Hybrid external fixation of comminuted tibial plateau fractures.

Yale University School of Medicine, Orthopaedics and Rehabilitation, Orthopedic Associates of New Haven, CT 06510, USA.
Clinical Orthopaedics and Related Research (Impact Factor: 2.88). 08/1996; DOI: 10.1097/00003086-199607000-00032
Source: PubMed

ABSTRACT Comminuted tibial plateau fractures present a surgical challenge to the orthopaedic surgeon. Over the years, treatment has ranged from traction to cast immobilization to open reduction and internal fixation. More recently, indirect reduction techniques with external fixation have been used. At the authors' institution, from 1990 to 1992, 18 Schatzker Types V and VI tibial plateau fractures were treated in 18 patients with indirect reduction and application of a Monticelli-Spinelli hybrid external fixation system. Two patients had additional internal fixation and were excluded from this review. All 16 patients were available for followup evaluation. The mean time to union was 4.5 months. There were no nonunions. Three patients developed a varus deformity. Fifteen had radiographic evidence of early degenerative changes at 1 year followup. There were 11 superficial pin tract infections in 4 patients; all resolved with local pin care and a short course of oral antibiotics. There were no deep infections. With the added advantages of minimal to no soft tissue stripping and early knee range of motion, this technique is recommended for treatment of these difficult fractures.

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    ABSTRACT: Objective Whether external or plating fixation is more appropriate for high-energy tibial plateau fractures is still being disputed, our aim was to test the hypothesis whether external fixation can provide a fair outcome with fewer complications, when compared to the results with previously reported data of plating fixation for high-energy tibial plateau fractures. Methods An Ovid of Medline, Embase, and Cochrane Library search was conducted for the relevant English orthopedic journals, and eligible studies, including twenty-four case series and one comparative study containing 885 patients associated with 892 fractures, were enrolled. Results The results showed there were a higher proportion of men, open fractures, malunion, knee instability, and posttraumatic arthritis occurred in external fixation group than those in plating group (P = 0.007, P = 0.000, P = 0.024, P = 0.006, P = 0.000, respectively), while valgus deformity happened at a significantly higher rate in plate group (P = 0.014). No significant differences were found between the two groups in terms of age, Schatzker type, follow-up, mean time to union, mean range of knee motion, and rate of reoperation. With regard to the functional and radiological outcome assessment, despite what assessment tools were used, most of these studies presented less than 90 % good/excellent results in their high-energy fracture series. Besides, there was a trend for patients in plating group to have a higher risk than those in external fixation group in terms of heterotopic ossification and local irritation (1.23 vs 0.17 %, 4 vs 1.94 %, accordingly). Conclusions Although lack of good quality randomized control trials, there are rather enough samples supporting the current available results. Meanwhile, future multicentered, randomized, controlled studies should be implemented to test these outcomes.
    European Journal of Orthopaedic Surgery & Traumatology 09/2014; 25(3). DOI:10.1007/s00590-014-1528-7 · 0.18 Impact Factor
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    ABSTRACT: Background: Bicondylar tibial plateau fractures are complex injuries and treatment is challenging. Ideal method is still controversial with risk of unsatisfactory results if not treated properly. Many different techniques of internal and external fixation are used. This study compares the clinical results in single locked plating versus dual plating (DP) using two incision approaches. Our hypothesis was that DP leads to less collapse and change in alignment at final followup compared with single plating. Materials and Methods: 61 cases of Type C tibial plateau fractures operated between January 2007 and June 2011 were included in this prospective study. All cases were operated either by single lateral locked plate by anterolateral approach or double plating through double incision. All cases were followed for a minimum of 24 months radiologically and clinically. The statistical analysis was performed using software SPSS 10.0 to analyze the data. Results: Twenty nine patients in a single lateral locked plate and 32 patients in a double plating group were followed for minimum 2 years. All fractures healed, however there was a significant incidence of malalignment in the single lateral plating group. Though there was a significant increase in soft tissue issues with the double plating group; however, there was only 3.12% incidence of deep infection. There was no significant difference in Hospital for special surgery score at 2 years followup. Conclusion: Double plating through two incisions resulted in a better limb alignment and joint reduction with an acceptable soft tissue complication rate.
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    ABSTRACT: RESUMEN Se realizó un estudio descriptivo mixto de 646 pacientes tratados mediante la fijación externa en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto", para la solución de afecciones traumáticas o sus secuelas, en el período comprendido desde 1978 hasta 1998. Se emplearon 7 modelos de fijadores externos. Hubo una significativa incidencia del sexo masculino en las décadas de mayor actividad física. La tibia fue la diáfisis más afec-tada en 346 casos, mientras que en las articulaciones, la muñeca en 76 oportunidades. Predominó la fractura abierta en 248 ocasiones. El objetivo para el cual se empleó el fijador se logró en el 89,3 %. Las secuelas funcionales no impidieron la reincorporación laboral en la mayoría de los pacientes. Se muestran las bondades del método y se analizan de manera exhaustiva las complicaciones. DeCS: EPIDEMIOLOGIA DESCRIPTIVA; FIJADORES EXTERNOS/efectos adversos; FIJADORES EXTERNOS/utilización; FIJACION DE FRACTURA; FRACTURAS EX-PUESTAS/cirugía; FRACTURAS DE LA TIBIA/cirugía; TRAUMATISMOS DE LA MUÑECA/cirugía; MEDICINA MILITAR. 1 Especialista de I Grado en Ortopedia y Traumatología. 2 Especialista de II Grado en Ortopedia y Traumatología. Desde que en 1902 Albin Lambotte diseña y aplica el primer fijador lineal ver-dadero, múltiples variantes tecnológicas se han introducido en relación con los dispo-sitivos externos en todo el mundo. 1-3 Importante función desempeñó la es-cuela soviética en este sentido, fundamen-talmente desde 1951 con las modificacio-nes y principios establecidos por el profe-sor Ilizarov. 2-4 A partir de 1978 un grupo de destaca-dos ortopedistas cubanos introdujeron esta metodología en el país y su empleo se ex-tendió rápidamente. En la década de los 80 el profesor Álvarez Cambras diseñó un novedoso sistema de fijación externa 82 denominado RALCA (Álvarez Cambras R. Presentación de un sistema cubano de fija-ción externa. Tesis Doctoral. La Habana, 1984.) y los profesores Ceballos y Balmaseda han desarrollado el fijador CIMEQ. 3-5 La utilización de los fijadores exter-nos constituyen uno de los pilares funda-mentales sobre el que se sustentan la ciru-gía ortopédica y la traumatológica. El presente trabajo está dirigido a mostrar nuestra experiencia en la utiliza-ción efectiva de la fijación externa y el análisis de las complicaciones derivadas de su empleo en los últimos 20 a en el Institu-to Superior de Medicina Militar "Dr. Luis Díaz Soto".