Dual Plate Fixation Compared with Hybrid External Fixator Application for Complex Tibial Plateau Fractures

Background: Tibial fractures is most common type of long bone fractures. Highspeed lifestyles with vehicles motorcycles as well as growing waves of violence, contributingincrease occurrence of tibial fractures. Tibial plateau fractures continues to be a challenge fororthopedic surgeon. Treatment of these fractures have been plagued by complications. Recentimprovements in the techniques and development of hybrid external fixator have revolutionizedthe treatment of such fractures. Objective: To evaluate the clinical outcomes of hybrid externalfixator in high energy Schatzkar V and VI tibial plateau fractures. Study Design: Descriptive,Case series. Period: 27 June 2013 to 26 June 2016. Setting: Nishtar Hospital, Multan. Materialand methods: A total of 125 patients with open and close tibial plateau fractures, 20 to 50 yearsof age of both genders were included in the study. Patients having history of pervious surgeryor intervention tibial plateau fractures, and h/o malignancy were excluded. All the patients wereoperated by a consultant orthopedic surgeon. Outcome was assessed at 16 weeks by serialradiological x-ray by formation of callus and noting any grade of pin track infection. Results; Ourstudy comprised of 125 patients having Schatzker V and Schatzker VI tibial plateau fractureswho met our inclusion criteria. Mean age of 38.925 ± 7.09 years. Majority of the patients 47(37.60%) were between 41 to 50 years of age. Mean duration since injury in our study was 13.18± 4.79 hours. Out of 125 patients, 102 (81.60%) were males and 23(18.40%) were females withmale to female ratio of 1.2:5.4. Fifty three (42.4%) patients presented with Schatzker V and 72(57.6%) had Schatzker VI type of tibial plateau fractures. In our study, non-union was seen in10cases (8.0%) and pin track infection was noted to be present in 19 (15.20%) patients. So, theacceptable outcome (achievement of union without non-union or pin track infection during 16weeks) was seen in 96(76.8%) patients. Conclusion: This study concluded that there is highrate of acceptable outcome (achievement of union without any non-union or pin track infectionduring 16 weeks) after hybrid external fixator of the open and closed fractures of tibial plateauamong the patients having schatzker-V and VI.

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Comment on Chang et al.: Meta-analysis shows that highly comminuted bicondylar tibial plateau fractures treated by single lateral locking plate give similar outcomes as dual plate fixation

International Orthopaedics ◽

10.1007/s00264-016-3196-1 ◽

2016 ◽

Vol 40 (10) ◽

pp. 2143-2144

Author(s):

Hao Yin ◽

Zhang Huang

Keyword(s):

Tibial Plateau ◽

Locking Plate ◽

Plate Fixation ◽

Meta Analysis ◽

Tibial Plateau Fractures ◽

Dual Plate ◽

Bicondylar Tibial Plateau

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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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Functional outcome of hybrid external fixator in proximal tibial fractures Schatzker type V and VI with Gustillo grade-II

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214959 ◽

2021 ◽

Vol 8 (1) ◽

pp. 43

Author(s):

Johney Juneja ◽

Mohzin Asiger ◽

Dinesh Kumar ◽

Mahendra P. Jain ◽

Gaurav Garg ◽

...

Keyword(s):

Soft Tissue ◽

External Fixator ◽

Tibial Plateau ◽

High Energy ◽

Tibial Plateau Fractures ◽

Bony Union ◽

Fracture Stabilization ◽

Hybrid External Fixator ◽

Schatzker Type ◽

Type V

<h2>Background: Management of high energy tibial plateau fractures along with extensive soft tissue damage is still challenging to many orthopaedic surgeons. This study evaluates the purpose of hybrid external fixator intreating high energy tibial plateau fractures with minimal invasion and accurate reduction.</h2><h2>Methods: Twenty patients with high energy Schatzker type V and VI tibial plateau fractures with severe soft tissue injury were enrolled into the study in RNT medical college, Udaipur.</h2><h2>Results: The results- bony union, range of movements and associated complications were assessed. All fractures united in an average time period of 20 weeks. Ten patients developed knee stiffness, five patients developed delayed union andthreenon-union.15 patients required split skin graft. Final outcome showed excellent score in 53 patients.</h2><h2>Conclusions: Hybrid external fixation is a safe option for managing complex high energy tibial plateau fractures by simultaneously providing adequate fracture stabilization and necessary protection to soft tissue healing to achieve bony union.</h2>

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Management of tibial plateau fractures with compromised soft tissue using hybrid external fixator

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204600 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1297

Author(s):

Mahesh K. Sharma ◽

Mukul Jain ◽

Harish K. Jain ◽

Sukhveer Khichar ◽

Rahul Jadoo

Keyword(s):

Soft Tissue ◽

External Fixator ◽

Tibial Plateau ◽

High Energy ◽

Tibial Plateau Fractures ◽

Neurovascular Compression ◽

Radiological Outcome ◽

High Energy Trauma ◽

Soft Tissue Envelope ◽

Hybrid External Fixator

<p class="abstract">Tibial plateau fractures with high energy trauma are complex injury due to its precarious soft tissue envelope. High energy trauma has high incidence of open fractures, articular depression, fracture comminution and displacement, soft tissue injury, and neurovascular compression. It is often difficult to achieve and maintain reduction and commonly predisposes to secondary arthritis. Hybrid external fixator minimizes the iatrogenic soft tissue damage, provides adequate fixation of the fracture, permits early range of motion, easy wound care and leave no large implant in subcutaneous position. This study was performed to evaluate the functional and radiological outcome with this procedure. In this case series, prospective study of 15 cases of tibial plateau fractures were treated with hybrid external fixator at tertiary care teaching hospital in southern Rajasthan from July 2018 to June 2019. The functional and radiological outcome was assessed by Rasmussen functional and radiological score. The mean interval between surgery and union was 16 weeks (range 13 to 18 weeks). Rasmussen functional results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Rasmussen radiological results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Minimal internal and hybrid external fixation for management of tibial plateau fracture with compromised soft tissue is more biological, require less surgical time, less hospital stay, very effective in compromised soft tissue, highly cost effective and has minimal complications with good functional outcome.</p>

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