Minimal internal fixation augmented by small wire transfixion frames for high-energy tibial plateau fractures.
OBJECTIVE
To evaluate the outcome of bicondylar tibial plateau fractures treated with minimal internal fixation augmented by small wire external fixation frames and to assess the necessity of bridging the knee joint by extending the external fixation to the distal femur.


METHODS
This is a retrospective study of 48 tibial plateau fractures. There were 40 (83.5%) Schatzker type VI fractures, 8 Schatzker type V fractures, and 18 (37.5%) fractures were open. A complex injury according to the Tscherne-Lobenhoffer classification was recorded in 30 (62.5%) patients. All fractures were treated with combined minimally invasive internal and external fixation. Closed reduction was achieved in 32 (66.6%) of the fractures. Extension of the external fixation to the distal femur was done in 30 (62.5%) fractures. Results were assessed according to the criteria of Honkonen-Jarvinen.


RESULTS
Follow-up ranged from 28 to 60 months with an average of 38 months. All fractures but 1 united at an average of 13.5 weeks (range 11-18 weeks). One patient developed an infected nonunion of the diaphyseal segment of his fracture. Thirty-nine (81%) patients achieved an excellent or good radiologic result. An excellent or good final clinical result was recorded in 36 patients (76%). Bridging the knee joint did not affect significantly the result (P < 0.418). No significant correlation was found between the type of fracture and the final score (P < 0.458).


CONCLUSIONS
Hybrid internal and external fixation combined with tibiofemoral extension of the fixation is an attractive treatment option for complex tibial plateau fractures.
Katsenis
Dimitris
D
Orthopaedic Department, General Hospital Argos, Argos, Greece. katsenis@yahoo.com
Athanasiou
Vasilis
V
Vasilis
Athanasiou
A
Megas
Panayiotis
P
Panayiotis
Megas
M
Tyllianakis
Minos
M
Minos
Tillianakis
T
Lambiris
Elias
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D016267:External Fixators; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology; D011182:Postoperative Care; D011859:Radiography; D016059:Range of Motion, Articular; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome