Advertisement

Comparative study of internal and hybrid external fixation in tibial condylar fractures

  • A. Malakasi
  • S. N. LallosEmail author
  • E. Chronopoulos
  • D. S. Korres
  • N. E. Efstathopoulos
Original Article

Abstract

Background

The spectrum of injuries to the tibial plateau is so great that no single method of treatment has been proven to be uniformly successful. The purposes of this study were to evaluate the clinical results, to identify the advantages and disadvantages and to take out useful conclusions of the application of the internal and hybrid external fixation in the treatment of these fractures.

Method

Sixty tibial condylar fractures, of all types, according to Schatzker’s classification were treated with open reduction and internal fixation (30 patients) or with hybrid external fixation (30 patients). The following parameters were recorded: time of surgical procedure, time of postoperative hospitalization, time of starting of weight bearing on the affected extremity, complications, and postoperative functional (according to Knee Society Score) and radiological results (according to Rasmussen’s Radiological Score). The average time of follow-up was 12 months.

Results

Neither of the two methods showed superiority regarding the duration of the surgical procedure [mean difference 4.4 ± 5.4 (min), P = NS], the postoperative hospitalization time [0.6 ± 0.7 (days), P = NS], and the radiological and functional evaluation (χ2, P = NS for all comparisons). However, the internal fixation method proved to be superior to the hybrid external fixation regarding the time of starting the weight bearing [3.1 ± 0.4 (weeks), P < 0.001].

Conclusion

Internal fixation showed superiority to the time starting of weight bearing as it occurred at an earlier time than that of hybrid external by almost 3 weeks whereas no other differences were identified in the other parameters regarding patients’ rehabilitation.

Keywords

Tibial condylar fractures Hybrid external fixation Open reduction and internal fixation Weight bearing 

