Abstract
Introduction:
Bicondylar tibial plateau fractures are serious periarticular injuries. We investigated outcomes in injuries managed with Ilizarov external fixators.
Methods:
We retrospectively reviewed bicondylar tibial plateau fractures treated with Ilizarov fixators in a major trauma centre from 2008–2012. Radiological parameters were measured from standardised weight-bearing radiographs. A subset (n=34) had patient-related outcome measures.
Results:
Of 80 injuries, all fractures united. Two developed septic arthritis and one osteomyelitis. 76.3% were graded a good-excellent outcome (Rasmussen radiological score). 30.3% had evidence of osteoarthritis (Kellgren Lawrence>1). Neither parameter correlated significantly with lower functional scores. Referrals from neighbouring hospitals had longer times to surgery, which associated with increased condylar widening (p=0.0214) and posterior tibial slope (p=0.0332). Risk of developing osteoarthritis correlated with lower joint line congruency angle (JLCA) (p=0.0017) and increased articular step-off (p=0.0008) on initial radiographs. 3 patients have progressed to total knee arthroplasty.
Discussion and Conclusion:
This is the largest study of bicondylar tibial plateau fractures treated by Ilizarov fixation. Rates of septic arthritis and osteomyelitis compare with previously reported rates, with no cases of non-union. Over 76% achieved good-excellent radiological outcome, compared with 63–96% in studies of internal fixation. Achieving normal JLCA and smooth articular surface at the time of fixation reduce risk of developing osteoarthritis.
