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Erschienen in: European Orthopaedics and Traumatology 1/2014

01.03.2014 | Original Article

Management of high-energy tibial plateau fractures by Ilizarov external fixator

verfasst von: Kamal El-Gafary, Wael El-adly, Osama Farouk, Mohamed Khaled, Marwa Mahmoud Abdelaziz

Erschienen in: European Orthopaedics and Traumatology | Ausgabe 1/2014

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Abstract

Background

Despite the evolution of surgical techniques and implants, high energy tibial plateau fractures remain a challenging problem. The goals of treatment are to obtain a well-aligned stable joint with a painless functional range of motion and prevention of posttraumatic arthritis. Indirect reduction techniques and other soft tissue preservation methods safeguard the vascularity and emphasize restoring both joint congruity and the mechanical axis of the limb. The aim of this study was to evaluate the clinical outcome of using Ilizarov external fixator in the treatment of Schatzker type V–VI tibial plateau fracture.

Methods

This study was done during the period 2009–2011 for the treatment of 30 patients with high energy tibial plateau fractures (Schatzker type V in 17 and type VI in 13 patients) by Ilizarov external fixator. The mean age was 36 years .There were 23 males. The right limb was affected in 17 patients. There were 10 open fractures and other associated injuries in 9 patients.

Results

The mean of follow up period was 18 months. All the fractures were united in an average time of 15 weeks. There were pin track infection in 20 patients and other few complications in 8 patients. According to knee society score, there was an excellent result in 16.7 %, good in 60 %, fair in 20 %, and poor in 3.3 %.

