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

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>

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

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.

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

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>

scholarly journals TIBIAL PLATEAU FRACTURES

2018 ◽  
Vol 25 (06) ◽  
pp. 810-814
Author(s):  
Saeed Ahmad ◽  
Tariq Mahmood ◽  
Muhammad Imran Haider
Keyword(s):  
External Fixator ◽  
Tibial Plateau ◽  
Case Series ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Tibial Fractures ◽  
Female Ratio ◽  
Non Union ◽  
Hybrid External Fixator ◽  
Pin Track

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.

A COMPARATIVE STUDY OF FUNCTIONAL AND RADIOLOGICAL OUTCOME OF HIGH ENERGY PROXIMAL TIBIA FRACTURE USING ILLIZAROV EXTERNAL FIXATOR VS HYBRID EXTERNAL FIXATOR

2021 ◽  
pp. 7-10
Author(s):  
Aditya Shrimal ◽  
Mahesh Bhati ◽  
Avinash Choudhary ◽  
Pradeep Choudhary ◽  
Jayesh Chohan
Keyword(s):  
Soft Tissue ◽  
External Fixator ◽  
Operative Time ◽  
Proximal Tibia ◽  
High Energy ◽  
Tibia Fracture ◽  
Ilizarov Method ◽  
Proximal Tibia Fracture ◽  
Hybrid External Fixator ◽  
Soft Tissue Dissection

Background: In High energy proximal tibia fracture aim is to achieve adequate reduction and stability without signicantly compromising the soft tissue integrity and vascularity . External xator minimizes soft tissue dissection and minimize other complications. Method: 60 patients' high energy proximal tibia fracture with cases were considered in the study. 30 patients were treated with Ilizarov external xator and 30 patients were treated with hybrid external xator. Results were analyzed both clinically and radiologically using Johner and Wruh's criteria. Results: Mean time of union was 22 week in ilizarov xator group and 34 week in hybrid xator group. Pin tract infection occured in 6 patient (20%) in ilizarov xator group and 4 patient in hybrid xator group. Joint stiffness occured in 3 Patient (10 %) in ilizarov group and 10 patient in hybrid xator group.Shortning occured in 2 patient (6.6 %) in ilizarov xator group and 2 patient in hybrid xator group. Overal results in ilizarov group were excellent in 23 patient (76.7%), good in 5 patient (16.67%) , fair in 2 patient (6.67%) while in hybrid group excellent in 16 patient( 53.33%),good in 10 patient(33.33%),fair in 4(13.33%)patient. Conclusion: External xators are excellent modalities in treatment of high energy proximal tibia fracture with ilizarov method has advantage of early mobilization and early union but require long operative time and bulky framework on other hand hybrid xator has simpler construct ,lesser operative time but has lesser stability , longer union time and longer immobilization time.

Management of high-energy tibial plateau fractures by Ilizarov external fixator

2013 ◽  
Vol 5 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Kamal El-Gafary ◽  
Wael El-adly ◽  
Osama Farouk ◽  
Mohamed Khaled ◽  
Marwa Mahmoud Abdelaziz
Keyword(s):  
External Fixator ◽  
Tibial Plateau ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Ilizarov External Fixator

MANAGEMENT OF HIGH VELOCITY TIBIAL PLATEAU FRACTURES BY LIGAMENTOTAXIS USING ILIZAROV EXTERNAL FIXATOR

2021 ◽  
pp. 33-35
Author(s):  
Mayank Poddar ◽  
Abhinav Sinha ◽  
Amit Narang
Keyword(s):  
Soft Tissue ◽  
High Velocity ◽  
Bone Grafting ◽  
Tibial Plateau ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Type Iv ◽  
Schatzker Type ◽  
Duration Of Surgery ◽  
The Mean

