Archives of Orthopaedic and Trauma Surgery

, Volume 130, Issue 7, pp 897–901 | Cite as

Hybrid external fixation in treatment of proximal tibial fractures: a good outcome in AO/ASIF type-C fractures

  • V. T. Savolainen
  • Jarkko PajarinenEmail author
  • E. Hirvensalo
  • J. Lindahl
Trauma Surgery



The treatment of proximal tibial fractures is often challenging, and internal fixation is occasionally associated with problems in wound healing due to frequently co-existing soft tissue injuries. External fixation of these fractures have yielded satisfactory results, but some studies have reported problems in the achievement and maintenance of fracture reduction. The purpose of the present study was to evaluate the performance of a hybrid external fixator in the treatment of different types of proximal tibial fractures.

Materials and methods

Thirty-three proximal tibial fractures, of which 20 were high energetic, were treated with a hybrid external fixator (Tenxor® Strker-Howmedica) in the acute phase. Fracture categorisation was done according to AO/ASIF, and the reduction was performed most often by closed means or through mini-open reduction (26/78.8%). The patients were followed up to an average of 12.7 months (range 10–22) and were evaluated with radiographs and clinical examinations.


Five AO/ASIF type-C intraarticular fractures had a poor postoperative reduction, and were thus treated with internal fixation in a second operation. Of the remaining 28 patients, local and transient pin tract infection was observed in seven patients, and one had septic arthritis of the knee. All 13 C1 and five of six C2/C3 fractures united in mean time of 15.1 weeks, whereas three of nine type-A fractures failed to unite, albeit an adequate reduction, and needed a second operation (odds ratio 11.4, 95% CI 1.0–143, compared with type-C fractures). For the remaining six type-A fractures, the mean healing time was 24 weeks (mean difference 8.9, 95% CI 6–12 weeks compared with type-C fractures). Age over 48 and the presence of an open fracture, but not fracture type, gender, or the level of injury energy, correlated to a poor subjective outcome.


The hybrid external fixation method we have used is safe, and type-C1 fractures are particularly suitable to be treated with this method. However, even C2/C3 fractures may be candidates for this method, but a meticulous fracture reduction should be performed. Type-A fractures are liable to healing problems when the fixator is used as a rigid complex.


