title: Retrospective review of tibial plateau fractures treated by two methods without staging.
abstract: BACKGROUND
  Management of complex tibial plateau fractures can be challenging for orthopaedic surgeons. Wide disagreement still remains about the best surgical technique to use in these fractures. The purpose of this study was to compare the results of complex tibial plateau fractures treated by an open reduction and internal fixation (ORIF) versus hybrid external fixation (EF) in term of clinical and functional outcomes.
  
  
  METHODS
  We retrospectively examined a series of 79 patients affected by tibial plateau fractures admitted at our Department between January 2006 and November 2011. Forty-one patients were treated using a hybrid EF; in 38 cases, ORIF technique was used. Clinical evaluation was performed using the method of Rasmussen; functional assessment was made using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Residual pain was detected using a Numeric Rating Scale (NRS).
  
  
  RESULTS
  The average time to union in the plate group was 17.2 weeks (9.1-45 weeks), while in the EF one 15.9 (7.5-32). The mean overall hospital stay was 14.2 days for the ORIF group and 7.8 for the EF group. At the last follow-up, the mean Rasmussen score was 24.9 (good) in the patients treated with ORIF and 25 (good) in those who received EF. The WOMAC index disclosed a relatively higher score in the EF group (80.5 ORIF-84.2 EF). Pain evaluation revealed no differences between the groups. In terms of complications, deep infection occurred in four (10.5%) patients belonging to the ORIF group and 2 (4.9%) to EF one. Signs of osteoarthritis (OA) were observed in 4 (10.5%) knees that had open reduction and in 11 (26.9%) that had a hybrid external fixator.
  
  
  CONCLUSIONS
  Either ORIF or hybrid EF represents a valid treatment option in complex tibial plateau fractures. However, hybrid external fixation has shown relative better functional outcome results, relative lower rate of infection and decreased hospital stays. These aspects make of EF our best choice in case of high-energy complex tibial fractures.
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Conserva
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy. Electronic address: dott.gvicenti@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vicenti
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Allegretti
authors.affiliation: Orthopaedics and Traumatology Department - Vito Fazzi Hospital, Lecce, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Filipponi
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Monno
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Girolamo
authors.initials: G
authors.lastname: Picca
authors.affiliation: Department of Neuroscience and Organs of Sense, Orthopedics Section, Faculty of Medicine and Surgery, University of Bari, Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Moretti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Complex tibial plateau fracture; Hybrid EF; ORIF; Outcomes; Schatzker classification