Background: Tibial plateau fractures resulting from high energy trauma, typically Schatzker type IV, V and VI pattern fractures are difcult to deal with due to poor overlying soft tissue cover. Ligamentotaxis with ilizarov ring xator can be a suitable denitive treatment option for such injuries with fewer associated complications as compared to internal xation. Patients and Methods: 30 patients within the age group of 18-80 years with Schatzker type IV, V and VI pattern injuries were included in the study. A four ring ilizarov assembly was used with knee spanning with a proximal femoral ring. The patients were followed for 12 months and evaluation was analyzed as per Rasmussen clinical and radiological criteria. Results: The mean age of patients in our study was 39.76 years. Twenty cases were Schatzker type VI, 7 cases were Schatzker type IV (with extensive soft tissue swelling following high velocity trauma) and only 3 cases were type V. The mean duration of surgery was 47±12 mins without bone grafting and 72±14 mins with bone grafting. The mean interval from injury to surgery was 2.36 days (range 1-5 days). Rasmussen total anatomical outcome was excellent in 14 patients(46.66%) and good in 16 patients(53.33%). Rasmussen total functional outcome was excellent in 21 patients(70%) and good in 9 patients(30%). Final Outcome was excellent in 22 patients(73.33%) and good in 8 patient(26.66%). Discussion: High velocity tibial plateau fractures, when treated with internal xation and plating, carry a higher risk of associated complications ranging from deep infections to even compartment syndrome. The rate of re-operation following internal xation in such injuries has been high with most of the re-surgeries being required within one year of primary xation which adds to the morbidity of the patient. Ligamentotaxis with ilizarov ring xation as denitive treatment in such cases can be a fruitful operation with lesser complications and early return to previous level of activity.

scholarly journals High-energy tibial plateau fractures treated with Ilizarov fixator

2019 ◽  
Vol 147 (7-8) ◽  
pp. 427-431
Author(s):  
Slavko Tomic ◽  
Andreja Baljozovic ◽  
Danilo Jeremic
Keyword(s):  
Soft Tissue ◽  
Knee Society Score ◽  
Tibial Plateau ◽  
Articular Surface ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Anatomical Reconstruction ◽  
Significant Group ◽  
Ilizarov Fixator

Introduction/Objective. Tibial plateau fractures constitute a significant group of injuries to a major weight-bearing joint. High-energy fractures are difficult to treat, as they entail articular depression, condylar displacement, dissociation of comminuted metaphysis, and closed degloving injuries. The principles of the treatment are anatomical reconstruction of the articular surface, restoration of the anatomical axis, fixation spanning the metaphyseal comminution, and further minimization of soft tissue injury. The aim of this study is to evaluate the clinical outcome of using Ilizarov external fixator in the treatment of high-energy Schatzker IV, V, and VI tibial plateau fractures. Methods. This retrospective study was conducted from 2013?2016 on 35 patients (36 fractures) with high-energy tibial plateau fractures classified as Schatzker type IV, V, and VI. The mechanisms of injury were road traffic accident, fall from a height and direct trauma. The fractures were closed in 26 cases and open in 10 cases. All patients were treated with ligamentotaxis and percutaneous fixation using Ilizarov fixator. Functional outcome was determined using the Knee Society Score. Results. The mean follow-up period was 20 months. All fractures healed in an average time of 14 weeks. The range of knee flexion after one-year follow-up averaged at 100?. Average Knee Society Score in our study was 77. Conclusion. Ilizarov external fixation is a safe and efficient treatment modality for high-energy tibial plateau fractures. It allows reconstruction of the articular surface, stable fixation, early rehabilitation, and care of soft tissue injuries.

scholarly journals Complex Tibial Plateau Fractures Treated with a Hybrid External Fixator – Long Term Results

2021 ◽  
Vol 48 (3) ◽  
pp. 26-29
Author(s):  
Y. Andonov
Keyword(s):  
Internal Fixation ◽  
External Fixator ◽  
Tibial Plateau ◽  
Soft Tissues ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Long Term Results ◽  
Joint Degeneration

Abstract Introduction: High energy tibial plateau fractures represent a challenge because of the combined bone and soft tissue injury. The iatrogenic impact can further increase the likelihood for crippling complications. Less invasive treatment protocols have been developed to improve the results. Objective: We present the long-term results of limited internal fixation combined with a small wire external fixator. Patients and Methods: Fourteen patients were followed for at least 10 years. Initial and final functional results, complications and presence of joint degeneration were registered according to validated rating scores. Results: Of all patients included in the study, thirteen showed an excellent initial rating and one had an average result at baseline. 10 years later, eight patients still showed excellent grading results, four – good ones, one – average and one – poor results. Ten knees (71%) had osteoarthritis. Postphlebitic syndrome was diagnosed in two cases. Three knees showed medio-lateral instability, one showed a varus and one – a valgus deformity. Knee arthroplasty was performed in one case. Conclusion: The limited internal fixation combined with a hybrid ex fix can be considered as an alternative to the ORIF, especially when the soft tissues are severely compromised. Despite the inevitable joint degeneration, the associated overall morbidity is low and the long term function is quite satisfactory.

Sign in / Sign up

Export Citation Format

Share Document