TREATMENT OF COMPLEX TIBIAL PLATEAU FRACTURE WITH ILIZAROV EXTERNAL FIXATION AND MINIMAL OPEN SURGICAL PROCEDURE

Abstract

Introduction: Tibial plateau fracture is an intra-articullar complex fracture. Surgery aim is to restore articular surface height, preserve knee joints stability and alignment in order to obtain maximal range of motion and to prevent future joint degenerative changes. Ilizarov external frame using ligamentotaxis, minimal invasive techniques, smooth or olive wires (sometimes augmented by screws) allows articular surface reconstruction and stabilization. In unstable fractures, bridging of the knee with slight distraction of the joint is provided by including the distal femur to the frame with an additional ring.

Study Aims: To assess the results of complex tibial plateau fracture treated with Ilizarov external fixator.

Materials and Methods: Between 1997–2005, twenty five patients with complex fractures of the tibial plateau, Schatzker type V–VI fractures (all closed), average age 45 years old (range 30–78) were treated by hybrid 3 ring Ilizarov external frames alone or in combination with another procedure. 11 out of 25 patients were treated with ligamentotaxis using extension of the frame to the femur with hinges on the center of joint rotation. Some of these patients (10 out of 11) required lateral minimal opening for joint surface elevation. 8 out of the 25 patients needed additional bone graft/ substitute supplementation. One needed 6.5 mm canulated cancellous screw augementation. Patients with below knee frame remain non-WB for 6 weeks and partial WB for another 6 weeks. Patients with above knee frame were allowed full WB. In 3 months the frame was removed under anesthesia and the knee was manipulated. Patients were placed in a brace or a cast-brace with full WB. Physiotherapy started early after the operation.

Results: All fractures united with an average time of 12 weeks. 22 patients had full extension with 100 degree of flexion or more. 3 patients had extension lag of 10–20 degree, one of them had 20 degree of posterior slop of the tibial plateau. All patients had normal axial alignment, except one case resulted in mild valgus alignment due to osteoporotic bone (70 years old patient). One had mild unstable knee. One patient developed posttraumatic osteoarthrosis. There were no cases of postoperative infection, septic arthritis or neuro-vascular complications were reported. Pin site infection was resolved locally.

Conclusion: The use of Ilizarov external fixation in the management of complex tibial plateau fractures results in satisfactory out come as an alternative to the traditional tibial plateau open surgery. This minimal invasive intervention allowed the surgeons to reduce and fixate the tibial articular surface with out further damaging the soft tissue envelope.