HYBRID FIXATION FOR HIGH ENERGY TIBIAL PLATEAU FRACTURES. KNEE RECOVERY AT 7 YEARS FOLLOW UP.

Abstract

Purpose: To assess the function of the knee joint and the development of knee arthrosis, at seven years postoperatively, in patients in whom a high energy tibial plateau fracture had been treated with minimal internal fixation augmented by small wire external fixation frames.

Material and Methods: Between October 1989 and November 1999, one hundred twenty nine high energy tibial plateau fractures were treated with hybrid fixation including small wire circular or hybrid frames, minimum internal fixation and occasionally provisional extension of the external fixation to the distal femur. The average patient age was 39 years. There were 69 (53%) C1 fractures, 19 (15%) C2 and 41 (32%) C3 fractures and 49 (38%) fractures were open. Complex injury according to Tscherne-Lobenhoffer classification was recorded in 87 (67%) patients. Clinical, subjective, objective and radiographic results were evaluated after an average follow up of 84 months.

Results: Results were assessed according to the criteria of Honkonen–Jarvinen. Excellent or good functional result was recorded in 98 (76%) patients. However, only 74 (57.5%) patients retained an excellent or good radiographic result at the final follow up. Compared with the radiographic appearance of the post-traumatic arthritis after an average of 48 months, there was found no statistically significant deterioration of the knee arthrosis (p< 0,05). No reconstruction operations were performed after the completion of the index procedure.

Conclusion: A high percentage of radiographic post-traumatic arthritis should be expected, after high energy tibial plateau fractures had been treated with minimal internal fixation augmented by small wire external fixation frames. However, because all the objectives of the fracture treatment can be obtained, the functional results remain satisfactory over time.