Staged Treatment of Bicondylar Tibial Plateau Fracture (Schatzker Type V or VI) Using Temporary External Fixator: Correlation between Clinical and Radiological Outcomes

Abstract

Purpose: This study is to investigate clinical and radiological results of staged treatment using a temporary external fixator in bicondylar tibial plateau fractures (TPFs) and to evaluate correlation between prognostic factors and postoperative clinical outcomes.

Materials and methods: Twenty-four bicondylar TPF patients were selected. All patients were operated by a temporary external fixator first and then open reduction and internal fixation with dual plating. Clinical and radiological outcomes were evaluated.

Results: The mean American Knee Society score (AKSS) was 85.3. The mean Western Ontario and McMaster Universities Osteoarthritis index was 11.2. The mean range of motion (ROM) was 123.4°. The mean medial tibial plateau angle (mTPA) was 88.3°, and the mean proximal posterior tibial angle (PPTA) was 8.4°. Compared with the uninjured limb, the mean difference of mTPA was 1.5° and that of PPTA was 4.0°. The difference of PPTA and the AKSS demonstrated negative correlation (p=0.007). Patients with normal mTPA showed better ROM than those with abnormal mTPA (p=0.041).

Conclusions: Staged treatment using a temporary external fixator in bicondylar TPFs showed good clinical and radiological outcomes. Surgeons should evaluate the reduction status intraoperatively by fluoroscopy and also refer to the uninjured limb radiologically.

Keywords: Bicondylar; External fixator; Fracture; Plateau; Tibia.

Fig. 1

Patient enrollment flow chart. FTA: femoral tibial angle, MA: mechanical axis.

Fig. 2

Radiographs of case no. 19 presented in Table 1. (A) A 60-year-old male patient was injured in a pedestrian traffic accident and suffered a tibial plateau fracture (Schatzker type VI) as well as a fracture of the fibula. (B) A temporary external fixator was immediately applied after injury. (C) Six days after the first operation, dual plating using medial and lateral approaches was applied.

Fig. 3

Radiological evaluation. (A) The medial tibial plateau angle was measured between the axis of the articular surface of the tibial plateau and the anatomical axis of the proximal tibia on the anteroposterior view of the knee. (B) The proximal posterior tibial angle was measured between the articular surface of the medial tibial plateau and the perpendicular line to the anterior cortical margin of the proximal tibia on the lateral view of the knee. (C) The femoral tibial angle was measured between the anatomical axes of the femur and tibia. Genu valgum was given a positive angle. (D) Mechanical axis and deviation of the mechanical axis. The mechanical axis was defined as a line connecting the center of the hip and the center of the ankle. Mechanical axis deviation was measured by assessing the location of the mechanical axis crossing through the articular surface of the tibial plateau.

Fig. 4

Correlation between open fracture and compartment syndrome. ^a)Fisher exact test.