Schatzker V-VI fractures of tibial plateau healed fast within 3.5 months: Ilizarov fixation with 6 weeks femoral ring offload

Authors

  • M. Maruf Al Hasan Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • Nazmul Huda Shetu Department of Orthopedics & Traumatology, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • S. M. A. Rahim Department of Orthopedics Joints & Spine Surgery, UNICO Hospital, Dhaka, Bangladesh
  • M. Sahidur Rahman Khan Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • Ahmad Hussain Siddique Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • M. Zahidur Rahman Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh
  • M. Jamal Uddin Department of Orthopedics, 250 Bed General Hospital, Feni, Bangladesh

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261203

Keywords:

Ilizarov fixation, Distal femoral ring removal, Schatzker classification, Tibial plateau fracture, Union strategy

Abstract

Background: Schatzker V and VI tibial plateau fractures with significant soft-tissue injury, the Ilizarov circular fixator provides essential, stable fixation while minimizing further disruption. A key advantage is the staged removal of the distal femoral ring, which allows for earlier knee mobilization and is critical for preserving long-term joint function. To evaluate the effectiveness of a three-and-a-half-month union strategy using Ilizarov fixation with distal femoral ring removal at six weeks in patients with Schatzker type V and VI tibial plateau fractures.

Methods: This prospective cohort study was conducted at Department of Orthopedics, National Institute of Traumatology and Orthopaedic Rehabilitation, Dhaka, Bangladesh, Bangladesh, from January 2023 to December 2024. A 41-patient cohort undergoing Ilizarov fixation with femoral ring removal at six weeks was assessed for union, knee motion, alignment, weight-bearing, and complications. Data analysis was performed using SPSS version 23.0 to evaluate these outcomes.

Results: The study cohort (mean age 38.6±9.4 years, 70.7% male) showed favorable outcomes. Radiological union was achieved in 87.8% of patients at a mean of 14.2±1.6 weeks, with 90.2% maintaining acceptable alignment. Final mean knee flexion was 118°±12°. Complications included pin-tract infection (14.6%) and stiffness (9.8%), with no deep infections or non-unions.

Conclusions: Ilizarov fixation with planned distal femoral ring removal at six weeks is an effective strategy for managing Schatzker type V and VI tibial plateau fractures, promoting early union, functional recovery, and low complication rates.

References

Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Morakis EA, Kontovazenitis PI, et al. Complications after tibia plateau fracture surgery. Injury. 2006;37(6):475-84.

Elsoe R, Larsen P, Nielsen NP, Swenne J, Rasmussen S, et al. Population-based epidemiology of tibial plateau fractures. Orthopedics. 2015;38(9):e780-6.

Yan H, Cheng L, Tuoheti Y, Wu Y, Tang X, et al. Global research status and trends of tibial plateau fracture over the past 28 years: a historical review and bibliometric analysis. Front Surg. 2023;10:1120023.

Rademakers MV, Kerkhoffs GM, Sierevelt IN, Raaymakers EL, Marti RK. Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma. 2007;21(1):5-10.

Metcalfe D, Hickson CJ, McKee L, Griffin XL. External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis. J Orthop Traumatol. 2015;16(4):275-85.

Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev. 2016;1(5):225-32.

Turkmen I, Esenkaya I. A patellar tendon length conservation method: Biplanar retrotubercle open-wedge proximal tibial osteotomy. North Clin Istanb. 2018;5(3):246-53.

Fragomen AT, Livingston KS, Sabharwal S. External Fixators for Deformity Correction. In: Essential Biomechanics for Orthopedic Trauma: A Case-Based Guide. Cham: Springer International Publishing; 2020: 107-126.

Girotra P, Singh NK, Kumar S. Functional outcome of locking compression plate in the management of proximal tibia fracture. Int J Orthop. 2020;6(1):152-6.

Pirwani MA, Ali M, Memon S, Ahmed G, Sial AH, et al. Evaluation of complex tibial plateau fractures treated with Ilizarov circular fixator. J Liaquat Univ Med Health Sci. 2019;18(01):16-21.

Lin XL, Gu JL, Kan SH, Ye WL, Zhang J, et al. Expression of miR-195 and its target gene Bcl-2 in human intervertebral disc degeneration and their effects on nucleus pulposus cell apoptosis. J Orthop Surg Res. 2021;16(1):412.

Kaushal P. Radiological and Functional Outcome of Dual Plating in Comminuted Intra-Articular Distal Femur Fractures [Dissertation]. Karnataka: BLDE (Deemed to be University); 2024. Available at: http://dspace.bldedu.ac.in:8080/jspui/handle/123456789/1000. Accessed on 24 April 2026.

Islam BZ, Islam S, Hossain S, Islam R, Rahman A, et al. Trauma care scenarios following road traffic crashes in Bangladesh: a scoping review. Glob Health Sci Pract. 2023;11(2):e2200384.

El-Barbary H, Abdel-Ghani H, Hegazy M, Wong J. Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Int Orthop. 2005;29(3):182-5.

Sawant RM, Chaudhari PL. Observational study to evaluate the impact of intraoperative C-arm image-based surgical path planning on improvement of functional outcome in intra-articular proximal tibia fractures. J Med Thesis. 2024;12(1):7-16.

Ruffolo MR, Fragomen AT, Rozbruch SR. Complications of high-energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions. J Orthop Trauma. 2015;29(2):85-90.

Zhang BB, Zhan Y, Yu MJ, Zhu SN, Zhai QL, et al. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res. 2019;8(8):357-366.

Ali AM, El-Shafie M, Willett KM. Failure of fixation of tibial plateau fractures. J Orthop Trauma. 2002;16(5):323-9.

Hayek K, Garlich JM, Saper D, De Giacomo AF, Tornetta P 3rd. Cost reduction for knee-spanning external fixation in the staged treatment of tibial plateau fractures: a practical intervention. J Orthop Trauma. 2022;36(5):246-50.

Yao Y, Lv H, Zan J, Li J, Zhu N, et al. Functional outcomes of bicondylar tibial plateau fractures treated with dual buttress plates and risk factors: a case series. Injury. 2014;45(12):1980-4.

Maripuri SN, Rao P, Guyot A, Peter V. The classification systems for tibial plateau fractures: how reliable are they? Injury. 2008;39(10):1216-21.

Lansinger O, Bergman B, Körner L, Andersson GB. Tibial condylar fractures: a twenty-year follow-up. J Bone Joint Surg Am. 1986;68(1):13-9.

Parameswaran AD, Roberts CS, Seligson D, Voor M. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma. 2003;17(7):503-7.

Catagni MA, Ottaviani G, Maggioni M. Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma. 2007;63(5):1043-53.

Prajwal N. Clinical Study of Outcome of Schatzker’s Type-V and Type-VI Tibial Plateau Fractures Treated with Dual Plating [Dissertation]. Bengaluru: Rajiv Gandhi University of Health Sciences; 2019. Available at: http://repository-tnmgrmu.ac.in/handle/ 123456789/1234. Accessed on 24 April 2026.

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Published

2026-04-27

How to Cite

Maruf Al Hasan, M., Shetu, N. H., Rahim, S. M. A., Sahidur Rahman Khan, M., Siddique, A. H., Zahidur Rahman, M., & Jamal Uddin, M. (2026). Schatzker V-VI fractures of tibial plateau healed fast within 3.5 months: Ilizarov fixation with 6 weeks femoral ring offload. International Journal of Research in Orthopaedics, 12(3), 572–577. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20261203

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Original Research Articles