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Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature

  • Orthopaedic Surgery
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Abstract

Introduction

Bicondylar/Schatzker 6 type tibial plateau fractures are a significant challenge to the trauma and orthopaedic surgeon. These injuries tend to be complex, high energy and are activated with significant morbidity. Two surgical methods are commonly in use: (1) hybrid external fixation or (2) internal fixation. We performed a systematic analysis of papers comparing these two techniques.

Methods

The Medline database was used and the MeSH terms associated with bicondylar/severe tibial plateau fractures were inserted.

Results

Forty-nine studies were retrieved but only five papers presented data to directly compare the two techniques as these studies actually compared the implants. Study designs and outcome measures were not consistent in all studies and therefore no direct comparison could be made between the papers. The first two studies were laboratory based and suggested that hybrid external fixation may have a benefit over internal fixation with respect to failure load and its use in compromised bone. Two further papers presented only type 4 evidence. The final paper was a multicentre randomised controlled trial and it demonstrated a marginal non-significant benefit of hybrid external fixation over internal fixation although there was suggestion of beta error [i.e. accepting the hypothesis when it is not true].

Conclusion

Bicondylar/Schatzker 6 type fractures are difficult to manage. The treatment of such fractures, need to pay specific attention to the soft tissue envelope around the knee. Hybrid external fixation has theoretical advantages in terms of the soft tissues but the benefit over internal fixation is modest at best and has not demonstrated improved outcome. Newer fixed angle screw and plate systems are increasingly in use and need comparative studies to determine their role in this complex group of fractures.

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References

  1. Ali AM, Saleh M, Bologaro S, Yang L (2003) The strength of different fixation techniques for bicondylar tibial plateau fractures-a biomechanical study. Clin Biomech (Bristol, Avon) 18(9):864–870

    Article  Google Scholar 

  2. Ali AM, Saleh M, Eastell R, Wigderowitz CA, Rigby AS, Yang L (2006) Influence of Bone quality on the strength of internal and external fixation of tibial plateau fractures. J Orthop Res 24(11):2080–2086

    Article  PubMed  Google Scholar 

  3. Mallik AR, Covall DJ, Whitelaw GP (1992) Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev 21:1433–1436

    PubMed  CAS  Google Scholar 

  4. Covall DJ, Fowble CD,Foster TE,Whitelaw GP (1994) Bicondylar tibial plateau fractures:principles of treatment. Contemp Orthop 28:115–122

    PubMed  CAS  Google Scholar 

  5. The Canadian Orthopaedic Trauma Society (2006) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicentre, prospective, randomized clinical trial. J Bone Joint Surg Am 88:2613–2623

    Article  Google Scholar 

  6. Barei DP, Nork SE, Mills W, Henley B, Benirscke S (1992) Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 18(10):649–657

    Article  Google Scholar 

  7. Kumar A, Whittle AP (2000) Treatment of complex (Schtzker type 6) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma 14(5):339–344

    Article  PubMed  CAS  Google Scholar 

  8. Egol KA, Su E, Tejwani NC, Sims SH, Kummer FJ, Koval KJ (2004) Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating. J Trauma 57:340–346

    Article  PubMed  Google Scholar 

  9. Stannard JP, Wilson TC, Volgas DA, Alonso JE (2004) Less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short term results. J Orthop Trauma 18(8):552–558

    Article  PubMed  Google Scholar 

  10. Gosling T, Schandelmaier P, Marti A, Hufner T, Partenheimer A, Krettek C (2004) Less invasive stabilization of complex tibial plateu fractures. J Orthop Trauma 18(8):546–551

    Article  PubMed  CAS  Google Scholar 

  11. Watson JT, Ripple S, Hoshaw SJ, Fyhrie D (2002) Hybrid external fixation for tibial plateau fractures. Orthop Clin North Am 33(1):199–209

    Article  PubMed  Google Scholar 

  12. Piper KJ, Won HY, Ellis AM (2005) Hybrid external fixation in complex tibial plateau and plafond fractures: an Australian audit of outcomes. Injury 36(12):1467–1475

    Article  Google Scholar 

  13. Ali AM, Yang L, Hashmi M, Saleh M (2001) Bicondylar tibial plateu fractures managed with the Sheffireld hybrid fixator biomechanical study and operative technique. Injury 32(Suppl 4):SD86–SD89

    PubMed  Google Scholar 

  14. Mills WJ, Nork SE (2002) Open reduction and internal fixation of high-energy tibial plateau fractures. Orthop Clin North Am 33(1):177–198

    Article  PubMed  Google Scholar 

  15. Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23:149–154

    PubMed  CAS  Google Scholar 

  16. Dirschl DR, Dahners LE, Hill C (1997) Current treatment of tibial plateau fractures. J South Orthop Assoc 6(1):54–61

    PubMed  CAS  Google Scholar 

  17. Chin TYP, Bardana D, Bailey M, Williamson OD, Miller R, Edwards ER, Esser MP (2005) Functional outcome of tibial plateau fractures treated with the fine wire fixator. Injury 36:1467–1475

    Article  PubMed  Google Scholar 

  18. Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK (2006) Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisons and medial and lateral plate. J Bone Joint Surg Am 88(8):1713–1721

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, University Hospitals Coventry and Warwickshire, Warwickshire, Coventry, Warwickshire, CV2 2DX, UK

    D. Mahadeva, M. L. Costa & A. Gaffey

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  1. D. Mahadeva
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  2. M. L. Costa
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  3. A. Gaffey
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Correspondence to D. Mahadeva.

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Mahadeva, D., Costa, M.L. & Gaffey, A. Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature. Arch Orthop Trauma Surg 128, 1169–1175 (2008). https://doi.org/10.1007/s00402-007-0520-7

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  • DOI: https://doi.org/10.1007/s00402-007-0520-7

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