Tibia plateau fracture External fixation 


  1. 1.
    Ali AM, El-Shafie M, Willett KM (2002) Failure of fixation of tibial plateau fractures. J Orthop Trauma 16(5):323–329CrossRefPubMedGoogle Scholar
  2. 2.
    Ali AM, Yang L, Hashmi M, Saleh M, Koval KJ, Helfet DL (2001) Bicondylar tibial plateau fractures managed with the Sheffield hybrid. Fixator biomechanical study and operative technique. Injury 32(Suppl 4):86–91CrossRefGoogle Scholar
  3. 3.
    Anglen JO, Healy WL (1988) Tibial plateau fractures. Orthopedics 11(11):1527–1534PubMedGoogle Scholar
  4. 4.
    Bai B, Kummer FJ, Sala DA, Koval KJ, Wolinsky PR (2001) Effect of articular step-off and meniscectomy on joint alignment and contact pressures for fractures of the lateral tibial plateau. J Orthop Trauma 15(2):101–106CrossRefPubMedGoogle Scholar
  5. 5.
    Benirschke SK, Agnew SG, Mayo KA, Santoro VM, Henley MB (1992) Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol. J Orthop Trauma 6(1):78–86PubMedGoogle Scholar
  6. 6.
    Bernfeld B, Kligman M, Roffman M (1996) Arthroscopic assistance for unselected tibial plateau fractures. Arthroscopy 12(5):598–602PubMedCrossRefGoogle Scholar
  7. 7.
    Blokker CP, Rorabeck CH, Bourne RB (1984) Tibial plateau fractures: an analysis of the results of treatment in 60 patients. Clin Orthop 182:193–199PubMedGoogle Scholar
  8. 8.
    Delamarter R, Hohl M (1989) The cast brace and tibial plateau fractures. Clin Orthop 242:26–31PubMedGoogle Scholar
  9. 9.
    Gaudinez RF, Mallik AR, Szporn M (1996) Hybrid external fixation in tibial plafond fractures. Clin Orthop 329:223–232CrossRefPubMedGoogle Scholar
  10. 10.
    Gaudinez RF, Mallik AR, Szporn M (1996) Hybrid external fixation of comminuted tibial plateau fractures. Clin Orthop 328:203–210CrossRefPubMedGoogle Scholar
  11. 11.
    Kumar A, Whittle AP (2000) Treatment of complex (Schatzker type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma 14(5):339–344CrossRefPubMedGoogle Scholar
  12. 12.
    Lundy DW, Albert MJ, Hutton WC (1988) Biomechanical comparison of hybrid external fixators. J Orthop Trauma 12(7):496–503CrossRefGoogle Scholar
  13. 13.
    Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, Llinias A (2002) Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg (Am) 84(7):1259–1271Google Scholar
  14. 14.
    Marsh JL, Smith ST, Do TT (1995) External fixation and limited internal fixation for complex fractures of the tibial plateau. J Bone Joint Surg (Am) 77(5):661–673Google Scholar
  15. 15.
    Mills WJ, Nork SE (2002) Open reduction and internal fixation of high-energy tibial plateau fractures. Orthop Clin N Am 33(1):177–198CrossRefGoogle Scholar
  16. 16.
    Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. the Toronto experience 1968–1975. Clin Orthop 138:94–104PubMedGoogle Scholar
  17. 17.
    Sirkin MS, Bono CM, Reilly MC, Behrens FF (2000) Percutaneous methods of tibial plateau fixation. Clin Orthop 375:60–68CrossRefPubMedGoogle Scholar
  18. 18.
    Stamer DT, Schenk R, Staggers B, Aurori K, Aurori B, Behrens FF (1994) Bicondylar tibial plateau fractures treated with a hybrid ring external fixator: a preliminary study. J Orthop Trauma 8(6):455–461PubMedGoogle Scholar
  19. 19.
    Stevens DG, Beharry R, McKee MD, Waddell JP, Schemitsch EH (2001) The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 15(5):312–320CrossRefPubMedGoogle Scholar
  20. 20.
    Tscherne H, Lobenhoffer P (1993) Tibial plateau fractures: management and expected results. Clin Orthop 292:87–100PubMedGoogle Scholar
  21. 21.
    Watson JT, Ripple S, Hoshaw SJ, Fhyrie D (2002) Hybrid external fixation for tibial plateau fractures: clinical and biomechanical correlation. Orthop Clin N Am 33(1):199–209CrossRefGoogle Scholar
  22. 22.
    Watson JT (2001) Hybrid external fixation for tibial plateau fractures. Am J Knee Surg 14(2):135–140PubMedGoogle Scholar
  23. 23.
    Weigel DP, Marsh JL (2002) High-energy fractures of the tibial plateau: knee function after longer follow-up. J Bone Joint Surg (Am) 84(9):1541–1551Google Scholar
  24. 24.
    Weiner LS, Kelley M, Yang E, Steuer J, Watnick N, Evans M, Bergman M (1995) The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures. J Orthop Trauma 9(3):244–250CrossRefPubMedGoogle Scholar
  25. 25.
    Yang L, Saleeh M, Nayagam S (2000) The effects of different wire and screw combinations on the stiffness of a hybrid external fixator. Proceedings of the institution of mechanical engineers, part H. J Eng Med 214(6):669–676CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • V. T. Savolainen
    • 1
  • Jarkko Pajarinen
    • 1
    Email author
  • E. Hirvensalo
    • 1
  • J. Lindahl
    • 1
  1. 1.Department of Orthopaedics and TraumatologyHelsinki University Central HospitalHelsinkiFinland

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