Treatment of High Energy Tibial Plateau Fractures with Hybrid External Fixation

Abstract

Objective: The current study aimed to assess the treatment results of high energy tibial plateau fractures with hybrid external fixation. Methodology: It included 20 adult patients (17 males and 13 females). At emergency rooms, patients were clinically and radiologically evaluated according to standard protocols, then the assessment was completed and treatment was started in the inpatient department. Preoperative preparation was completed according to standard protocols. Then, the surgical fixation was performed and the patient scheduled for postoperative evaluation. Radiological evaluation had been achieved by anteroposterior and lateral X-ray of the knee and leg. Computed tomography and Doppler ultrasound were requested for specific patients when indicated. Routine laboratory investigations were carried out. All operations carried out under spinal anesthesia. The 1st follow up visit was at the 2nd week postoperative, and follow up was done every 2 weeks. In each visit, patient was assessed clinically and by radiological investigations. Results: Five patients (25 %) had excellent, 8 patients (40%) had good, 2 patients (10 %) had fair, 5 patients (25%) had poor final result. In addition, 13 patients (65%) had no varus or valgus angulation, 18 patients (90 %) had 0-5mm limb shortening, 14 patients (70 %) had normal knee range of motion, 12 patients (60 %) had no pain and 14 patients (70 %) had normal gait. Two patients had non-union treated by removal of Ilizarov, proximal tibial locked plate, autologous iliac bone graft. 6 patients had multiple degrees of stiffness treated by physiotherapy and had fair, good outcomes, 3 patient had Pin track infection treated by surgical debridement with good outcome, 1 patient had deep vein thrombosis DVT treated by anticoagulant medication. Conclusion: Hybrid external fixation is a safe and effective treatment modality for tibial plateau fractures.