Management of tibial plateau fractures with compromised soft tissue using hybrid external fixator

Mahesh K. Sharma, Mukul Jain, Harish K. Jain, Sukhveer Khichar, Rahul Jadoo


Tibial plateau fractures with high energy trauma are complex injury due to its precarious soft tissue envelope. High energy trauma has high incidence of open fractures, articular depression, fracture comminution and displacement, soft tissue injury, and neurovascular compression. It is often difficult to achieve and maintain reduction and commonly predisposes to secondary arthritis. Hybrid external fixator minimizes the iatrogenic soft tissue damage, provides adequate fixation of the fracture, permits early range of motion, easy wound care and leave no large implant in subcutaneous position. This study was performed to evaluate the functional and radiological outcome with this procedure. In this case series, prospective study of 15 cases of tibial plateau fractures were treated with hybrid external fixator at tertiary care teaching hospital in southern Rajasthan from July 2018 to June 2019. The functional and radiological outcome was assessed by Rasmussen functional and radiological score. The mean interval between surgery and union was 16 weeks (range 13 to 18 weeks). Rasmussen functional results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Rasmussen radiological results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Minimal internal and hybrid external fixation for management of tibial plateau fracture with compromised soft tissue is more biological, require less surgical time, less hospital stay, very effective in compromised soft tissue, highly cost effective and has minimal complications with good functional outcome.


Tibial plateau fracture, Hybrid fixator, Schatzker, External fixator, Rasmussen score

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Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator. J Bone Joint Surg. 1996;78(5):710-7.

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(6):455-61.

Weiner LS, Kelley M, Yang E, Steuer J, Watnick N, Evans M, Bergman M. The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures. J Orthop Trauma. 1995;9(3):244-56.

Lachiewicz PF, Funcik T. Factors influencing the results of open reduction and internal fixation of tibial plateau fractures. Clin Orthop Relat Res.1990;259:210-5.

Duwelius PJ, Rangitsch MR, Colville MR, Woll ST. Treatment of tibial plateau fractures by limited internal fixation. Clin Orthop Relat Res. 1997;339:47-57.

Cross AR, Lewis DD, Murphy ST, Rigaud S, Madison JB, Kehoe MM, Rapoff AJ. Effects of ring diameter and wire tension on the axial biomechanics of four-ring circular external skeletal fixator constructs. Am J Vet Res. 2001;62(7):1025-30.

Gossling HR, Peterson CA. A new surgical approach in the treatment of depressed lateral condylar fractures of the tibia. Clin Orthop Relat Res. 1979;140:96-102.

DeCoster TA, Crawford MK, Kraut MA. Safe extracapsular placement of proximal tibia transfixation pins. J Orthop Trauma. 1999;13(4):236-40.

Su EP, Westrich GH, Rana AJ, Kapoor K, Helfet DL. Operative treatment of tibial plateau fractures in patients older than 55 years. Clin Orthop Relat Res. 2004;421:240-8.

Geller J, Tornetta III P, Tiburzi D, Kummer F, Koval K. Tension wire position for hybrid external fixation of the proximal tibia. J Orthop Trauma. 2000;14(7):502-4.

Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN. Complications after tibia plateau fracture surgery. Injury. 2006;37(6):475-84.

Gausewitz ST, Hohl MA. The significance of early motion in the treatment of tibial plateau fractures. Clin Orthop Relat Res. 1986;202:135-8.

Gaudinez RF, Mallik AR, Szporn M. Hybrid external fixation of comminuted tibial plateau fractures. Clin Orthop Relat Res.1996;328:203-10.

Burri C, Bartzke G, Coldewey J, Muggler E. Fractures of the tibial plateau. Clin Orthop Relat Res.1979;138:84-93.

Rasmussen PS. Tibial condylar fractures: impairment of knee joint stability as an indication for surgical treatment. JBJS. 1973;55(7):1331-50.

Kataria H, Sharma N, Kanojia RK. Small wire external fixation for high-energy tibial plateau fractures. J Orthop Surg. 2007;15(2):137-43.