Introduction and Aims: Severe tibial plateau fractures are generally considered high-energy injuries, requiring ORIF. Bone grafting at time of surgery is generally advocated and the most devastating complication is deep infection. Our aim was to see whether we could avoid a bone graft and prevent deep infections by using a ring fixator.

Method: From 1997 to date, we treated 46 patients with Schatzker V & VI fractures, 41 males, five females, average age 43.2 years (range 30 –71). Follow-up ranged from 18 to 72 months. Forty fractures, closed or grade I compound and six grade II compound.

Reduction was by Bohler’s method. When indicated, fixation was supplemented by internal fixation. Three or four proximal wires were placed 15mm distal to the joint. Surgery was within 24 hours post-admission, irrespective of date of injury or swelling. No weight-bearing was allowed for the first six weeks. Thereafter gradual increments in weight bearing.

Results: All fractures united. No bonegrafting was required. No deep, i.e. grade III, sepsis. Osteoporosis is not a contra-indication. Pain at 4 years: Grade 0 to I - 30, grade II - 12, grade III - 4. Mean range of movement at 6 months was 5° to 115° of flexion.

Complications: Grade I pin tract sepsis - 24 patients. Grade II pin tract sepsis - 10 patients. Grade III – 0 patients.

Treatment consisted of mechanical cleansing of the pins. Added to that were antibiotics for grade II sepsis, and in 2 cases we had to re-site one of the proximal wires in order to prevent a deep infection.

Conclusion: A ring fixator can be used up to 10 days post-injury, irrespective of severity of swelling. No deep-seated infection, most likely due to minimal interference with soft tissue envelope around the proximal tibia. No bone grafting required, BMP’s stay in fracture hematoma. Follow-up now at six years.