Management of tibial plateau fractures in patients having compromised soft tissue envelope using hizarov external fixator

ABSTRACT

Complex fractures of the tibial plateau are associated with considerable displacement of the articular surface together with either open wounds or severe soft tissue injury. Adequate Condition of the soft tissue is an important prerequisite before reconstruction of the tibial plateau. Conventional treatment by open reduction and internal fixation by plate and screws necessitates extensive dissection through compromised soft tissue with high rates of shin necrosis and infection. Twenty three patients with tibial plateau fractures having compromised soft tissue envelope were treated using the Ilizarov method with or without minimal internal fixation. There were nineteen male [82.6%] and four female [17.4%] patients with average age 39.4 years [range 22 to 65 years]. The mechanism of injury was road traffic accident in seventeen patients [73.9%], fall from height in five patients [21.7%] and one patient [4.4%] injured by wall collapse. Using the criteria of Honkonen and Jarvinen as regard functional results, fifteen patients [65.2%] were considered to have excellent results, six [26.1%] good and two [8.7%] fair. The Ilizarov method for treatment of tibial plateau fractures with or without minimal internal fixation is considered a mini invasive procedure with low morbidity for a fracture that would otherwise require an extensive dissection and internal fixation with plates and screws with further soft tissue compromise and high rate of complications