Conclusion

Ilizarov external fixation is a safe and effective treatment option for high energy tibial plateau fractures with good functional results.
Literatur
1.
Zurück zum Zitat Gaston P, Will EM, Keating JF (2005) Recovery of knee function following fracture of the tibial plateau. J Bone Joint Surg Br 87-B:1233–1236CrossRef Gaston P, Will EM, Keating JF (2005) Recovery of knee function following fracture of the tibial plateau. J Bone Joint Surg Br 87-B:1233–1236CrossRef
2.
Zurück zum Zitat Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 138:94–104PubMed Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 138:94–104PubMed
3.
Zurück zum Zitat Watson JT (1994) High-energy fractures of the tibial plateau. Orthop Clin N Am 25:723–752 Watson JT (1994) High-energy fractures of the tibial plateau. Orthop Clin N Am 25:723–752
4.
Zurück zum Zitat Mills WJ, Nork SE (2002) Open reduction and internal fixation of high-energy tibial plateau fractures. Orthop Clin N Am 33:177–198CrossRef Mills WJ, Nork SE (2002) Open reduction and internal fixation of high-energy tibial plateau fractures. Orthop Clin N Am 33:177–198CrossRef
5.
Zurück zum Zitat Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of 1,025 open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg 8-a:453–458 Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of 1,025 open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg 8-a:453–458
6.
Zurück zum Zitat Tscherne H, Gotzen L (1984) Fractures with soft tissue injuries. Springer, BerlinCrossRef Tscherne H, Gotzen L (1984) Fractures with soft tissue injuries. Springer, BerlinCrossRef
7.
Zurück zum Zitat Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14PubMed
8.
Zurück zum Zitat Kumar A, Whittle AP (2000) Treatment of complex (Schatzker type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma 14:339–344PubMedCrossRef Kumar A, Whittle AP (2000) Treatment of complex (Schatzker type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma 14:339–344PubMedCrossRef
9.
Zurück zum Zitat Tscherne H, Lobenhoffer P (1993) Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res 292:87–100PubMed Tscherne H, Lobenhoffer P (1993) Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res 292:87–100PubMed
10.
Zurück zum Zitat Moore TM, Patzakis MJ, Harvey JP (1987) Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma 1:97–119PubMedCrossRef Moore TM, Patzakis MJ, Harvey JP (1987) Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma 1:97–119PubMedCrossRef
11.
Zurück zum Zitat Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23:149–154PubMed Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23:149–154PubMed
12.
Zurück zum Zitat Mallik AR, Covall DJ, Whitelaw GP (1992) Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev 21(12):1433–1436PubMed Mallik AR, Covall DJ, Whitelaw GP (1992) Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev 21(12):1433–1436PubMed
13.
Zurück zum Zitat Stokel EA, Sadesivan KK (1991) Tibial plateau fractures standardized evaluation of operative results. Orthopedics 14:263–270PubMed Stokel EA, Sadesivan KK (1991) Tibial plateau fractures standardized evaluation of operative results. Orthopedics 14:263–270PubMed
14.
Zurück zum Zitat Jiang R, Luo C, Wang M, Yang T, Zeng B (2008) A comparative study of less invasive stabilization system (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee 8:139–143CrossRef Jiang R, Luo C, Wang M, Yang T, Zeng B (2008) A comparative study of less invasive stabilization system (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee 8:139–143CrossRef
15.
Zurück zum Zitat Lee JA, Papadakis SA, Moon C, Zalavras CG (2007) Tibial plateau fractures treated with the less invasive stabilization system. Int Orthop 31:415–418PubMedCentralPubMedCrossRef Lee JA, Papadakis SA, Moon C, Zalavras CG (2007) Tibial plateau fractures treated with the less invasive stabilization system. Int Orthop 31:415–418PubMedCentralPubMedCrossRef
16.
Zurück zum Zitat Stannard JP, Wilson TC, Volgas DA, Alonso JE (2004) The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma 18:552–558PubMedCrossRef Stannard JP, Wilson TC, Volgas DA, Alonso JE (2004) The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma 18:552–558PubMedCrossRef
17.
Zurück zum Zitat Rangitsch MR, Duwelius PJ, Colville MR (1993) Limited internal fixation of tibial plateau fractures: a prospective protocol. J Orthop Trauma 7:168–169CrossRef Rangitsch MR, Duwelius PJ, Colville MR (1993) Limited internal fixation of tibial plateau fractures: a prospective protocol. J Orthop Trauma 7:168–169CrossRef
18.
Zurück zum Zitat Gosling T, Schandelmaier P, Muller M et al (2005) Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 439:207–214PubMedCrossRef Gosling T, Schandelmaier P, Muller M et al (2005) Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 439:207–214PubMedCrossRef
19.
Zurück zum Zitat Christensen K, Powell J, Bucholz R, Stills M (1990) Early results of combined internal–external fixation for treatment of high-grade tibial plateau fractures. J Orthop Trauma 4:226CrossRef Christensen K, Powell J, Bucholz R, Stills M (1990) Early results of combined internal–external fixation for treatment of high-grade tibial plateau fractures. J Orthop Trauma 4:226CrossRef
20.
Zurück zum Zitat Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND (1980) The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage An experimental investigation in the rabbit. J Bone Joint Surg Am 62:1232–1251PubMed Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND (1980) The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage An experimental investigation in the rabbit. J Bone Joint Surg Am 62:1232–1251PubMed
21.
Zurück zum Zitat El Barbary H, Abdel Ghani H, Misbah H (2005) Complex tibial plateau fractures treated with ilizarov external fixator with or without minimal internal fixation. Int Orthop 29:182–185PubMedCentralPubMedCrossRef El Barbary H, Abdel Ghani H, Misbah H (2005) Complex tibial plateau fractures treated with ilizarov external fixator with or without minimal internal fixation. Int Orthop 29:182–185PubMedCentralPubMedCrossRef
22.
