Ilizarov and Locking Plate Fixation for Closed Bicondylar Tibial Plateau Fracturesa Prospective Study

Abstract

BACKGROUNDIn bicondylar tibial plateau fractures, the most frequently used treatment is ORIF with screws and plates; however, the soft tissue complications are frequently reported. Minimally-invasive Ilizarov technique is an alternative. The purpose of this study was to compare and analyse the clinical and radiological results of locking plate and Ilizarov technique in bicondylar tibial plateau fractures treated at a level I trauma centre. MATERIALS AND METHODSThe patients with closed isolated bicondylar tibial fractures (Schatzker V/VI) were included in the study. Fifteen patients (8 of type V and 7 of type VI) in one group were treated using locked plating system and fifteen patients (5 of type V and 10 of type VI) in another group were treated with Ilizarov technique. Pre-and post-operatively, conventional radiographs, CT scans, hospital stay and complications were evaluated. The outcomes were evaluated using modified Rasmussen clinical and radiological criteria. RESULTSThe two groups were similar demographically. Both the techniques achieved acceptable osseous reduction. When compared with internal fixation, Ilizarov had increased average range of motion (124˚ vs 117˚), decreased complications (p= 0.01), reduced hospital stay (0.001), earlier weight-bearing and marginally faster recovery (outcome in terms of modified Rasmussen clinical assessment score) at 6 months. But the outcomes were not significantly different at 1 year. In this study, Ilizarov technique had slight favourable outcome compared to locked plating group. CONCLUSIONThe Ilizarov method produces a good clinical outcome and is a valuable alternative treatment for bicondylar tibial plateau fractures with added advantage of decreased hospital stay, decreased waiting time for definitive surgery and early weight bearing.

Comparison between open reduction with internal fixation to circular external fixation for tibial plateau fractures: A systematic review and meta-analysis

“…Three studies [18,20,26] reported the incidence of non-unions in the two groups. Pooled analysis indicates no difference in the incidence of non-union with either methods of management (OR, 1.44; 95%CI, 0.14-14.27; I 2 = 74%; p = 0.76) ( Fig 6B) Five studies [16,18,21,22,25] reported the incidence of postoperative thromboembolism and four studies reported data on knee stiffness [18,23,28,29] in both study groups. Metaanalysis demonstrated no difference in the incidence of postoperative thromboembolism (OR, 2.47; 95%CI, 0.89-6.84; I 2 = 10%; p = 0.08) ( Fig 7A) and knee stiffness (OR, 1.19; 95%CI, 0.32-4.40; I 2 = 42%; p = 0.79) ( Fig 7B) between ORIF and circular external fixator.…”

“…Three studies [18,24,28] reported data on post-operative knee ranges of motion in degrees. The pooled mean difference did not demonstrate any significant difference in range of motion between the two treatment modalities (MD,2.28; 95% CI, -11.27 to 15.82; I 2 = 86%, p = 0.74) (Fig 3).…”

“…Five studies [17,23,24,28,30] reported the length of hospital stay for both study cohorts. All the studies found the patients in the circular external fixation cohort had shorter hospital stays than those in the ORIF cohort (Fig 4).…”