Outcome of complex tibial plateau fractures treated with external fixator.

Abstract

Tibial plateau fractures are usually associated with communition and soft tissue injury. Percutaneous treatment of these complex fractures is intended to reduce soft issue complications and postoperative stiffness of the knee joint. We assessed the complications, clinical outcome scores, and postoperative knee range of movements, after fluoroscopic assisted closed reduction and external fixator application. Seventy eight complex tibial plateau fractures in 78 patients were included in the study. All fractures were managed with closed reduction and external fixator application. In 28 cases with intraarticular split, we used percutaneous cancellous screw fixation for reduction and fixation of condylar parts. In nine open fractures, immediate debridement was done. In 16 cases, elevation of depressed segment and bone grafting was required, which was done from a very small incision. All patients were clinically and radiographically evaluated at a mean followup of 26.16 months (range 6-60 months). Clinical results were evaluated according to the Rasmussen's criteria. Average healing time was 13.69 weeks (range 12- 28 weeks). Mean knee range of motion was 122.60° (range 110°-130°). Forty seven results were scored as excellent, 25 good, 2 fair, and 1 as poor. We believe that minimally invasive treatment by percutaneous techniques and external fixation is a fairly reasonable treatment alternative, if near anatomical reduction of joint surface can be confirmed on fluoroscopy.