Notes

Conflict of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Wiss D, Watson JT (2002) Fractures of the proximal tibia and fibula. In: Rockwood C, Green D, Bucholz R (eds) Fractures in adults, 5th edn. Lippincott Williams and Wilkins, USA, pp 1801–1838Google Scholar
  2. 2.
    Hohl M (1991) Part I: Fractures of the proximal tibia and fibula. In: Rockwood C, Green D, Bucholz R (eds) Fractures in adults, 3rd edn. Lippincott JB, Philadelphia, pp 1725–1761Google Scholar
  3. 3.
    Agoropoulos Z (2001) Tibial condylar fractures. In: Faculty of 1st Orthopaedic Department of University of Athens (eds) Orthopaedics and traumatology, 1st edn. Konstantaras Medical Publications, Athens, Greece, pp 148–152Google Scholar
  4. 4.
    Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23:149–154PubMedGoogle Scholar
  5. 5.
    Schatzker J (1996) Fractures of the tibial plateau. In: Schatzker J, Tile M (eds) The rationale of operative fracture care, 2nd edn. Springer, Berlin, pp 419–438CrossRefGoogle Scholar
  6. 6.
    Stamer DT, Schenk R, Staggers B et al (1994) Bicondylar tibial plateau fractures treated with a hybrid ring external fixator: a preliminary study. J Orthop Trauma 8(6):455–461PubMedGoogle Scholar
  7. 7.
    Gaudinez RF, Mallik AR, Szporn M (1996) Hybrid external fixation of comminuted tibial plateau fractures. Clin Orthop 328:203–210PubMedCrossRefGoogle Scholar
  8. 8.
    Ali AM, Lang Y, Hashimi M, Saleh M (2001) Bicondylar tibial plateau fractures managed with Sheffield hybrid fixator: biomechanical study and operative technique. Injury 32:86–89CrossRefGoogle Scholar
  9. 9.
    Piper KJ, Won HY, Ellis AM (2005) Hybrid external fixation in complex tibial plateau and Plafond fractures: an Australian audit of outcomes. Injury 36:176–184CrossRefGoogle Scholar
  10. 10.
    Insall JN, Dorr LD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop 248:13–14PubMedGoogle Scholar
  11. 11.
    Rasmussen PS (1973) Tibial condylar fractures: impairment of knee joint stability as indication for surgical treatment. J Bone Joint Surg Am 55(1):1331–1350PubMedGoogle Scholar
  12. 12.
    Morandi MM, Pearse MF (1996) Management of complex tibial plateau fractures with the Ilizarov external fixator. Tech Orthop 11:125–131CrossRefGoogle Scholar
  13. 13.
    Watson JT (1994) High-energy fractures of the tibial plateau. Orthop Clin North Am 25:723–752PubMedGoogle Scholar
  14. 14.
    Mitchell N, Shepard N (1980) Healing of articular cartilage in intrarticular fractures in rabbits. J Bone Joint Surg Am 62(A):628–634PubMedGoogle Scholar
  15. 15.
    Rademakers M, Kerkhofts G et al (2007) Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 21(1):5–10PubMedCrossRefGoogle Scholar
  16. 16.
    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):312–320PubMedCrossRefGoogle Scholar
  17. 17.
    Gosling T, Schandelmaier P et al (2005) Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop 439:207–214PubMedCrossRefGoogle Scholar
  18. 18.
    Schutz M, Kääb MJ, Haas N (2003) Stabilization of proximal tibial fractures with the LIS-system: early clinical experience in Berlin. Injury 34(Suppl 1):A30–A35PubMedCrossRefGoogle Scholar
  19. 19.
    Stannard JP, Wilson TC, Volgas DA, Alonso JE (2004) The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma 18(8):552–558PubMedCrossRefGoogle Scholar
  20. 20.
    Biggi F, Di Fabio S, D’ Antimo C, Trevisani S (2010) Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. Injury 41(11):1178–1182PubMedCrossRefGoogle Scholar
  21. 21.
    Katsenis D, Dendrinos G, Kouris A, Savas N, Schoinochoritis N, Pogiatzis K (2009) Combination of fine wire fixation and limited internal fixation for high-energy tibial plateau fractures: functional results at minimum 5-year follow-up. J Orthop Trauma 23(7):493–501PubMedCrossRefGoogle Scholar
  22. 22.
    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):339–344PubMedCrossRefGoogle Scholar
  23. 23.
    Blake R, Watson JT, Morandi M et al (1993) Treatment of complex tibial plateau fractures with the Ilizarov external fixator. J Orthop Trauma 7:167–168Google Scholar
  24. 24.
    Zecher SB, Danziger MB, Segal D et al (1996) Treatment of high-energy proximal tibial fractures using the Monticelli-Spinelli external fixator: a preliminary report. Am J Orthop 25:49–54PubMedGoogle Scholar
  25. 25.
    Mikulak SA, Gold SM, Zinar DM (1998) Small wire external fixation of high energy tibial plateau fractures. Clin Orthop 356:230–238PubMedCrossRefGoogle Scholar
  26. 26.
    Wiss D, Watson JT (1998) Tibial plateau fractures: ORIF. In: Wiss D (ed) Fractures. Lippincott-Raven, USA, pp 363–379Google Scholar
  27. 27.
    Papagelopoulos P, Partsinevelos A et al (2006) Complications after tibia plateau fracture surgery. Injury 37(6):475–484PubMedCrossRefGoogle Scholar
  28. 28.
    Behrens FF (1998) Tibial plateau fractures: spatial frame. In: Wiss D (ed) Fractures. Lippincott-Raven, USA, pp 381–395Google Scholar
  29. 29.
    Hall JA, Beuerlein MJ, McKee MD, Society CanadianOrthopaedicTrauma (2009) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Surgical technique. J Bone Joint Surg Am 91(Suppl 2 Pt 1):74–88PubMedGoogle Scholar
  30. 30.
    Kumar G, Peterson N, Narayan B (2011) Bicondylar tibial fractures: Internal or external fixation. Indian J Orthop 45(2):116–124PubMedCrossRefGoogle Scholar
  31. 31.
    Mahadeva D, Costa ML, Gaffey A (2008) Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature. Arch Orthop Trauma 128(10):1169–1175CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • A. Malakasi
    • 1
  • S. N. Lallos
    • 1
    Email author
  • E. Chronopoulos
    • 1
  • D. S. Korres
    • 1
  • N. E. Efstathopoulos
    • 1
  1. 1.Second Department of OrthopaedicsAthens University Medical SchoolAthensGreece

Personalised recommendations