Purpose. To assess results of small wire external fixation using a ligamentotaxis technique for high-energy tibial plateau fractures. Methods. Between April 2002 and May 2004, 38 consecutive patients aged 21 to 60 (mean, 32) years underwent small wire external fixation for high-energy tibial plateau fractures. 15 involved the right and 23 the left knee. 34 were closed and 4 were open injuries. Fractures were classified according to Schatzker's staging system. After a minimal of 2 years' follow-up (range, 24–42 months), each affected knee was evaluated using Rasmussen's (1) 30-point clinical grading system and (2) radiological evaluation. Results. There were 22 type-VI and 16 type-V Schatzker tibial plateau fractures. Complications consisted of: 2 superficial infections, 3 pin site infections, and 4 peroneal nerve palsies. No soft tissue necrosis or devitalisation occurred. The mean range of knee movement was 132°. The mean Rasmussen radiological score was 14 (range, 10–18): excellent in 6, good in 26, and fair in 6. The mean Rasmusssen functional score was 26 (range, 17–30): excellent in 19 patients, good in 17, and fair in 2. Clinical results did not parallel the radiological results. Conclusion. Small wire external fixation allows anatomical reconstruction of the articular surface, stable fixation of fracture fragments, early movement of the joint, and care of associated soft tissue injuries, without a high rate of complications.
High energy tibial plateau fractures treated with hybrid external fixation