title: Role of Joshi's external stabilization system with percutaneous screw fixation in high-energy tibial condylar fractures associated with severe soft tissue injuries.
abstract: OBJECTIVE
  The treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries.
  
  
  METHODS
  Between June 2008 and June 2010, 25 consecutive patients who were 17e71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade I&II). The injury mechanisms were motor vehicle accidents (n=19), fall from a height (n=2) and assault (n=1). The fractures were classified according to Schatzker classification system.
  
  
  RESULTS
  There were 7 type-V, 14 type-VI and 1 type-lV Schatzker's tibial plateau fractures. The average interval between the injury and surgery was 6.8 days (range 2-13). The average hospital stay was 13 days (range, 7-22). The average interval between the surgery and full weight bearing was 13.6 weeks (range 11-20). The average range of knee flexion was 121°(range 105°-135°). The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections (n=4) with no knee stiffness.
  
  
  CONCLUSIONS
  JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.
authors.affiliation: Department of Orthopedics, Bhagwan Mahavir Hospital, New Delhi 110088, India.
authors.forename: Ashish-Kumar
authors.initials: AK
authors.lastname: Gupta
authors.forename: Rahul
authors.initials: R
authors.lastname: Sapra
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Som-Prakash
authors.initials: SP
authors.lastname: Gupta
authors.forename: Devwart
authors.initials: D
authors.lastname: Kaushik
authors.forename: Sahil
authors.initials: S
authors.lastname: Gaba
authors.forename: Mahesh Chand
authors.initials: MC
authors.lastname: Bansal
authors.forename: Ratan Lal
authors.initials: RL
authors.lastname: Dayma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D016267:External Fixators; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017695:Soft Tissue Injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome