site infection. Four had chronic pain. Two pilon fractures had delayed union and one had nonunion. One patient had foot compartment syndrome and underwent decompression. No cases of osteomyelitis, broken pins or nerve palsy occurred. With proper training, preoperative and postoperative care, TSF can be used in a district general hospital safely. The procedures can be planned well in advance. Referral to specialist centre, possible complications during transfer and a second procedure at the referral centre could be avoided.