EC Orthopaedics

Research Article Volume 10 Issue 12 - 2019

Role of Ilizarov in Management of Comminuted Tibial Plateau Fracture (Prospective Study)

Mohamed Fadel and Mohamed Fawzy Kandil*

Orthopaedic Surgeon, Arab Board, Egyptian Board, Egypt

*Corresponding Author: Mohamed Fawzy Kandil, Orthopaedic Surgeon, Arab Board, Egyptian Board, Egypt.
Received: February 04, 2019; Published: November 19, 2019

Background: Using Ilizarov in management of comminuted Tibial plateau fractures is not a new method but it is increasing nowadays.

Purpose: Evaluate the outcomes of using Ilizarov external fixator in management of high energy tibial plateau fractures type V and VI according to Schatzker's classification.

Study Design: Prospective study.

Methods: We selected patients with type V and VI Schatzker's classification, explained to them the open reduction and internal fixation (ORIF) and Ilizarov external fixator (IEF) as a management techniques. Patients between 19 and 57 years old had been selected and managed with IEF as their choice. All cases were evaluated clinically and radiologically. The femoral frame was removed after a mean of 5 (range 4 - 7) weeks and the tibial frame was removed after healing of the tibia.

Results: They were 33 patients diagnosed as tibial plateau fractures, twenty eight males and 5 females with a mean age of 39.5 (19 - 57) years old. Twenty-five patients had Left (Lt) tibia fractures while 8 patients had Right (Rt) tibia fractures. Twenty nine patients had closed fractures and 4 had open fractures. Twenty cases were type V and 13 cases were type VI and all fractures united at a mean of 19.6 (range 16 - 36) weeks. All patients were followed up for 2 years for pain, stability, range of motion, limping, patient satisfaction, radiographs, and ability to return to pre injury activity level. All patients returned to work except one case. According to Lysholm score; 2 cases were excellent, 2 cases were poor and the remaining were good results. Complications occurred in the form of skin infection, skin loss, compartment syndrome and unhappiness with the device.

Conclusion: We recommend using Ilizarov external fixation for stabilization of closed or open high energy tibial plateau fractures type V and VI Schatzker's classification.

Keywords: High Energy Tibial Plateau; Ilizarov External Fixator

  1. Collins DN and Temple SD. “Open joint fractures: Classification and treatment”. Clinical Orthopaedics 243 (1989): 48-56.
  2. David P Barei., et al. “Functional Outcomes of Severe Bicondylar Tibial Plateau Fractures Treated with Dual Incisions and Medial and Lateral Plates”. Journal of Bone and Joint Surgery: American Volume 8 (2006): 1713-1721.
  3. Guanche CA and Markman AW. “Arthroscopic management of tibial plateau fractures”. Arthroscopy4 (1993): 467- 471.
  4. Honkonen SE. “Indications for surgical treatment of tibial condyle fractures”. Clinical Orthopaedics 302 (1994): 199-205.
  5. Hvid I. “Mechanical strength of trabecular bone at the knee”. Dan Med Bull4 (1988): 345-365.
  6. Jeremy A Hall., et al. “Open Reduction and Internal Fixation Compared with Circular Fixator Application for Bicondylar Tibial Plateau Fractures: Surgical Technique”. The Journal of Bone and Joint Surgery2 (2009): 74-88.
  7. Koval KJ, Helfet DL. “Tibial plateau fractures: evaluation and treatment”. Journal of the American Academy of Orthopaedic Surgeons2 (1995): 86-94.
  8. Krober MW., et al. “Effects of early estrogen replacement therapy on bone stability of ovariectomized rats. A biomechanical and radiologic study of the tibial plateau”. Orthopade12 (2000): 1082-1087.
  9. Lalić I., et al. “Treatment of complex tibial plateau fractures using Ilizarov technique”. Acta Clinica Croatica4 (2014): 437-448.
  10. Lucht U and Pilgaard S. “Fractures of the tibial condyles”. Acta Orthopaedica Scandinavica 42 (1971): 366-376. Marsh JL., et al. “Articular fractures: does an anatomic reduction really change the result?”. The Journal of bone and joint surgery. American volume 84 (2002): 1259-1271.
  11. Mills WJ and Nork SE. “Open reduction and internal fixation of high-energy tibial plateau fractures”. Orthopedic Clinics of North America1 (2002): 177-198.
  12. Muller M. “The comprehensive classification of long bones”. In: Muller ME, Allgower M, Schneider R, Willenegger H, eds. Manual of Internal Fixation. Berlin: Springer-Verlag (1995): 118-158.
  13. Rockwood CA., et al. “Fractures in adults: fracture of proximal tibia”. 6th Lippincott Williams & Wilkins (2006): 2000-2029.
  14. Schatzker J. “Fractures of the tibial plateau”. In: Schatzker J, Tile M, eds. The Rationale of Operative Fracture Care. Berlin: Springer-Verlag (1987): 279-295.
  15. Stamer DT., et al. “Bicondylar tibial plateau fractures treated with a hybrid ring external fixator: a preliminary study”. Journal of Orthopaedic Trauma 8 (1994): 455-461.
  16. Tegner Y and Lysholm J. “Rating systems in the evaluation of knee ligaments injuries”. Clinical Orthopaedics and Related Research 198 (1985): 43-49.
  17. W Wang., et al. “Cross-cultural translation of the Lysholm knee score in Chinese and its validation in patients with anterior cruciate ligament injury”. BMC Musculoskeletal Disorders 17 (2016): 436.
  18. Weiner LS., et al. “The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures”. Journal of Orthopaedic Trauma 9 (1995): 244-250.

Mohamed Fadel and Mohamed Fawzy Kandil. Role of Ilizarov in Management of Comminuted Tibial Plateau Fracture (Prospective Study). EC Orthopaedics 10.12 (2019): 01-09.