Purpose Schatzker Type V and VI are severe tibial plateau fractures that occur as a direct result of high-energy trauma. To date, treatment for these tibial plateau fractures remains controversial. The purpose of this study was to determine if open or closed reduction hybrid external fixation effectively and safely provided successful reduction with Schatzker V and VI fractures for reducing articular surface, anatomic alignment, successful knee rating score, and a stable construct to allow early knee motion.
Methods This retrospective, consecutive series analysis of 35 subjects, 29 male and 6 female, were treated for high-energy tibial plateau fractures. There were 29 Schatzker Type VI fractures, and 6 Schatzker Type V. Follow-up was from 3 to 85 months (average 22.4 months) and three patients died. All fractures were secondary to high-energy trauma. All open fractures were treated with immediate irrigation and debridement and hybrid external fixation. Each fracture was stabilized with fine wires and pins transfixing the proximal tibia metaphysis. Limited internal fixation with screws was used to stabilize the articular surface in 21 tibias.
Results Functional grading according to Clinical Knee Rating Score revealed average of 91.0%. Knee function score of 71.3%, knee range of motion 84.8%, and knee joint stability 97.6% were revealed. Twenty-seven fracture's limb alignments were anatomic, 2 valgus and 4 vargus following surgery. Nine patients had pin tract infections, one sepsis, and one osteomyelitis. Nine patients had post-traumatic osteoarthritis.
Conclusion The study indicates that management of Schatzker Type V and VI fractures with hybrid external fixation was optimal to previous published procedures. By reducing and holding the bone fragments in a localized environment until the fractures united was optimal with hybrid external fixation. This technique yielded encouraging clinical results. The goals of articular reduction, knee stability, and anatomic limb alignment, and early motion were consistently achieved.