Combination of Fine Wire Fixation and Limited Internal Fixation for High-Energy Tibial Plateau Fractures: Functional Results at Minimum 5-Year Follow-up

Background: Fractures of the proximal tibia involve a major weight bearing joint and are intra-articular injuries which frequently result in functional impairment. They require an accurate reduction of the articular surface with stable internal fixation. If these fractures are not managed appropriately, they often result in high rates of morbidity in the form of knee stiffness and arthritis. This study was done to assess the functional and radiological outcomes following various surgical modalities and to compare them with other studies as available in literature.Methods: 30 patients with tibial plateau fractures treated by various surgical modalities at Saveetha Medical College and Hospital were studied from January 2013 to February 2015 and were followed up for a minimum period of 6 months. Functional and radiological outcomes were assessed by the Rasmussens scoring system.Results: All 30 patients fulfilling the inclusion criteria were thoroughly evaluated and were taken up for surgery with various modalities of fixation which included cannulated cancellous screws, T and L buttress plates and locking compression plates. Articular surface elevation with bone grafting was done in depressed fractures. Early knee mobilization was started and strict non-weight bearing walking was advocated. We had a 90% acceptable functional result which was comparable with other studies.Conclusions: In our study, we conclude that accurate reduction of the articular surface with stable internal fixation and early mobilization with bone grafting in depressed fractures with protracted weight bearing till fracture union gives good functional results. Also radiological values often do not often correlate well with functional outcomes.

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

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174601 ◽

2017 ◽

Vol 5 (10) ◽

pp. 4582

Author(s):

Alamgir Jahan ◽

Muhammad Haseeb ◽

Fahad Wazir

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

External Fixator ◽

Tibial Plateau ◽

High Energy ◽

Deep Infection ◽

Tibial Plateau Fractures ◽

Open Fractures ◽

Hybrid External Fixator ◽

Primary Management

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.

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Tibial plateau fractures

10.1093/med/9780199550647.003.012056 ◽

2011 ◽

Author(s):

Phil Walmsley ◽

John Keating

Keyword(s):

Internal Fixation ◽

External Fixation ◽

Tibial Plateau ◽

Soft Tissues ◽

Plate Fixation ◽

High Energy ◽

Soft Tissue Envelope ◽

Fine Wire ◽

Peroneal Palsy ◽

Lateral Plateau

♦ Split depression pattern lateral plateau most common type♦ Bicondylar and medial plateau fractures high energy injuries♦ Compartment syndrome, vascular injury, and common peroneal palsy may occur with high energy patterns♦ Internal fixation preferred treatment with good soft tissue envelope♦ Limited internal fixation suitable for many simple patterns♦ Plate fixation preferred for medial and bicondylar fractures♦ External fixation used with poor soft tissues♦ Fine wire external fixation should be considered for most complex patterns.

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Functional Evaluation in High Energy (Schatzker Type V and Type VI) Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation

International Scholarly Research Notices ◽

10.1155/2014/589538 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Kavin Khatri ◽

Devendra Lakhotia ◽

Vijay Sharma ◽

G. N. Kiran Kumar ◽

Gaurav Sharma ◽

...

Keyword(s):

Internal Fixation ◽

Wound Infection ◽

Open Reduction ◽

Tibial Plateau ◽

Oxford Knee Score ◽

High Energy ◽

Tibial Plateau Fractures ◽

Functional Evaluation ◽

Schatzker Type ◽

Type V

Objective. To review functional outcome in high energy tibial plateau fractures treated by plating. Design. Retrospective analysis. Material and Methods. Sixty-five patients with Schatzker type V and type VI tibial plateau fractures treated with open reduction and internal fixation using plates were included in the study. The functional evaluation of the patients was carried out with Oxford knee scoring. Results. Fifty-four cases (83%) had Oxford knee score between 40 and 48. Seven (10.7%) had score between 30 and 39, three (4.6%) had score between 20 and 29, and one patient (1.5%) had a score of 18. Delayed union was seen in two cases and nonunion was seen in one case. The superficial wound infection was noticed in (9.2%) patients which was resolved with regular dressings and oral antibiotics. Three (4.6%) patients had developed deep wound infection and one among them had developed osteomyelitis. Conclusion. Open reduction and internal fixation in high energy tibial plateau fractures can provide good functional results in appropriately selected cases.

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