Functional Outcome of Complex Tibial Plateau Fractures Using Hybrid External Fixators
Introduction: Tibial plateau fractures are associated with communition and soft tissue injury and are usually managed with ORIF (Open Reduction and Internal Fixation). The hybrid external fixer helps to reduce the associated complications by allowing early mobilization and weight bearing, minimal soft tissue damage, and stable fixation. In this study, we assessed the complications, clinical outcome scores, and postoperative range of knee movements associated with Schatzker type 5 and 6 tibial fractures.
Aim: To study the functional outcome and role of hybrid external fixators in complex tibial plateau fractures.
Methods: The study included 75 patients with Schatzker type 5 and 6 fractures who underwent open/close reduction with a hybrid external fixator. Informed consent was obtained from all the patients and a 2 months post-operative follow-up was done. The analyses were performed with NEER’s RATING SYSTEM FOR KNEE.
Results: The mean age of the patients was 51.28±14.28 years and a male predominance prevailed. RTA accounted for 68% of the fractures and with hybrid external fixator, excellent results were achieved in 60% of the cases. knee stiffness, pin site infection, malunion and limb shortening were the associated complications.
Conclusion: A promising alternative therapy for high-energy plateau fractures is a hybrid external fixator. It permits a safe fixation of fraction fragments, early joint recovery and the treatment of related soft tissue injuries with minimum complication rates.
Korres DS, Soucacos PN. Complications after tibia plateau fracture surgery.
Injury. 2006; 37: 475–84.
2. Benirschke SK, Agnew SG, Mayo KA, Santoro VM, Henley MB. Immediate
internal fixation of open, complex tibial plateau fractures: treatment by a
standard protocol. Trauma. 1992; 6:78–86.
3. Mallik AR, Covall DJ, Whitelaw GP. Internal versus external fixation of
bicondylar tibial plateau fractures. Orthop Rev. 1992; 21:1433–6.
4. Sirkin MS, Bono CM, Reilly MC, Behrens FF. Percutaneous methods of
tibial plateau fixation. Clin Orthop Relat Res 2000; 375:60-8.
5. Weiner LS, Kelley M, Yang E, Steuer J, Watnick N, Evans M, et al. The
use of combination internal fixation and hybrid external fixation in severe
proximal tibia fractures. J Orthop Trauma 1995; 9:244-50.
6. Bianchi-Maiocchi A, Aronson J. Operative Principles of Ilizarov. Baltimore:
Williams & Wilkins; 1991.
7. Piper KJ, Won HY, Ellis AM. Hybrid external fixation in complex tibial
plateau and plafond fractures: An Australian audit of outcomes. Injury. 2005;
36:178–84. [PubMed] [Google Scholar]
8. Watson JT, Ripple S, Hoshaw SJ, Fhyrie D. Hybrid external fixation for
tibial plateau fractures: Clinical and biomechanical correlation. Orthop Clin
North Am. 2002; 33:199–209. ix.
9. Karunakar MA, Bose MJ. Rockwood and Greens Fracture in Adults. 5th ed.
Ch. 231-245. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.
10. Farrar M, Yang L, Saleh M. The Sheffield hybrid fixator – A clinical and
biomechanical review. Injury 2001;32 Suppl 4:SD8-13.
11. Schatzker J, Mc Broom R, Bruce D. The tibial plateau fracture: the Toronto
experience: 1968–1975. Clin Orthop Relat Res. 1979; 138:94–104.
12. Krupp RJ, Malkani AL, Roberts CS, Seligson D, Crawford CH, 3rd, Smith L.
Treatment of bicondylar tibia plateau fractures using locked plating versus
external fixation. Orthopedics. 2009;32: 559.