Published: 2020-12-23

Comparative analysis between locking compression plate and Joshi's external stabilization system in the management of proximal tibial fractures

Amit Dwivedi, Anupinder Sharma, Vaibhav Ashta, Robium Nairobi, Sunandan Nandi


Background: Proximal tibial fractures present with a variety of patterns. They are mostly treated using plate osteosynthesis or Joshi's external stabilization system (JESS) depending upon the injury configuration and surgeon preference. We have compared the efficacy of plate fixation to JESS in the treatment of complex proximal tibial fractures.

Methods: 36 patients of proximal tibial fractures with a mean age of 47 years were included in the study, 20 were treated using plate osteosynthesis while the other 16 were treated using JESS, they were followed up at regular intervals till 24 weeks and the progress was recorded in accordance with the knee society score (KSS) parameters

Results: 20 patients were treated using plate osteosynthesis, 18 of them had excellent KSS scores, 2 patients recorded good scores, average range of flexion was 126o, no incidences of superficial or deep infections were seen in any of them. Bone consolidation was achieved around 12 weeks in plate fixation group of the16 patients treated using JESS, 12 had excellent scores, 4 recorded a good score, average range of flexion was 118o, superficial infection was seen in 2 patients, with no incidence of deep infection. Bone consolidation was achieved around 16 weeks in JESS group.

Conclusions: Both open reduction internal fixation (ORIF) with plating and JESS appear to be adequate fixation methods for complex proximal tibial fractures, but as per our study plate fixation resulted in earlier bone consolidation and gave a slightly better functional outcome compared to JESS.


Locking compression plate, JESS, Schatzker, KSS

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Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691-7.

Naik MA, Arora G, Tripathy SK, Sujir P, Rao SK. clinical and radiological outcome of percutaneous plating in extra articular proximal tibial fractures; a prospective study. Injury. 2013;44(8):1081-6.

Schatzker J, McBroom R, Bruce D. The tibial plateau fractures. The Toronto experience 1968-1975. Clin Orthop Relat Res. 1979;138:94-104.

Wagner M. General principles for the clinical use of the LCP. Injury. 2003;34:B31-42.

Zahid M, Sherwani MKA, Siddiqui YS, Abbas M, Asif N, Sabir AB. The role of JESS fixator in the management of tibial plateau fractures which are associated with severe soft tissue injuries. J Clin Diagn Res. 2010;4:3356-61.

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

Subhasi 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;12:347-53.

Martimbianco ALC, Calabrese FR, Iha LAN, Petrilli M. Reliability of the American Knee Society Score. Acta Ortop Bras. 2012;20(1):34-8.

Kim PH, Leopold SS. Gustilo Anderson Classification. Clin Orthop Relat Res. 2012;407(11):3270-4.

Blokker CP, Rorabeck PB, Tibia plateau fractures-An analysis of the result of treatment in 60 patients. Clin Orthop. 1984;182:193-8

Drennan DB, Locher FG, Maylahn DJ. Fractures of the tibial plateau: Treatment by closed reduction and spica cast. JBJS. 1979;61;989-5.

Jiangr, Luo CF, Zeng BF. Biomechanical evaluation of different fixation methods for fracture dislocation involving the proximal tibia. Clin Biomech. 2008;23:1059-64.

Duvelius PJ, Conolly JF. Closed reduction of the tibial plateau fracture. A comparison of functional and roentgenographic end results. Clin Orthop.1988;230:116-25.

Porter BB. Crush fractures of the lateral tibial condyle. Factors influencing the prognosis. JBJS. 1970;52:676.

Chaix. Fractures of the tibial plateau. In: Insall JN, Winsdor RE, Scottw, editors. Surgery of the knee. 2nd Edition. New York: Churchill Livingstone. 1993:1038.

Burri C, Bartzle G, Coldway J. Fractures of the tibial plateau. Clin Orthop. 1979;138:84-93.

Tscherne H, Lobenhoffer P. Tibial plateau fractures, management and expected result. Clin Orthop. 1993;292:87-100.

Babis GC, Evangelopoulos DS, Kontovazenitis P, Nikolopoulos K, Soucacos PN. High energy tibial plateau fractures treated with hybrid external fixator. J OrthopSurge Res. 2011;6:35-41.

Muhammad AK, Muhammad IK, Muhammad S. Management of complex tibial plateau fractures with Illizarov Fixator. Pak J Surg. 2012;28:110-13.

Berven et al. Comparing case control study for treatment of proximal tibia fractures with a complete metaphyseal component in two centres with distinct strategies: fixation with illizarov frame or locking plate. J Orthop Surg Res. 2018;13:121.

Kruppe RJ, Malkani AL, Roberts CS, Seligson D, Crawford CH. Treatment of bicondylar tibial plateau fractures using locking plate versus external fixation. Orthoaedics. 2009;32(8):5242-4.