Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator

Mohamed, Osman Abdellah; Youssef, Salah

doi:10.4103/0975-2870.108637

Cited by 4 publications

(9 citation statements)

References 12 publications

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“…18 Mohamed found that 6.7% of patients treated for Schatzker V and IV fractures had an articular step-off greater than 4 mm. 19 In one case we observed a spontaneous filling of an articular gap up to 4 mm (►Fig. 6).…”

Section: Discussionmentioning

confidence: 82%

“…In the present series, condylar widening greater than 3 mm was observed in five patients (25%), with a mean of 5 mm (range, 3-7 mm). Mohamed 19 found condylar widening in 10 of 30 patients treated with external fixation. In a large study with 5-year follow-up, Stevens et al 1 with open reduction observed three cases of condylar widening greater than 5 mm.…”

Section: Discussionmentioning

confidence: 99%

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Treatment with Circular External Fixation of Bicondylar Tibial Fractures: Potential in Accurate Reduction and Efficacy on Functional Results

Lovisetti

Vulcano²,

Bettella

et al. 2017

J Knee Surg

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Surgical reconstruction of bicondylar tibial fractures with external fixation relies on indirect fracture reduction that could affect anatomical restoration. The aim of the present study is to evaluate the radiographic and clinical outcomes of tibial bicondylar fractures treated with circular external fixation. A total of 20 bicondylar fractures of the proximal tibia in 20 patients treated with circular external fixation were included in the study. Two fractures were open. Mean clinical and radiographic follow-up was 37.3 months after frame removal. Angular, translation, and length deformities were assessed on nonweight-bearing anteroposterior, lateral, and two 45 degrees oblique views. The medial proximal tibia (MPTA) and posterior proximal tibia angles (PPTA) were calculated in all cases. The condylar widening was calculated in relation to the width of the femoral condyles. Joint depressions or gaps of the articular surface were identified on the four views of the knee. The modified Hospital for Special Surgery (HSS) knee scoring system was used for clinical evaluation. The MPTA was good in 18 (90%) and fair in 2 patients (10%). The PPTA was good in 13 (65%), fair in 6 (30%), and poor in 1 patient (5%). The articular reduction was good in 12 (60%) and fair in 8 patients (40%). The condylar widening was good in 15 (75%) and fair in 5 patients (25%). Mechanical axis deviation was within the normal range in 11/12 patients (91.7%). All fractures consolidated. One deep infection was successfully treated with local debridement, the mean modified HSS knee score at the latest follow-up was 90.5 (range: 67-100). Articular reconstruction and tibia alignment based on radiographic evaluation in the present study, along with functional results compare favorably with those of external and internal fixation presented in the literature.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Treatment with Circular External Fixation of Bicondylar Tibial Fractures: Potential in Accurate Reduction and Efficacy on Functional Results

Lovisetti

Vulcano²,

Bettella

et al. 2017

J Knee Surg

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“…The most popular treatment option has been open reduction and internal fixation with double plating but research data showed that this method is associated with many complications that include joint stiffness, non-union, mal-union, skin defects, osteomyelitis, which could lead to amputation and even death [5]. The complication rate appeared to be as high as 50% in some studies and the rate of postoperative skin infection and osteomyelitis has been reported to be up to 33% [6]. In order to reduce the occurrence of these problems, closed reduction and percutaneous external fixation was proposed by Ilizarov [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…The complication rate appeared to be as high as 50% in some studies and the rate of postoperative skin infection and osteomyelitis has been reported to be up to 33% [6]. In order to reduce the occurrence of these problems, closed reduction and percutaneous external fixation was proposed by Ilizarov [6,7].…”

Section: Introductionmentioning

confidence: 99%

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High-energy tibial plateau fractures treated with Ilizarov fixator

2019

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Introduction/Objective Tibial plateau fractures constitute a significant group of injuries to a major weight-bearing joint. High-energy fractures are difficult to treat, as they entail articular depression, condylar displacement, dissociation of comminuted metaphysis, and closed degloving injuries. The principles of the treatment are anatomical reconstruction of the articular surface, restoration of the anatomical axis, fixation spanning the metaphyseal comminution, and further minimization of soft tissue injury. The aim of this study is to evaluate the clinical outcome of using Ilizarov external fixator in the treatment of high-energy Schatzker IV, V, and VI tibial plateau fractures. Methods This retrospective study was conducted from 2013-2016 on 35 patients (36 fractures) with high-energy tibial plateau fractures classified as Schatzker type IV, V, and VI. The mechanisms of injury were road traffic accident, fall from a height and direct trauma. The fractures were closed in 26 cases and open in 10 cases. All patients were treated with ligamentotaxis and percutaneous fixation using Ilizarov fixator. Functional outcome was determined using the Knee Society Score. Results The mean follow-up period was 20 months. All fractures healed in an average time of 14 weeks. The range of knee flexion after one-year follow-up averaged at 100°. Average Knee Society Score in our study was 77. Conclusion Ilizarov external fixation is a safe and efficient treatment modality for high-energy tibial plateau fractures. It allows reconstruction of the articular surface, stable fixation, early rehabilitation, and care of soft tissue injuries.

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Treatment of high‐energy intra‐articular fractures of tibia with Ilizarov external fixator in adults: A tertiary centre experience

et al. 2021

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Objective To evaluate the clinical and radiological outcomes of the Ilizarov fixator in the proximal and distal fractures of the tibia. Materials and methodology This retrospective study reviewed 59 patients having high‐energy intra‐articular proximal and distal tibia fractures associated with severe soft‐tissue injury, who were managed surgically with an Ilizarov fixator. The functional outcome was evaluated by using the American Orthopaedic Foot and Ankle Society scoring system (AOFAS) and the Association for the Study and Application of the Method of Ilizarov (ASAMI) Italy scoring system for tibial plateau and plafond fractures respectively. Results The most common mode of injury was road traffic accidents. According to the Gustilo open fracture classification, there were 16 patients with grade‐I and nine with grade II open fractures. The remaining had closed fractures. According to the Schatzker classification of plateau fractures, 20 were graded as type V and 15 as type VI. According to the AO classification of plafond fractures, 12 fractures were graded as Type‐43C1, 5 as Type‐43C2, and 7 as Type‐43C3. There was delayed union in 11 proximal and four distal fractures, all of which achieved union without additional bone grafting. In proximal fractures, according to AOFAS, out of 35, 26 had an acceptable while nine had a fair result. In distal fractures, according to ASAMI, out of 24, 16 had an acceptable while five had fair results. There were 192/448 wires in 58 patients with pin site infection; all were superficial and settled. Posttraumatic joint arthrosis was noted in nineteen. Conclusions The postoperative clinical and radiological outcome indicated that primary Ilizarov external fixator is a reliable minimal invasive surgery and definitive fixation method for high‐energy intra‐articular proximal and distal tibial fractures with compromised soft‐tissue. It also offers early stabilisation and painless joint motion without a high rate of complications.

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Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator

Cited by 4 publications

References 12 publications

Treatment with Circular External Fixation of Bicondylar Tibial Fractures: Potential in Accurate Reduction and Efficacy on Functional Results

Treatment with Circular External Fixation of Bicondylar Tibial Fractures: Potential in Accurate Reduction and Efficacy on Functional Results

High-energy tibial plateau fractures treated with Ilizarov fixator

Treatment of high‐energy intra‐articular fractures of tibia with Ilizarov external fixator in adults: A tertiary centre experience

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