O2315 INDICATIONS OF KNEE BRIDGING FOR HIGH ENERGY TIBIAL PLATEAU FRACTURES TREATED WITH CIRCULAR FRAMES

Abstract

Aims: Circular þxation has become increasingly popular for high-energy tibial plateau fractures (HETPF). These injuries are associated with comminution and soft tissue compromise and may require additional þxation to the femur. This study investigates the indications for bridging the knee joint and the appropriate type of the tibiofemoral construct. Methods: Between 1988 and 1999, 112 patients (mean age: 37; range: 18 to 67) underwent circular þxation for HETPF. There were 8 Schatzker type IV fractures, 11 type V, and 93 Schatzker type VI fractures. 40 fractures were open whereas 55 fractures had Tscherne type 1 or 2 damage of the soft tissues. 30 fractures underwent simple tibial þxation and 80 fractures required extension of the þxation to the femur for 6 weeks, using either þxed or mobile hinges. Mean follow up was 5 years (range, 28 months to 13 years). Results were evaluated according to the system of Honkonen and Jarvinen. Results: 93 (82%) injuries had at least one, and 65 (57%) more than one indication for tibiofemoral þxation. The most common indications were: extensive comminution (73 knees), soft tissue compromise (60 knees), and ligamentous injuries (58 knees). Patients with tibiofemoral þxation achieved better þnal axial alignment and knee stability than patients with tibial þxation. Fixed joint bridging resulted in the same knee ßexion but signiþcantly lower extension lag than mobile bridging. Conclusions: 80% of HETPF are associated with injuries that require knee bridging. Fixed tibiofemoral þxation offers better subjective, clinical, functional and radiological results.