Summary

Tibial plateau fractures (Schatzker type V and VI) are complex fractures often associated with soft tissue damage and are at the high risk for wound complications after open reduction and internal fixation (ORIF), dificulty is to estabilsh stable fixation of comminuted fractures. Ilizarov metod provide percutaneous stabilization and early rehabilitation, with minor adverse effects.

Abstract

Tibial plateau represent one of the most critical weight-bearing surfaces in human body; fractures of impact the stability, mobility and knee joint line. Proper treatment of these fractures are crucial for decrease disability and risc of documented complications, specialy posttraumatic osteoarthritis. Tibial plateau fractures (Schatzker type V and VI) are complex fractures caused by high energy, often associated with soft tissue damage and are at the high risk for wound comlications after open reduction and internal fixation (ORIF). Another dificulty is to estabilsh stable fixation of comminuted fractures. Clasical operative technique with two plates is related with potentional complications such as failed fixation, malunion, nonunion, joint stifness, posttraumatic arthritis, infection, and most of all soft tissue complications that range from 23%-87,5%. Veri and.all compared internal and external fixation in double cohort studies, and recorder high degree of wound complications and reoperations in ORIF group through single incision and two plates. Also, their results suggested efficasy and safety, with low degree of wound complications and early functional recovery in external hybrid fixation group. From 2005.-2023. 147 patients with Schatzker V and VI bicondylar tibial fractures were operated using the Ilizarov method. Of these, there were 98 men and 49 women, average age 53 years (23-73). Left knee in 83 cases, right in 64 patients. There were 33 open fractures (Gustillo Anderson gr II-IIIb). The cause of injury was a traffic accident in 75 patients, a fall in 30, a landing and a fall from a height in 42. Operations were performed under spinal or general anesthesia using the Ilizarov method. An extension table and X-ray control were used. Reposition was established by manual traction and a patellar bone holder. Poor reposition or depression of the fragments was solved with the placement of a cancellous graft and elevation with a metal rammer through a small anteromedial or anterolateral scin incision and and a bone tunnel. 4 pins with an olive were placed through the tibial plateau and connected to a ring, in order to pull the fragments by tightening and obtain a satisfactory reposition. The position was checked by x-ray control. The metadiaphyseal angle was corrected with additional rings and spacers. Early physical treatment was started from the first postoperative day with exercises for knee movements and muscle strengthening, support was allowed on average after 4 weeks. The device was worn for an average of 5 months (4-12), disassembly was performed under analog sedation or TIVA, after disassembly a functional knee cast was placed for 4 weeks, and after removing the cast, the patients were referred for physical treatment. Follow up were done after one month, 3 months, 6 months and one year. Fractures healed in all but 1 patient. In one case of open fracture, infection developed postoperatively, in 3 cases, septic arthritis occurred. In one case, a low femoral amputation was performed due to an infection of the knee joint. In one case, we had an unsatisfactory leveling of the plateau, but the range of motion is satisfactory (120 degrees) and painless. In 2 cases, reoperations were performed to correct the apparatus and fragments of the tibial shaft. In three cases there were indicated TKA due to severe osteoarthrosis. At the last controls, the average range of motion in all operated patients was flexion 135º (range 115º-150º) and extension -3 (range -10º to +5º). 73 patients developed a transient "pin-track" infection.