Treatment of complex tibial plateau fractures using Ilizarov external fixator with or without minimal internal fixation

Abstract

Background The tibial plateau is a critical weight-bearing area located on the upper end of the tibia. The lesion may be restricted to the tibia or associated with significant soft-tissue injury. The aim of the present study is to assess the results of closed reduction and Ilizarov external fixation in management of comminuted tibial plateau fractures. Patients and methods The study included 20 patients with high-energy tibial plateau fractures (Schatzker types V and VI). The ages ranged from 23 to 56 years, with an average of 30 years. The trauma was a road traffic accident in 11 cases and a fall from a height in nine cases. The fractures were closed in 16 cases and open in four cases. The open fractures were Gustilo–Anderson type I in one case and type II in three cases. Soft-tissue injuries associated with closed fractures were classified according to Tscherne system. The follow-up period averaged 31 months. The mean duration of surgery was 70 min (range: 40–120 min). The mean time to union was 10.4 weeks. At the final follow-up, the average total range of knee flexion was 112.5° (range: 0–170°). Results Results were satisfactory in 18 cases and unsatisfactory in two cases according to the Rasmussen knee functional score. Complications included pin-tract infection in 12 cases, an extension lag in two cases and varus deformity of about 15° in one case. Conclusion Hybrid external fixation is a good method for the treatment of comminuted tibial plateau fractures. It allows for early joint movement and reduces the risk of serious complications.