Definitive management of complex tibial plateau fractures: Combining limited internal fixation with bridge spiral Ilizarov frame.

Abstract

High-energy tibial plateau fractures are commonly observed in concomitant with other injuries, soft tissue lacerations, and ischemic complications. The widely accepted management approach involves the application of a bridging external fixator to allow for soft tissue recovery, followed by delayed ORIF. Nonetheless, delayed internal fixation remains associated with notable risks, including deep infection, non-union, and implant failure. As an alternative, limited internal fixation in conjunction with tensioned-wire external fixators has been introduced. However, the use of metaphyseal wires has been linked to a considerable risk of pyoarthrosis, a severe and potentially devastating complication. This research aims to determine the clinical outcomes of using limited internal fixation in combination with a knee-bridging external fixator as a definitive treatment strategy, with particular attention to the impact of prolonged knee immobilization on the final range of motion and soft tissue healing. A total of 42 retrospective cases were analyzed, all presenting with high-energy tibial plateau fractures classified as Schatzker types V and VI. Management involved limited open reduction, percutaneous fixation of the articular component using lag screws, and application of a multiplanar arch external fixator placed anteriorly to bridge the knee. Outcomes were classified as excellent in 12 patients (28.6 %), good in 19 patients (45.2 %), fair in 8 patients (19 %), and poor in 3 patients (7.2 %). No systemic complications were observed. However, some treatment-related issues arose during the clinical course, all of which were effectively managed. The proposed technique proved effective in addressing this complex clinical scenario, successfully minimizing the risk of severe knee joint infection while preserving satisfactory knee range of motion. Additionally, the positive impact of knee-bridging external fixation on soft tissue healing was clearly demonstrated. level IV (case series).