Staged Treatment of Bicondylar Tibial Plateau Fracture (Schatzker Type V or VI) Using Temporary External Fixator: Correlation between Clinical and Radiological Outcomes

Abstract

PurposeThis study is to investigate clinical and radiological results of staged treatment using a temporary external fixator in bicondylar tibial plateau fractures (TPFs) and to evaluate correlation between prognostic factors and postoperative clinical outcomes.Materials and MethodsTwenty-four bicondylar TPF patients were selected. All patients were operated by a temporary external fixator first and then open reduction and internal fixation with dual plating. Clinical and radiological outcomes were evaluated.ResultsThe mean American Knee Society score (AKSS) was 85.3. The mean Western Ontario and McMaster Universities Osteoarthritis index was 11.2. The mean range of motion (ROM) was 123.4°. The mean medial tibial plateau angle (mTPA) was 88.3°, and the mean proximal posterior tibial angle (PPTA) was 8.4°. Compared with the uninjured limb, the mean difference of mTPA was 1.5° and that of PPTA was 4.0°. The difference of PPTA and the AKSS demonstrated negative correlation (p=0.007). Patients with normal mTPA showed better ROM than those with abnormal mTPA (p=0.041).ConclusionsStaged treatment using a temporary external fixator in bicondylar TPFs showed good clinical and radiological outcomes. Surgeons should evaluate the reduction status intraoperatively by fluoroscopy and also refer to the uninjured limb radiologically.

Intra-articular Calcaneal Fracture Treatment With Staged Medial External Fixation

“…The staged approach using external fixation has been widely accepted as the standard care protocol in clinical settings for periarticular fractures of the tibia, such as tibial plateau and pilon fractures. 2,25,28,30 Although the optimal management of calcaneus fractures remains controversial, surgeons have recently preferred using a medial calcaneal external fixator that can achieve initial multiplanar deformity correction, including height and length, and rigid fixation. 3,14 In addition, an external fixator does not interfere with the incision for the definite surgery and avoids potential wound complications.…”

“…5,14 The staged approach using temporary external fixation has become widely accepted for tibial plateau and pilon fractures with severe soft tissue swelling. 25,28,30 However, in calcaneus fractures, controversy exists regarding whether delaying operative fixation or a staged treatment is the ideal treatment choice. Traditionally, most surgeons have advocated for delaying operative fixation for 1-2 weeks to reduce swelling and allow for recovery of skin wrinkling.…”

Mid-Term Radiological and Functional Outcomes of Bicondylar Tibial Plateau Fractures Managed with Open Reduction and Internal Fixation Using Dual Plates

“…Numerous surgical fixation methods—such as a conventional dual-plate, a hybrid external fixator and/or less invasive stabilizing system—have been proposed for the treatment of complex tibial plateau fractures. 7 Pun et al . reported a series of 21 bicondylar tibial plateau fractures treated with dual plating or with the Ilizarov fixator.…”

“…Alternatively, circular external fixation with limited internal fixation (hybrid fixator) and arthroscopically assisted percutaneous reduction and internal fixation have been reported for the treatment of tibial plateau fractures. 5 – 7 Despite the plethora of techniques, malalignment and secondary osteoarthritis are common complications encountered after surgery for complex tibial plateau fractures. This study aimed to evaluate the mid-term radiological and functional outcome of tibial plateau fractures managed with ORIF using dual plates.…”

Magnetic Resonance Imaging of the Knee in the Presence of Bridging External Fixation: A Comparative Experimental Evaluation of Four External Fixators, Including Dolphix®

“…Bridging external fixation of the knee must be implemented for the temporary emergent stabilization of the knee joint [ 1 , 2 ]. There are many injuries that can benefit from a temporary surgical stabilization of the knee, including tibial plateau fractures, knee dislocations, and femoral condylar fractures [ 2 ] External fixation plays a role in orthopedics’ traumatology as an optimal management while awaiting the healing of soft tissue or the right timing for definitive surgery [ 2 , 3 , 4 , 5 ]. The concomitant utilization of magnetic resonance imaging (MRI) is an indispensable diagnostic tool in several orthopedic trauma scenarios and has widely increased in the last decade [ 6 , 7 , 8 ].…”