ORIGINAL ARTICLE
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 33-41

Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator


Department of Orthopaedic, Al-Azhar University, Damietta, Egypt

Correspondence Address:
Osman A Mohamed
Department of Orthopedic Surgery, Al-Azhar University, Damietta
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.108637

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Background: We treated 30 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Ten fractures were open, and 20 patients had complex injuries. Of all, 15 were treated by ligamentotaxis and percutaneous fixation, eight by limited open reduction, and seven by open reduction bone graft and screws. There is, however, no "gold standard" procedure for this complicated and multi-disciplinary problem. Objectives: Evaluation of Ilizarov circular fixation method of treatment for these fractures when extensive dissection and internal fixation are contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution. Materials and Methods: Between October 2007 and October 2011, we treated 30 consecutive patients with severe bicondylar fractures of the tibial plateau by the Ilizarov fixator. They were reviewed 24 months postoperatively and the level of function, clinical and radiological findings, and the patients' opinion were assessed. There were 20 men and 10 women with a mean age of 39 years (18 to 69 years). Six patients were car drivers or passengers, 12 were pedestrians struck by motor vehicles, and seven were motor-cycle riders. Four had been injured by falls from a height and one had a crush injury caused by a collapsed wall. Ten (33.3%) of the fractures were open. There were 10 Schatzker (1987) type-V and 20 type-VI fractures; 20 (66.6%) were comminuted. Results: All the fractures united within mean duration of 14.4 weeks. The femoral fixator could be removed within mean period of 6 weeks (range, 4 to 7 weeks) and the tibial fixator was retained for a mean of 13 weeks (range, 12 to 20 weeks). Full weight-bearing was allowed at a mean of 14.4 weeks (range, 12 to 24 weeks). The patients were followed up for a mean of 36.5 months (range, 24 to 53 months). The results were assessed according to the criteria of Honkonen and Järvinen (1992) which considers the subjective opinion of the patient, the clinical state, the function, and the radiological assessment. On the basis of the clinical criteria, outcome in ten cases were excellent, ten good, five fair, and five poor. Conclusion: Our study confirms the low morbidity and good outcomes associated with the Ilizarov method. The technique is appropriate for complex fractures of the tibial plateau when extensive dissection and internal fixation are contraindicated due to comminution at the fracture site and compromise of the soft tissue.


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