Subscribe to RSS

DOI: 10.1055/s-0044-1785203
Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods
Article in several languages: português | EnglishFinancial Support The authors declare that they did not receive funding from agencies in the public, private, or not-for-profit sectors for the conduction of the present study.

Abstract
Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia.
Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator.
Result There were no statistically significant differences (p > 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain.
Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.
Work developed at the Orthopedics and Traumatology Service, Hospital Governador Celso Ramos, Florianópolis, SC, Brazil.
Publication History
Received: 11 July 2023
Accepted: 06 November 2023
Article published online:
10 April 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referências
- 1 Higgins TF, Klatt J, Bachus KN. Biomechanical analysis of bicondylar tibial plateau fixation: how does lateral locking plate fixation compare to dual plate fixation?. J Orthop Trauma 2007; 21 (05) 301-306
- 2 Zura RD, Browne JA, Black MD, Olson SA. Current management of high-energy tibial plateau fractures. Curr Orthop 2007; 21 (03) 229-235
- 3 Hall JA, Beuerlein MJ, McKee MD. Canadian Orthopaedic Trauma Society. Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Surgical technique. J Bone Joint Surg Am 2009; 91 (Suppl 2 Pt 1): 74-88
- 4 Yilmaz E, Belhan O, Karakurt L, Arslan N, Serin E. Mechanical performance of hybrid Ilizarov external fixator in comparison with Ilizarov circular external fixator. Clin Biomech (Bristol, Avon) 2003; 18 (06) 518-522
- 5 Gessmann J, Citak M, Jettkant B, Schildhauer TA, Seybold D. The influence of a weight-bearing platform on the mechanical behavior of two Ilizarov ring fixators: tensioned wires vs. half-pins. J Orthop Surg Res 2011; 6: 61
- 6 Cardoso GS, Amorim R, Penha FM, Horn FJ, Roesler CR, Marques JL. Biomechanical analysis of the behaviour at the metaphyseal-diaphyseal junction of complex tibial plateau fractures using two circular fixator configurations. Strateg Trauma Limb Reconstr 2020; 15 (03) 138-145
- 7 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 1979; (138) 94-104
- 8 Bronson DG, Samchukov ML, Birch JG, Browne RH, Ashman RB. Stability of external circular fixation: a multi-variable biomechanical analysis. Clin Biomech (Bristol, Avon) 1998; 13 (06) 441-448
- 9 Ali AM, Burton M, Hashmi M, Saleh M. Outcome of complex fractures of the tibial plateau treated with a beam-loading ring fixation system. J Bone Joint Surg Br 2003; 85 (05) 691-699
- 10 Ghimire A, Devkota P, Bhandari KK, Kharel Y, Pradhan S. Ilizarov ring external fixation for complex tibial plateau fractures. Rev Bras Ortop 2021; 57 (04) 667-674
- 11 Canadian Orthopaedic Trauma Society. Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am 2006; 88 (12) 2613-2623
- 12 Choo KJ, Morshed S. Postoperative complications after repair of tibial plateau fractures. J Knee Surg 2014; 27 (01) 11-19
- 13 Khatri K, Sharma V, Goyal D, Farooque K. Complications in the management of closed high-energy proximal tibial plateau fractures. Chin J Traumatol 2016; 19 (06) 342-347
- 14 Ali AM. Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Eur J Orthop Surg Traumatol 2013; 23 (03) 349-355
- 15 Zhao XW, Ma JX, Ma XL. et al. A meta-analysis of external fixation versus open reduction and internal fixation for complex tibial plateau fractures. Int J Surg 2017; 39: 65-73
- 16 Subramanyam KN, Tammanaiah M, Mundargi AV, Bhoskar RN, Reddy PS. Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation. Chin J Traumatol 2019; 22 (03) 166-171