Outcome of open comminuted tibial plateau fractures treated using an external fixator.
BACKGROUND
The purpose of this study was to evaluate the outcome of open severe comminuted tibial plateau fractures treated with minimal internal fixation and circular external fixation frames.


METHODS
Fifteen open comminuted tibial plateau fractures were involved in this retrospective study. In eight knees, the fracture was reduced through an extended open traumatic wound. In seven patients, another limited incision over the major fracture line or area of comminution was performed to assist in reducing the articular reduction. Simultaneous bone grafting, soft tissue reconstruction, and stabilization of the fracture using a circular external fixator were carried out.


RESULTS
The patients were followed for an average of 32 months (range 24-54 months). The average time to union of the fractures and frame removal was 22.8 weeks (range 16-44 weeks). The quality of the reduction of the joint surface was rated as anatomical in four patients, good in five patients, fair in three patients, and poor in three patients. Four patients experienced loss of articular reduction. The Knee Society Clinical Rating scores indicated that three knees were excellent, seven were good, one was fair, and four were poor. Complications included one case of septic arthritis, one of osteomyelitis, one of malunion, and four with loss of reduction.


CONCLUSIONS
This technique provided acceptable results for open severe comminuted fractures of the tibial plateau without comminuted posterior wall fractures. The most significant disadvantage of the technique is insufficient anatomical reduction and loss of reduction in comminuted posterior wall fractures in the coronal plane. This technique should be combined with a minimally invasive internal fixation method to prevent loss of reduction in open severe comminuted and irreducible tibial plateau fractures.
Department of Orthopaedic Surgery, University of Gaziantep, 27310 Sehitkamil, Gaziantep, Turkey.
Mehmet
M
Subasi
Ahmet
A
Kapukaya
Huseyin
H
Arslan
Emin
E
Ozkul
Oguz
O
Cebesoy
D000328:Adult; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome