External Fixation of Tibial Plateau Fractures: A Retrospective Evaluation and Case Report

Abstract

Tibial plateau fractures can be treated with casting, internal fixation and external fixation: each method has associated benefits and risks. We conducted a retrospective review of 40 patients at the University of Louisville Hospital with both open and closed tibial plateau fractures treated with external fixation. Complications were tabulated. In this review, 27.5 % of the patients experienced complications, which included superficial infection, deep infection, non-union, arthrosis, and/or operative modification or readjustment of the frame. We then compared our infection rates, superficial and deep, to established infection rate data for both external fixation and internal fixation. We achieved a lower rate of superficial infection and deep infection than Hutson and Zych's rate for fixators and Blokker et al.'s rate for open reduction internal fixation. Comparison of our combined (deep + superficial) infection rate to Schulak and Gunn's open reduction internal fixation rate provides additional support for external fixation as a satisfactory treatment method. These results support external fixation as at least as good as internal fixation with regard to infection. Lastly, we present a case in which a patient with an open tibial plateau fracture was treated successfully with external fixation without complication.

Key words

Internal fixation - casting - pin tract infection - deep infection - arthrosis - non-union

References

• 1 Blokker C P, Rorabeck C H, Bourne R B. Tibial plateau fractures and analysis of treatment in 60 patients.  Clin Orthop. 1984;  182 193-198
• 2 Catagni M. Fractures of the leg (tibia). In: Maiocchi AB, Aronson J. Operative Principles of Ilizarov. Treatment, Nonunion, Osteomyelitis, Lengthening, Deformity Correction. Baltimore: Williams and Wilkins 1991; 91-124
• 3 Christensen K P, Powell I N, Bucholz R W, Stills M. Early results of combined internal-external fixation for the treatment of high-grade tibial plateau fractures.  J Orthop Trauma. 1990;  4 226
• 4 Decoster T A, Nepola J V, EI-Khoury G Y. Cast brace treatment of proximal tibia fractures.  Clin Orthop. 1988;  231 198-204
• 5 Delamarter R, Hohl M. Cast brace and tibial plateau fractures.  Clin Orthop. 1989;  242 26-31
• 6 Dendrinos G K, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator.  J Bone Joint Surg [Br]. 1996;  77 710-717
• 7 Duwelius P J, Connolly J F. Closed reduction of tibial plateau fractures: a comparison of functional and roentgenographic end results.  Clin Orthop. 1988;  230 116-126
• 8 Hutson J J, Zych G A. Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators.  J Orthop Trauma. 1998;  12 214-218
• 9 Ilizarov G A. The treatment of fractures, theoretical considerations, experimental studies and clinical applications of the apparatus. In: Ilizarov GA, Green SA. Transosseous Osteosynthesis: Theoretical and Clinical Aspects of the Regeneration of Growth of Tissues.  Berlin: Springer-Verlag. 1992;  369-452
• 10 Koval K J, Sanders R, Borrelli J, Helfet D, DiPasquale T, Mast J W. Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures.  J Orthop Trauma. 1992;  6 340-346
• 11 Lansinger O, Bergman B, Korner L, Anderson B GJ. Tibial condylar fractures. A twenty-year follow-up.  J Bone Joint Surg [Am]. 1986;  68 13-19
• 12 Littenberg B, Weinstein L, McCarren M, Mead T, Swiontkowski M, Rudicel S, Heck D. Closed fractures of the tibial shaft: A meta-analysis of three methods of treatment.  J Bone Joint Surg [Am]. 1998;  80 174-183
• 13 Marsh J L, Smith S T, Do T T. External fixation and limited internal fixation for complex fractures of the tibial plateau.  J Bone Joint Surg [Am]. 1995;  77 661-673
• 14 Murphy C P, D'Ambrosia R, Dabezies E J. The small pin circular fixator for proximal tibial fractures with soft tissue compromise.  Orthopedics. 1991;  14 273-280
• 15 Slomka R. Complications of ring fixators in the foot and ankle.  Clin Orthop. 2001;  391 155-162
• 16 Stamer D T, Schenk R, Staggers B, Aurori K, Aurori B, Behrens F. Bicondylar tibial plateau fractures treated with a hybrid ring external fixator: A preliminary study.  J Orthop Trauma. 1994;  8 455-461
• 17 Schulak D T, Gunn D R. Fractures of the tibial plateaus.  Clin Orthop. 1975;  109 166-177