Treatment of High-Energy Tibial Plateau Fracture: A comparison of External Fixation with Limited Internal Fixation to Plate and Screw Fixation

Yoon, Suk Woong; Hwang, Tae Sung; Park, Byoung Gue

Abstract

High energy tibial plateau fractures are associated with wevere articular depression, separation of both condyles, diaphyseal comminution and dissociation & loss of integrity of the soft tissue envelop. Thus it is very difficult to treat these fractures satisfactorily and severe complications may be developed. Authors carried out plate and screw fixation in 11 patients and external fixation(Ilizarov external fixator) with limited internal fixation in 8 patientsl who sustained high-energy tibial plateau fracture between Jan. 1992 and Feb. 1996. We compared the operative results of plate and screw fixation and external fixation with limited internal fixation in high-energy tibial plateau fractures which was follow up from 12months to 28months. The results were as follows; 1. The complications such as limitation of knee motion(3 cases), traumatic arthritis(1 case), angular deformity(2 cases), superficial infection(2 cases), deep infection(1 case), instability(1 case) were observed in plate fixation group. Limitation of knee motion(1 case), traumatic arthritis(1 case), delayed union(1 case) were developed in external fixation group. 2. According to Blokker's criteria, 6 cases(55%) among 11cases of plate and screw fixation group and 5 cases(63%) among 8 cases of Ilizarov external fixator group had satisfactory results. Ilizarov external fixation with limited internal fixation is useful method of treatment for high-energy tibial plateau fractures when extensive dissection and internal fixation are contraindicated due to comminution at the fracture site and compromise of the soft tissue.