Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation.
BACKGROUND
We intended to evaluate the technique of treatment of complex fractures of the tibial plateau using external circular fixation combined with limited internal fixation, and to evaluate the treatment outcomes.


METHODS
From 1992 to 2002, we treated 59 patients (40 men, 19 women) ranging in age from 23 to 63 years with the external circular fixation. All the cases were classified preoperatively as Schatzker types V, VI/Orthopedic Trauma Association 41-C1.3, C2.3, C3.1, C3.3. Five fractures were open. Three different strategies of treatment were used: (1) the frame is confined to the tibia when the external fixation is stable enough to allow knee bending; (2) the frame is extended onto the distal femur, with the proximal tibial ring located at the level of the tibial plateau when the joint surface is severely unstable; and (3) the frame is extended onto the distal femur, with the proximal tibial ring located more distally, bypassing the fracture, when the skin and soft tissue are compromised and within the fracture there is no bone suitable to place wires and pins for the external fixation construct.


RESULTS
The results were evaluated as excellent in 30 patients (50.85%), good in 27 patients (45.76%), fair in 1 patient (1.695%), and poor in another 1 (1.695%). The patients' satisfaction was significantly related with the functional results.


CONCLUSIONS
Our hybrid Ilizarov method combined with minimal internal fixation enables excellent to good results in most cases of complex tibial plateau fractures.
Catagni
Maurizio A
MA
Association for the Study and Application of the Method of Ilizarov (ASAMI), Department of Orthopedics and Ilizarov Unit, Alessandro Manzoni Hospital, Lecco, Italy. maurizio@catagni.it
Ottaviani
Giulia
G
Maggioni
Massimiliano
M
D000328:Adult; D001858:Bone Nails; D001864:Bone Wires; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007717:Knee / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000145:classification / Q000534:rehabilitation / Q000628:therapy*; D016896:Treatment Outcome