Surgical Treatment of Tibial Plateau Fractures

Abstract

Objective

Closed reduction of Schatzker type 4, 5, and 6 fractures of the tibial plateau, internal fixation by lag screws inserted through a mini-incision, and stabilization with Ilizarov external ring fixator.

Indications

Fractures of the tibial plateau of Schatzker type 4, 5, and 6.

Contraindications

Open infected tibial plateau fractures. Relative contraindications are Schatzker type 1, 2, and 3 fractures of the tibial plateau which can be treated by simpler methods.

Surgical Technique

Reduction of fracture by longitudinal traction on a frature table. Percutaneous insertion of two or three 6.5-mm lag screws to compress the major fragments. Stabilization of the fracture with a three-ring construction of the Ilizarov frame. Further compression of fragments with olive wires, used also to reduce and compress posterolateral and/or posteromedial fragments. The frame is ex-tended to the femur in instances of subluxation of the knee joint, ligamentous injuries, and associated femoral condylar fractures.

Results

Between 1991–1997, 56 patients were operated on. Aver-age follow-up: 3 years. Union occurred in all. Six patients showed a varus deformity of 5–10° and one a varus deformity of 15° four patients had an extension lag between 5–10°. A minor pin tract infection was observed 20 times and a major pin tract infection three times necessitating pin removal. One patient who suffered a compound fracture complicated by aseptic arthritis eventually required an arthrodesis. Applying the score of the American Knee Society, an excellent result was obtained 20 times, a good result 28 times, a fair one four times, and a poor one four times.