Small wire external fixation for high-energy tibial plateau fractures

Abstract

Purpose: To assess results of small wire external fixation using a ligamentotaxis technique for high-energy tibial plateau fractures.

Methods: Between April 2002 and May 2004, 38 consecutive patients aged 21 to 60 (mean, 32) years underwent small wire external fixation for high-energy tibial plateau fractures. 15 involved the right and 23 the left knee. 34 were closed and 4 were open injuries. Fractures were classified according to Schatzker's staging system. After a minimal of 2 years' follow-up (range, 24-42 months), each affected knee was evaluated using Rasmussen's (1) 30-point clinical grading system and (2) radiological evaluation.

Results: There were 22 type-VI and 16 type-V Schatzker tibial plateau fractures. Complications consisted of: 2 superficial infections, 3 pin site infections, and 4 peroneal nerve palsies. No soft tissue necrosis or devitalisation occurred. The mean range of knee movement was 132 degrees. The mean Rasmussen radiological score was 14 (range, 10-18): excellent in 6, good in 26, and fair in 6. The mean Rasmusssen functional score was 26 (range, 17-30): excellent in 19 patients, good in 17, and fair in 2. Clinical results did not parallel the radiological results.

Conclusion: Small wire external fixation allows anatomical reconstruction of the articular surface, stable fixation of fracture fragments, early movement of the joint, and care of associated soft tissue injuries, without a high rate of complications.