Outcome of tibial plateau fractures treated by hybrid and Ilizarov external fixation

Authors

  • Sandeep Raghuram Reddy Department of Orthopaedics, M. S. Ramaiah Medical College, Bengaluru, India
  • Harshad Mohanlal Shah Department of Orthopaedics, M. S. Ramaiah Medical College, Bengaluru, India
  • Ponugoti Godhasiri Department of Orthopaedics, M. S. Ramaiah Medical College, Bengaluru, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20193831

Keywords:

Tibial plateau fracture, Ilizarov fixation, Hybrid fixation

Abstract

Background: Tibial plateau fractures pose a challenge to the treating surgeon especially in cases with compromised soft tissue envelope. External fixation achieves good results with minimal complications. The objective of our study was to evaluate the functional outcome of tibial plateau fractures treated by Ilizarov and hybrid external fixation.

Methods: 46 patients with tibial plateau fractures were analysed. 6 were lost to follow-up. 20 patients were treated by Ilizarov method and 20 by hybrid external fixation.

Results: Mean time for union was 24.5 weeks in Ilizarov fixator group and 28 weeks in hybrid fixator group. Mean Lysholm’s score was 86.1 in Ilizarov cases and 83.4 in hybrid fixator cases. The mean knee society score in Ilizarov fixation cases was 78.5 and 77.3 in hybrid fixator cases. At one year by Lysholm score 6 patients had fair, 10 had good and 4 had excellent result in Ilizarov group and 1 had poor, 8 had fair, 8 had good and 3 had excellent results in hybrid group. 15 patients in Ilizarov method had good and excellent knee society scores and 12 patients had good and excellent results and 1 patient had poor score in Hybrid fixator group.

Conclusions: External fixation in complicated tibial plateau fractures gives acceptable outcomes. Ilizarov external fixator has an advantage of earlier mobilization and earlier union but requires longer operation time and a bulky apparatus. Hybrid fixator on the other hand has lesser operating time and simpler construct but has less stability and longer union time.

Author Biographies

Sandeep Raghuram Reddy, Department of Orthopaedics, M. S. Ramaiah Medical College, Bengaluru, India

DEPARTMENT OF ORTHOPAEDICS 

ASSISSTANT PROFESSOR

Harshad Mohanlal Shah, Department of Orthopaedics, M. S. Ramaiah Medical College, Bengaluru, India

SENIOR PROFESSOR
DEPARTMENT OF ORTHOPAEDICS

Ponugoti Godhasiri, Department of Orthopaedics, M. S. Ramaiah Medical College, Bengaluru, India

ILIZAROV FELLOW

DEPARTMENT OF ORTHOPAEDICS

References

Bhandari M, Audige L, Ellis T, Hanson B, Evidence-Based Orthopaedic Trauma Working Group. Operative treatment of extra-articular proximal tibial fractures. J Orthop Trauma. 2003;17:591–5.

Agnew SG, Tibial plateau fractures. Oper Tech Orthop. 1999;9:197–205.

Maripuri SN, Rao P, Manoj-Thomas A, Mohanty K. The classification systems for tibial plateau fractures: how reliable are they? Injury. 2008;39(10):1216–21.

Schatzker J. Fractures of the tibial plateau. In: Schatzker J, Tile M (eds). Rationale of Operative Fracture Care. New York: Springer; 1987: 279-295.

Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res. 1993;292:87-100.

Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: Definition, demographics, treatment rationale, and long term results of closed traction management or operative reduction. J Orthop Trauma. 1987;1:97-119.

Mallik AR, Covall DJ, Whitelaw GP. Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev. 1992;21:1433-6.

Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma. 2004;18:649-57.

Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev 1994;23:149-54.

Peccin MS, Ciconelli R, Cohen M. Specific questionnaire for knee symptoms- the Lysholm knee scoring scale. Acta Ortop. 2006;14:5.

Insall JN, Dorr LD, Scottt RD, Scott WN. Rationale of the knee society clinical rating system. Clin Orthop Relat Res. 1989;248:13-4.

Kateros K, Galanakos SP, Kyriakopoulos G, Papadakis SA, Macheras GA. Complex tibial plateau fractures treated by hybrid external fixation system: A correlation of followup computed tomography derived quality of reduction with clinical results. Int J Orthop. 2018;52(2):161-9.

Kokkalis ZT, Iliopoulos ID, Pantazis C, Panagiotopoulos E. What's new in the management of complex tibial plateau fractures? Injury. 2016;47:1162-9.

Singh H, Misra RK, Kaur M. Management of proximal tibia fractures using wire based circular external fixator. J Clin Diagn Res. 2015;9:1-4.

Piper KJ, Won HY, Ellis AM. Hybrid external fixation in complex tibial plateau and plafond fractures: An Australian audit of outcomes. Injury. 2005;36:178-84.

Watson JT, Ripple S, Hoshaw SJ, Fhyrie D. Hybrid external fixation for tibial plateau fractures: Clinical and biomechanical correlation. Orthop Clin North Am. 2002;33:199-209.

Stamer DT, Schenk R, Staggers B, Aurori K, Aurori B, Behrens FF. Bicondylar tibial plateau fractures treated with a hybrid ring external fixator: a preliminary study. J Orthop Trauma. 1994;8:455–61.

Subasi M, Kapukaya A, Arslan H, Ozkul E, Cebesoy O. Outcome of open comminuted tibial plateau fractures treated using an external fixator. J Orthop Sci. 2007;12(4):347-53.

Babis GC, Evangelopoulos DS, Kontovazenitis P, Nikolopoulos K, Soucacos PN. High energy tibial plateau fractures treated with hybrid external fixation. J Orthop Surg Res. 2011;6:35.

Mankar SH, Golhar AV, Shukla M, Badwaik PS, Faizan M, Kalkotwar S. Outcome of complex tibial plateau fractures treated with external fixator. Indian J Orthop. 2012;46(5):570–4.

Aseri MK, Gupta A, Khilji U. Role of hybrid external fixator in proximal tibial fractures: A prospective analysis. Int J Orthop Sci. 2017;3(1):810-3.

Jahan A, Haseeb M, Wazir F. Treatment of high energy tibial plateau fractures with hybrid external fixator: intermediate term outcome. Int J Res Med Sci. 2017;5(10):4582-7.

Hassan EB, Hisham G, Misbah H, Khaled S. Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Int J Orthop. 2005;29:182-5.

Ferreira N, Senoge ME. Functional outcome of bicondylar tibial plateau fractures treated with the Ilizarov circular external fixator. SA Orthop J. 2011;10(3):80-4.

Kamal E, Wael EA, Osama F, Mohamed H, Marwa MA. Management of high-energy tibial plateau fractures by Ilizarov external fixator. Eur Orthop Traumatol. 2013;5.

Elsoe R, Larsen P, Petruskevicius J, Kold S. Complex tibial fractures are associated with lower social classes and predict early exit from employment and worse patient-reported QOL: a prospective observational study of 46 complex tibial fractures treated with a ring fixator. Strategies in Trauma and Limb Recons. 2018;13(1):25–33.

Bari MM, Shahidul I, Shetu NH, Mahfuzer RM. Complex Tibial Plateau Fractures Treated with Ilizarov Ring Fixator. MOJ Orthop Rheumatol. 2014;1(2):9.

Aziz MA, Fawzy S. Treatment of complex tibial plateau fractures using Ilizarov external fixator with or without minimal internal fixation. Egypt Orthop J. 2016;51:60-4.

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Published

2019-08-26

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Original Research Articles