Download PDF
J Knee Surg 2018; 31(05): 459-466
DOI: 10.1055/s-0037-1604139
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Treatment with Circular External Fixation of Bicondylar Tibial Fractures: Potential in Accurate Reduction and Efficacy on Functional Results

Giovanni Lovisetti
1   Department of Orthopedics, Ospedale Erba Renaldi di Menaggio, Menaggio, Lombardia, Italy
,
Ettore Vulcano
2   Department of Orthopaedic Surgery, Universita' dell'Insubria, Varese, Italy
,
Lorenzo Bettella
1   Department of Orthopedics, Ospedale Erba Renaldi di Menaggio, Menaggio, Lombardia, Italy
,
Rohoman Tasarib
3   Department of Orthopedics, Hospital Serdang, Kajang, Selangor, Malaysia
,
Tania Tondolo
4   Department of Radiology, Ospedale Erba Renaldi di Menaggio, Menaggio, Lombardia, Italy
,
Francesco Sala
5   Department of Orthopaedic and Traumatology, Niguarda Hospital, Milan, Italy
› Author Affiliations
Further Information

Publication History

27 April 2016

31 May 2017

Publication Date:
18 July 2017 (online)

    Permissions and Reprints

Abstract

Surgical reconstruction of bicondylar tibial fractures with external fixation relies on indirect fracture reduction that could affect anatomical restoration. The aim of the present study is to evaluate the radiographic and clinical outcomes of tibial bicondylar fractures treated with circular external fixation. A total of 20 bicondylar fractures of the proximal tibia in 20 patients treated with circular external fixation were included in the study. Two fractures were open. Mean clinical and radiographic follow-up was 37.3 months after frame removal. Angular, translation, and length deformities were assessed on nonweight-bearing anteroposterior, lateral, and two 45 degrees oblique views. The medial proximal tibia (MPTA) and posterior proximal tibia angles (PPTA) were calculated in all cases. The condylar widening was calculated in relation to the width of the femoral condyles. Joint depressions or gaps of the articular surface were identified on the four views of the knee. The modified Hospital for Special Surgery (HSS) knee scoring system was used for clinical evaluation. The MPTA was good in 18 (90%) and fair in 2 patients (10%). The PPTA was good in 13 (65%), fair in 6 (30%), and poor in 1 patient (5%). The articular reduction was good in 12 (60%) and fair in 8 patients (40%). The condylar widening was good in 15 (75%) and fair in 5 patients (25%). Mechanical axis deviation was within the normal range in 11/12 patients (91.7%). All fractures consolidated. One deep infection was successfully treated with local debridement, the mean modified HSS knee score at the latest follow-up was 90.5 (range: 67–100). Articular reconstruction and tibia alignment based on radiographic evaluation in the present study, along with functional results compare favorably with those of external and internal fixation presented in the literature.

Keywords

Schatzker - tibial plateau - external fixation - radiographic alignment - knee X-ray
 