Zurück zum Zitat Kataria H, Sharma N, Kanojia RK (2007) Small wire external fixation for high-energy tibial plateau fractures. J Orthop Surg 15:137–143 Kataria H, Sharma N, Kanojia RK (2007) Small wire external fixation for high-energy tibial plateau fractures. J Orthop Surg 15:137–143
23.
Zurück zum Zitat Lemon RA, Bartlett DH (1985) Arthroscopic assisted internal fixation of certain fractures about the knee. J Trauma 25:355–358PubMedCrossRef Lemon RA, Bartlett DH (1985) Arthroscopic assisted internal fixation of certain fractures about the knee. J Trauma 25:355–358PubMedCrossRef
24.
Zurück zum Zitat Keogh P, Kelly C, Cashman WF, McGuinness AJ, O’Rourke SK (1992) Percutaneous screw fixation of tibial plateau fractures. Injury 23:387–389PubMedCrossRef Keogh P, Kelly C, Cashman WF, McGuinness AJ, O’Rourke SK (1992) Percutaneous screw fixation of tibial plateau fractures. Injury 23:387–389PubMedCrossRef
25.
Zurück zum Zitat Schwartsman V, Martin SN, Ronquist RA, Schwartsman R (1992) Tibial fractures. Clin Orthop Relat Res 278:207–216PubMed Schwartsman V, Martin SN, Ronquist RA, Schwartsman R (1992) Tibial fractures. Clin Orthop Relat Res 278:207–216PubMed
26.
Zurück zum Zitat Ali AM, Yang L, Hashmi M, Saleh M (2001) Bicondylar tibial plateau fractures managed with the Sheffield hybrid fixator. Biomechanical study and operative technique. Inj Int J Care Injured 32:86–91CrossRef Ali AM, Yang L, Hashmi M, Saleh M (2001) Bicondylar tibial plateau fractures managed with the Sheffield hybrid fixator. Biomechanical study and operative technique. Inj Int J Care Injured 32:86–91CrossRef
27.
Zurück zum Zitat Ali AM, Saleh M, Bolongaro S, Young L (2003) The strength of different fixation techniques for bicondylar tibial plateau fractures: a biomechanical study. Clin Biomech 18(9):864–870CrossRef Ali AM, Saleh M, Bolongaro S, Young L (2003) The strength of different fixation techniques for bicondylar tibial plateau fractures: a biomechanical study. Clin Biomech 18(9):864–870CrossRef
28.
Zurück zum Zitat Watson JT, Ripple S, Hoshaw SJ, Fyhrie D (2002) Hybrid external fixation for tibial plateau fractures: clinical and biomechanical correlation. Orthop Clin North Am 33 Watson JT, Ripple S, Hoshaw SJ, Fyhrie D (2002) Hybrid external fixation for tibial plateau fractures: clinical and biomechanical correlation. Orthop Clin North Am 33
29.
Zurück zum Zitat Ballmer FT, Hertel R, Notzli HP (2000) Treatment of tibial plateau fractures with small fragment internal fixation: a preliminary report. J Orthop Trauma 14:467–474PubMedCrossRef Ballmer FT, Hertel R, Notzli HP (2000) Treatment of tibial plateau fractures with small fragment internal fixation: a preliminary report. J Orthop Trauma 14:467–474PubMedCrossRef
30.
Zurück zum Zitat Giannoudis PV (2003) Surgical priorities in damage control in polytrauma. J Bone Joint Surg Br 85:478–483PubMedCrossRef Giannoudis PV (2003) Surgical priorities in damage control in polytrauma. J Bone Joint Surg Br 85:478–483PubMedCrossRef
31.
Zurück zum Zitat Weiner LS, Kelley M, Yang E et al (1995) The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures. J Orthop Trauma 9:244–250PubMedCrossRef Weiner LS, Kelley M, Yang E et al (1995) The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures. J Orthop Trauma 9:244–250PubMedCrossRef
32.
Zurück zum Zitat Ali AM, Burton M, Hashmi M, Saleh M (2003) Outcome of complex fractures of the tibial plateau treated with beam-loading ring fixation system. J Bone Joint Surg Br 85-B:691–699 Ali AM, Burton M, Hashmi M, Saleh M (2003) Outcome of complex fractures of the tibial plateau treated with beam-loading ring fixation system. J Bone Joint Surg Br 85-B:691–699
33.
Zurück zum Zitat Delamarter RB, Hohl M, Hopp E (1990) Ligament injuries associated with tibial plateau fractures. Clin Orthop Relat Res 250:226–233PubMed Delamarter RB, Hohl M, Hopp E (1990) Ligament injuries associated with tibial plateau fractures. Clin Orthop Relat Res 250:226–233PubMed
34.
Zurück zum Zitat Catagni MA, Ottaviani G, Maggioni M (2007) Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma 63(5):1043–1053PubMedCrossRef Catagni MA, Ottaviani G, Maggioni M (2007) Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma 63(5):1043–1053PubMedCrossRef
35.
Zurück zum Zitat Chin TYP, Bardana D, Bailey M, Williamson OD, Miller R, Edwards ER, Esser MP (2005) Functional outcome of tibial plateau fractures treated with the fine-wire fixator. Inj Int Care Injured 36:1467–1475CrossRef Chin TYP, Bardana D, Bailey M, Williamson OD, Miller R, Edwards ER, Esser MP (2005) Functional outcome of tibial plateau fractures treated with the fine-wire fixator. Inj Int Care Injured 36:1467–1475CrossRef
36.
Zurück zum Zitat Marsh JL, Smith S, Do TT (1995) External fixation and limited internal fixation for complex fractures. J Bone Joint Surg (Am) 77:661–663 Marsh JL, Smith S, Do TT (1995) External fixation and limited internal fixation for complex fractures. J Bone Joint Surg (Am) 77:661–663
37.
Zurück zum Zitat John K, Kean B (2007) Wire ring fixation of complex tibial plateau fractures. In: Rozbruch SR, Ilizarov S (eds) Limb lengthening and reconstruction surgery, Vol 1. Informa Healthcare, London, pp 79–96 John K, Kean B (2007) Wire ring fixation of complex tibial plateau fractures. In: Rozbruch SR, Ilizarov S (eds) Limb lengthening and reconstruction surgery, Vol 1. Informa Healthcare, London, pp 79–96
38.
Zurück zum Zitat Hutson T (1999) The treatment of complex proximal tibial fractures (OTA type C) with bridging hybrid fixation. Orthopedic Trauma Association Meeting. Podium Presentation, Vancouver Hutson T (1999) The treatment of complex proximal tibial fractures (OTA type C) with bridging hybrid fixation. Orthopedic Trauma Association Meeting. Podium Presentation, Vancouver
Metadaten
Titel
Management of high-energy tibial plateau fractures by Ilizarov external fixator
verfasst von
Kamal El-Gafary
Wael El-adly
Osama Farouk
Mohamed Khaled
Marwa Mahmoud Abdelaziz
Publikationsdatum
01.03.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
European Orthopaedics and Traumatology / Ausgabe 1/2014
Print ISSN: 1867-4569
Elektronische ISSN: 1867-4577
DOI
https://doi.org/10.1007/s12570-013-0187-1

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