Treatment of high-energy tibial plateau fractures using the Ilizarov circular fixator

Abstract

Background We treated 30 patients with high-energy fractures of the tibial plateau using Ilizarov fixators and transfixion wires: 10 fractures were open and 20 patients had complex injuries. Of the patients, 15 were treated by ligamentotaxis and percutaneous fixation, eight by limited open reduction and seven by open reduction bone graft and screws. There is, however, no ‘gold standard’ procedure for this complicated and multidisciplinary condition. Patients and methods Between October 2007 and October 2010 we treated 30 consecutive patients with severe bicondylar fractures of the tibial plateau using Ilizarov fixators. Ten (33.3%) fractures were open. There were 10 Schatzker type V and 20 type VI fractures; 20 (66.6%) were comminuted. Thirteen patients (43.3%) had complex knee trauma, which describes injuries that include more than one of the functional compartments of the knee, such as the soft-tissue envelope, the ligamentous stabilizers and the bony structures of the distal femur and the proximal tibia. Results All fractures united within a mean duration of 14.4 weeks. The femoral fixator was removed at a mean duration of 6 weeks (4–7 weeks), and the tibial fixator was retained for a mean duration of 13 weeks (12–20 weeks). Full weight-bearing was allowed at a mean time interval of 14.4 weeks (12–24 weeks). The patients were followed up for a mean duration of 36.5 months (24–53 weeks). The results were assessed according to the criteria of Honkonen and Jarvinen, which consider the subjective opinion of the patient, the clinical state, the function and the radiological assessment. Fifteen patients achieved full extension and the other 15 had an extension deficit of less than 6°. Ten patients had an extension lag of 6–10°, and five patients had a lag of more than 10°. On the basis of the clinical criteria 10 results were excellent, 10 were good, five were fair and five were poor. Conclusion Our study emphasizes the low morbidity associated with the Ilizarov method. No patient developed osteomyelitis or septic arthritis. This absence of infection and septic nonunion compares favourably with the results of other published studies on these complex injuries. The technique is well suited to the management of complex fractures of the tibial plateau when extensive dissection and internal fixation are contraindicated because of comminution at the fracture site and compromise of the soft tissue.