  • References

  • 1 Stevens DG, Beharry R, McKee MD, Waddell JP, Schemitsch EH. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001; 15 (05) 312-320
    CrossrefPubMedGoogle Scholar
  • 2 Stannard JP, Wilson TC, Volgas DA, Alonso JE. The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma 2004; 18 (08) 552-558
    CrossrefPubMedGoogle Scholar
  • 3 Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 2004; 18 (10) 649-657
    Google Scholar
  • 4 Cole PA, Zlowodzki M, Kregor PJ. Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma 2004; 18 (08) 528-535
    CrossrefPubMedGoogle Scholar
  • 5 Phisitkul P, McKinley TO, Nepola JV, Marsh JL. Complications of locking plate fixation in complex proximal tibia injuries. J Orthop Trauma 2007; 21 (02) 83-91
    CrossrefPubMedGoogle Scholar
  • 6 Cho KY, Oh HS, Yoo JH, Kim DH, Cho YJ, Kim KI. Treatment of Schatzker Type V and VI Tibial Plateau Fractures Using a Midline Longitudinal Incision and Dual Plating. Knee Surg Relat Res 2013; 25 (02) 77-83
    CrossrefPubMedGoogle Scholar
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 Hohl M. Tibial condylar fractures. J Bone Joint Surg Am 1967; 49 (07) 1455-1467
    CrossrefPubMedGoogle Scholar
  • 9 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res 1979; (138) 94-104
    PubMedGoogle Scholar
  • 10 Müller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. New York, NY: Springer; 1990
    Google Scholar
  • 11 Honkonen SE, Järvinen MJ. Classification of fractures of the tibial condyles. J Bone Joint Surg Br 1992; 74 (06) 840-847
    PubMedGoogle Scholar
  • 12 Charalambous CP, Tryfonidis M, Alvi F. , et al. Inter- and intra-observer variation of the Schatzker and AO/OTA classifications of tibial plateau fractures and a proposal of a new classification system. Ann R Coll Surg Engl 2007; 89 (04) 400-404
    CrossrefPubMedGoogle Scholar
  • 13 Brunner A, Horisberger M, Ulmar B, Hoffmann A, Babst R. Classification systems for tibial plateau fractures; does computed tomography scanning improve their reliability?. Injury 2010; 41 (02) 173-178
    CrossrefPubMedGoogle Scholar
  • 14 te Stroet MA, Holla M, Biert J, van Kampen A. The value of a CT scan compared to plain radiographs for the classification and treatment plan in tibial plateau fractures. Emerg Radiol 2011; 18 (04) 279-283
    CrossrefPubMedGoogle Scholar
  • 15 Doornberg JN, Rademakers MV, van den Bekerom MP. , et al. Two-dimensional and three-dimensional computed tomography for the classification and characterisation of tibial plateau fractures. Injury 2011; 42 (12) 1416-1425
    CrossrefPubMedGoogle Scholar
  • 16 Paley D. Principles of Deformity Correction. New York, NY: Springer; 2002
    Google Scholar
  • 17 Evanich CJ, Tkach TK, von Glinski S, Camargo MP, Hofmann AA. 6- to 10-year experience using countersunk metal-backed patellas. J Arthroplasty 1997; 12 (02) 149-154
    CrossrefPubMedGoogle Scholar
  • 18 Ramos T, Karlsson J, Eriksson BI, Nistor L. Treatment of distal tibial fractures with the Ilizarov external fixator--a prospective observational study in 39 consecutive patients. BMC Musculoskelet Disord 2013; 14: 30
    CrossrefPubMedGoogle Scholar
  • 19 Mohamed OA. Treatment of high-energy tibial plateau fractures using the Ilizarov circular fixator. Egypt Orthop J 2013; 48 (02) 173-179
    PubMedGoogle Scholar
  • 20 Boldin C, Fankhauser F, Hofer HP, Szyszkowitz R. Three-year results of proximal tibia fractures treated with the LISS. Clin Orthop Relat Res 2006; 445 (445) 222-229
    CrossrefPubMedGoogle Scholar
  • 21 Ali AM, Burton M, Hashmi M, Saleh M. Treatment of displaced bicondylar tibial plateau fractures (OTA-41C2&3) in patients older than 60 years of age. J Orthop Trauma 2003; 17 (05) 346-352
    CrossrefPubMedGoogle Scholar
  • 22 Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010; 24 (11) 683-692
    CrossrefPubMedGoogle Scholar
  • 23 Jöckel JA, Erhardt J, Vincenti M. , et al. Minimally invasive and open surgical treatment of proximal tibia fractures using a polyaxial locking plate system: a prospective multi-centre study. Int Orthop 2013; 37 (04) 701-708
    CrossrefPubMedGoogle Scholar
  • 24 Kataria H, Sharma N, Kanojia RK. Small wire external fixation for high-energy tibial plateau fractures. J Orthop Surg (Hong Kong) 2007; 15 (02) 137-143
    CrossrefPubMedGoogle Scholar
  • 25 Catagni MA, Ottaviani G, Maggioni M. Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma 2007; 63 (05) 1043-1053
    CrossrefPubMedGoogle Scholar
  • 26 Yu Z, Zheng L, Zhang Y, Li J, Ma B. Functional and radiological evaluations of high-energy tibial plateau fractures treated with double-buttress plate fixation. Eur J Med Res 2009; 14 (05) 200-205
    CrossrefPubMedGoogle Scholar
  • 27 El Barbary H, Abdel Ghani H, Misbah H, Salem K. Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Int Orthop 2005; 29 (03) 182-185
    CrossrefPubMedGoogle Scholar
  • 28 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
    CrossrefPubMedGoogle Scholar
  • 29 Katsenis D, Triantafillis V, Chatzicristos M, Dendrinos G. The reconstruction of tibial metaphyseal comminution using hybrid frames in severe tibial plafond fractures. J Orthop Trauma 2013; 27 (03) 153-157
    CrossrefPubMedGoogle Scholar
  • 30 Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 2005; 439 (439) 207-214
    CrossrefPubMedGoogle Scholar
  • 31 Nikolaou VS, Tan HB, Haidukewych G, Kanakaris N, Giannoudis PV. Proximal tibial fractures: early experience using polyaxial locking-plate technology. Int Orthop 2011; 35 (08) 1215-1221
    CrossrefPubMedGoogle Scholar
  • 32 Lee MH, Hsu CJ, Lin KC, Renn JH. Comparison of outcome of unilateral locking plate and dual plating in the treatment of bicondylar tibial plateau fractures. J Orthop Surg 2014; 9: 62
    CrossrefPubMedGoogle Scholar