Treatment of High-Energy Tibial Plateau Fractures by the Ilizarov Circular Fixator

Abstract

All the fractures united, with an average time to healing of 14.4 weeks. Thirteen patients achieved full extension and 13 more than 110° of flexion. Twenty-two knees were stable. Fifteen patients walked normally and the rest with only a slight limp. All but two knees had an articular step-off of less than 4 mm and all had normal axial alignment except two. There were no cases of postoperative skin infection, osteomyelitis or septic arthritis.Ilizarov circular fixation is an ideal method of treatment for these fractures when extensive dissection and internal fixation are contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution. [Br] 1996;78-B:710-7. Received 16 November 1995; Accepted after revision 15 February 1996 Bicondylar high-energy fractures are associated with severe articular depression, separation of both condyles, diaphyseal comminution and dissociation and loss of integrity of the soft-tissue envelope. They occur primarily in younger patients usually with multiple injuries. J Bone Joint SurgThe most popular treatment has been open reduction and internal fixation with double plating (Müller et al 1979;Schatzker, McBroom and Bruce 1979;Waddell, Johnston and Neidre 1981;Edwards 1983;Moore, Patzakis and Harvey 1987;Schatzker 1987; DeCoster, Nepola and ElKhoury 1988;Benirschke et al 1992;Tscherne and Lobenhoffer 1993;Watson 1994), but this is associated with many complications such as joint stiffness, malunion, skin loss, osteomyelitis, amputation and even death. The incidence has been as high as 50% in some studies (Rittman et al 1979;Perry et al 1984;Moore et al 1987;Schatzker 1987;Stokel and Sadesivan 1991) and the occurrence of postoperative skin infection and osteomyelitis has been reported as 42% and 33%, respectively (Uhl et al 1994). To reduce the incidence of such problems minimal internalexternal fixation through limited approaches has been attempted with some good results (Murphy, D'Ambrosia and Dabezies 1991; Tscherne and Lobenhoffer 1993;Carr 1994;Stamer et al 1994;Watson 1994).An alternative method was proposed by Ilizarov (Catagni 1991; Ilizarov 1992), and we have adopted his techniques for the treatment of fractures and nonunion (Dendrinos, Kontos and Lyritsis 1995;. In this prospective study we have used this method for the management of high-energy fractures of the tibial plateau. PATIENTS AND METHODSBetween October 1989 and July 1993 we treated 24 consecutive patients with severe bicondylar fractures of the tibial plateau by the Ilizarov fixator (Table I). They were reviewed at a minimum of 24 months and the level of function, clinical and radiological findings and the patients' opinion were assessed. There were 18 men and 6 women with a mean age of 39 years (18 to 69). Four patients were car drivers or passengers, eight were pedestrians struck by motor vehicles and seven were motor-cycle riders. Four had been injured by falls from a height and one had a crush injury caused by a collapsed wall. Eleven (46%) of the fractures were open. There we...

Study of surgical management of proximal tibial fractures using locking compression plate

“…Among modes of injury road traffic accidents are the most common (93.3%) with more (73.3%) fractures on right side. These are comparable to the studies made by Dendrinos et al [2], Barei et al [3] and Patil et al [4].…”

Double plating of unstable proximal tibial fractures using minimally invasive percutaneous osteosynthesis technique

“…The low incidence of soft tissue problems and infection seems to be lower than after conventional open plating. The fracture alignment we obtained was probably better after external fixation (Dendrinos et al 1996, Duwelius et al 1997.…”

Outcomes following the treatment of bicondylar tibial plateau fractures with fine wire circular frame external fixation compared to open reduction and internal fixation: A systematic review

“…The two key elements consist of the widespread use of contoured locking periarticular plates, 20,28 in addition to the wider use of modern circular frame external fixation in the primary management of fractures. 29,30 Despite such shift in the treatment approaches there has been paucity of highlevel research comparing the newer techniques. The studies presented here constitute the best available evidence to date addressing our research question.…”

“…28 Similarly, the use of fine wire circular frame as primary fixation was potentiated by the introduction of modern frames. 29,30 Despite this relatively wide interest, general consensus remains absent. Unanswered questions prevail on the superiority of fine wire circular frame fixation in terms of reduced soft tissue complication and their non-inferiority in terms of quality of fracture reduction and stabilisation.…”