Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(04): 667-674
DOI: 10.1055/s-0041-1739171
Artigo Original
Joelho

Ilizarov Ring External Fixation for Complex Tibial Plateau Fractures

Article in several languages: português | English
Anil Ghimire 
1   Hospital Ortopédico do Nepal, Jorpati, Kathmandu 44601, Nepal and Patan Academy of Health Sciences, Patan Hospital, Lalitpur 44700 Nepal
,
Pramod Devkota 
2   Departamento de Ortopedia e Cirurgia de Trauma, Patan Hospital, Academia Patan de Ciências da Saúde, Lalitpur, Kathmandu, Nepal
,
Kailash Kumar Bhandari 
1   Hospital Ortopédico do Nepal, Jorpati, Kathmandu 44601, Nepal and Patan Academy of Health Sciences, Patan Hospital, Lalitpur 44700 Nepal
,
Yubaraj Kharel 
1   Hospital Ortopédico do Nepal, Jorpati, Kathmandu 44601, Nepal and Patan Academy of Health Sciences, Patan Hospital, Lalitpur 44700 Nepal
,
Saju Pradhan 
1   Hospital Ortopédico do Nepal, Jorpati, Kathmandu 44601, Nepal and Patan Academy of Health Sciences, Patan Hospital, Lalitpur 44700 Nepal
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Objective To analyze the results of clinical, radiological, and functional outcomes of tibial plateau fracture (Schatzker Type V, VI) treated with Illizarov ring external fixator with or without minimum opening.

Methods A total of 52 tibial plateau fractures of type V, VI were treated with Ilizarov ring external fixator with or without mininum internal fixation were studied. Functional outcome assessment was done using the American Knee Society (AKS) score with clinical, radiological union, and complications were analyzed.

Results There were 37 (71.15%) male and 15 (28.84%) female patients, with a mean age of 39.07 ± 12.58 years old. Road traffic accidents (RTAs) were the major cause of fracture, accounting for 32 cases (61.53%) followed by fall injury, with 16 cases (30.76%), and direct impact, with 4 cases (7.69%). Twenty-one (40.38%) cases were type V and 31 (59.61%) cases were type VI fractures, and there were 24 (46.15%) cases of open fracture. The mean AKS score of Type V and Type VI fractures were 82.8 and 80.70, respectively, but this was statistically not significant at p<0.05. The mean AKS score of closed and open fractures were also statistically not significant at p<0.05.

Conclusions For Schatzker Types V and VI complex tibial plateau fractures, Ilizarov external fixation is a safe, cost-effective and efficient treatment method that presents a satisfactory outcome.

Keywords

Ilizarov technique - external fixator - tibial fracture - Schatzker classification

Contributions of the Authors

Ghimire A., Devkota P. and Bhandari K. K. contributed equally to the conception and design of the work. Ghimire A. collected the data and Devkota P. and Bhandari K. K. participated on the analysis and interpretation of the data, and drafting of the manuscript for important intellectual content, and agree to be accountable for all aspects of the work related to its accuracy and integrity. Kharel Y. and Pradhan S. contributed to the conception and design of the work and the acquisition, analysis, and interpretation of the data. All authors read and approved the final manuscript.


Work developed at the Department of Orthopaedics and Trauma Surgery, Nepal Orthopaedic Hospital, Jorpati, Kathmandu, Nepal.




