Tibia plateau fracture

The treatment of tibia plateau fractures is stil controversial especially in Schatzger Type-V and Type-VI.while some authors are advocating the open reduction internal fixation technique,the others have reported good functional results by using external fixator treatment,claiming that high rate of serious wound problems associated with this technique. In our study, 43 knees having TypeV, TypeVI and expulsive plateau fracture were treated using by Ilizarov external fixator. In open fractures radical debridement and irrigation were applied during the operation. Reduction of the fractures was attempted through an open traumatic wound.To the required fragments ,minimal osteosynthesis with cannulated screw was applied and then the operatıon finished with applying circular external fixator. There were 30 men and 12 women with a mean age of 39 years. Twelve fractures were gunshot,15 were traffic accident,10 were by falls from height and 6 were because of work accident. 26 fractures were open and 17 were closed. According to Schatzger,15 fractures were Type-V,22 were Type-VI and 5 were unclassified because these were expulsive fractures. Ligament and tendon injury were present in 22 of our patients,additional fractures were in 17 patients. The patients were followed for an average of 36 months(range 24 to 54). The average time to union of the fractures were 22.8 weeks in open fractures, and 19 weeks in closed fractures. Popliteal vein injury occured in one patient, peroneal nerve injury occured in an other patient intraoperatively.24 wire pin-site infections, in 4 patients osteomiyelitis, in 2 patients septic arthritis occured. 19 patients had nonanatomic reduction. At time of final follow up 6 patients had a fixed flexion contracture and 5 patients had loss of reduction. According to Knee Society Clinical Rating Score;13 knees were excellent,15 as good,4 as fair and 11 as poor. None of the patients having nonanatomic reduction had excellent score. Only 8 patients had good results. At time of final follow-up post-traumatic osteoarthrosis was grade-0 for ten knees, grade-1 eighteen, grade-2 eight,and grade-3 seven. 57 In summary, we found the circular external fixation to be successful fort the superficial and deep infection of open and closed extensive comminuted fractures of tibia plateau,but in this technique,loss of reduction and lower rate of anatomic reduction stil are the most important concern.