Treatment of high energy tibial plateau fractures with hybrid external fixator: intermediate term outcome

Abstract

Background: High energy tibial plateau fractures pose a management challenge because of the complexity of bone and soft tissue trauma. Because of the frequency and magnitude of soft tissue of soft tissue injury in these fractures, early internal fixation becomes difficult. Wound breakdown and deep infection are common complications in plating of these difficult fractures. Primary management with hybrid external fixator can be a useful alternative to internal fixation in such cases.Methods: The study was a prospective case series done in the orhtopaedic department of a teaching hospital. 20 patients were studied. There were 13 Schatzker VI, 5 Schatzker V and 2 Schatzker IV fractures included. 4 patients had open fractures and 1 had compartment syndrome. Open fractures were operated in emergency department. Those with severe swelling and blisters were allowed few days to settle. Primary fixation using a hybrid external fixator was done. Mobilisation was started early. Patients were followed up to 1 year.Results: Union was obtained in all patients within 18 weeks. There was only deep infection. 95% patients had range of motion of 90 degrees or more. No patient had an extensor lag.Conclusions: Primary management of high energy tibial plateau fractures using hybrid external fixator is a reasonable option for cases that are not immediately amenable to internal fixation. It provides adequate stabilization to allow early motion and hastens patient rehabilitation. We have a good experience with this technique and recommend it for judicious use.

Treatment of High Energy Tibial Plateau Fractures with Hybrid External Fixation

“…The development of Ilizarov frame increased the capability of axial compression with dynamization around the fracture site with respect to the associated soft tissue injuries. The development of olive wires has offered new likelihoods to the external fixators for the management of complex fractures (7) In agreement with the present work, Jahan et al (8) performed a study on 20 patients, 13 Schatzker VI, 5 Schatzker V and 2 Schatzker IV fractures. In addition, there were 4 patients with open fractures and one patient had compartment syndrome.…”

Does Early Postoperative Rehabilitation Affect Pain, Function, and Satisfaction for Patients Underwent Microvascular Lower Limb Free Flap?

“…The present study finding showed that the majority of the control group and all patients participant in study group were males. This study result was supported by Jahan et al, (2017) confirmed that more than half of studied patients were males. From the researchers' point of view, males are more likely to expose to occupational trauma when they are expected to support and meet the financial needs of their families in current society.…”

Outcome of tibial plateau fractures treated by hybrid and Ilizarov external fixation

“…21 Jahan et al in 2017 had excellent results in 15 patients and fair in 4 patients. 22 In our study, 20 26 Bari et al in 2014 operated on 40 patients with Ilizarov external fixator and had 28 patients with excellent, 9 patients with good, 2 with fair and 1 patient with poor results. 27 Aziz et al in 2016 operated on 20 patients, 18 had excellent and good results, poor in 2 patients.…”

“…Mean time for radiological union in patients treated by Ilizarov fixator was 24.5 weeks (range 15 to 32 weeks) and in patients treated by hybrid fixator was 28 weeks. Mean fixator period was 26 weeks (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) week) in Ilizarov and 30 week in hybrid fixator. Both the fixators were removed after 2 weeks of union ( Figure 7).…”