Publication History

Received: 06 September 2020

Accepted: 25 June 2021

Article published online:
11 November 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 El Barbary H, Abdel Ghani H, Misbah H, Salem K. EI Barbary H. Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Int Orthop 2005; 29 (03) 182-185
    CrossrefPubMedGoogle Scholar
  • 2 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 1979; (138) 94-104
    PubMedGoogle Scholar
  • 3 Debnath UK, Jha DK, Pujari PK. Results of ring (Ilizarov) fixator in high energy Schatzker type VI fractures of proximal tibia. J Clin Orthop Trauma 2018; 9 (02) 186-191
    CrossrefPubMedGoogle Scholar
  • 4 Lansinger O, Bergman B, Körner L, Andersson GB. Tibial condylar fractures. A twenty-year follow-up. J Bone Joint Surg Am 1986; 68 (01) 13-19
    CrossrefPubMedGoogle Scholar
  • 5 John KS, Bret K. Wire ring fixation of complex tibial plateau fractures. In: Rozbruch SR, Ilizarov S. editors. Limb Lengthening and Reconstruction Surgery. New York: Information of Health Care; 2007: 79-96
    Google Scholar
  • 6 DeCoster TA, Nepola JV, el-Khoury GY. Cast brace treatment of proximal tibia fractures. A ten-year follow-up study. Clin Orthop Relat Res 1988; (231) 196-204
    PubMedGoogle Scholar
  • 7 Ozkaya U, Parmaksizoglu AS. Dual locked plating of unstable bicondylar tibial plateau fractures. Injury 2015; 46 (Suppl. 02) S9-S13
    CrossrefPubMedGoogle Scholar
  • 8 Watson JT. High-energy fractures of the tibial plateau. Orthop Clin North Am 1994; 25 (04) 723-752
    CrossrefPubMedGoogle Scholar
  • 9 Leunig M, Hertel R, Siebenrock KA, Ballmer FT, Mast JW, Ganz R. The evolution of indirect reduction techniques for the treatment of fractures. Clin Orthop Relat Res 2000; (375) 7-14
    CrossrefPubMedGoogle Scholar
  • 10 Kumar A, Whittle AP. Treatment of complex (Schatzker Type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma 2000; 14 (05) 339-344
    CrossrefPubMedGoogle Scholar
  • 11 Subramanyam KN, Tammanaiah M, Mundargi AV, Bhoskar RN, Reddy PS. Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation. Chin J Traumatol 2019; 22 (03) 166-171
    CrossrefPubMedGoogle Scholar
  • 12 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
    PubMedGoogle Scholar
  • 13 Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58 (04) 453-458
    CrossrefPubMedGoogle Scholar
  • 14 Ranatunga IR, Thirumal M. Treament of Tibial Plateau Schatzker Type VI Fractures with the Ilizarov Technique Using Ring External Fixators Across the Knee: A Retrospective Review. Malays Orthop J 2010; 4 (02) 34-39
    CrossrefGoogle Scholar
  • 15 Makhdoom A, Jokhio MF, Tahir SM. et al. Ligamentotaxis by Ilizarov Method in the Management of Tibial Plateau Fractures. World J Med Sci 2014; 11 (04) 461-467
    Google Scholar
  • 16 Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res 1990; (250) 8-26
    PubMedGoogle Scholar
  • 17 Velazquez RJ, Bell DF, Armstrong PF, Babyn P, Tibshirani R. Complications of use of the Ilizarov technique in the correction of limb deformities in children. J Bone Joint Surg Am 1993; 75 (08) 1148-1156
    CrossrefPubMedGoogle Scholar
  • 18 Bennett WF, Browner B. Tibial plateau fractures: a study of associated soft tissue injuries. J Orthop Trauma 1994; 8 (03) 183-188
    CrossrefPubMedGoogle Scholar
  • 19 Ali AM, Burton M, Hashmi M, Saleh M. Outcome of complex fractures of the tibial plateau treated with a beam-loading ring fixation system. J Bone Joint Surg Br 2003; 85 (05) 691-699
    CrossrefPubMedGoogle Scholar
  • 20 Ali AM. Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Eur J Orthop Surg Traumatol 2013; 23 (03) 349-355
    CrossrefPubMedGoogle Scholar
  • 21 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 (05) 1043-1053
    Google Scholar
  • 22 Watson JT, Coufal C. Treatment of complex lateral plateau fractures using Ilizarov techniques. Clin Orthop Relat Res 1998; (353) 97-106
    CrossrefPubMedGoogle Scholar
  • 23 Weiner LS, Kelley M, Yang E. et al. The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures. J Orthop Trauma 1995; 9 (03) 244-250
    CrossrefPubMedGoogle Scholar
  • 24 Elsoe R, Kold S, Larsen P, Petruskevicius J. A prospective observational study of 56 patients treated with ring fixator after a complex tibial fracture. Strateg Trauma Limb Reconstr 2017; 12 (01) 35-44
    CrossrefPubMedGoogle Scholar
  • 25 Khatri K, Lakhotia D, Sharma V, Kiran Kumar GN, Sharma G, Farooque K. Functional Evaluation in High Energy (Schatzker Type V and Type VI) Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation. Int Sch Res Notices 2014; 2014: 589538
    PubMedGoogle Scholar
  • 26 Rohra N, Suri HS, Gangrade K. Functional and Radiological Outcome of Schatzker type V and VI Tibial Plateau Fracture Treatment with Dual Plates with Minimum 3 years follow-up: A Prospective Study. J Clin Diagn Res 2016; 10 (05) RC05-RC10
    PubMedGoogle Scholar
  • 27 Bertrand ML, Pascual-López FJ, Guerado E. Severe tibial plateau fractures (Schatzker V-VI): open reduction and internal fixation versus hybrid external fixation. Injury 2017; 48 (6, Suppl 6) S81-S85
    CrossrefPubMedGoogle Scholar
  • 28 Canadian Orthopaedic Trauma Society. Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am 2006; 88 (12) 2613-2623
    CrossrefPubMedGoogle Scholar
  • 29 Zhao XW, Ma JX, Ma XL. et al. A meta-analysis of external fixation versus open reduction and internal fixation for complex tibial plateau fractures. Int J Surg 2017; 39: 65-73
    CrossrefPubMedGoogle Scholar
  • 30 Stannard JP, Wilson TC, Volgas DA, Alonso JE. The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma 2004; 18 (08) 552-558
    CrossrefPubMedGoogle Scholar