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 study was to determine if open reduction hybrid external fixation effectively and safely provided successful resolution of Schatzker V and VI fractures for reducing related complications of pain, arthritis, and pin-tract infections.
Methods In a retrospective study, 36 patients, 30 male and 6 female, were treated for high-energy tibial plateau fractures. There were 29 Schatzker Type VI fractures and 7 Schatzker Type V; mean age was 40.9 years; mean follow-up time of 22.4 months. All fractures were secondary to high-energy trauma. Open fractures were treated with immediate irrigation, débridement, and hybrid external fixation. Fractures were stabilized with fine wires and pins transfixing the proximal tibial metaphysis. Limited internal fixation with screws was used to stabilize the articular surface in 21 tibias.
Results In our study of open reduction hybrid external fixation none of the findings were statistically significant because of the small number of cases; however, trends were noted. Twenty-one patients reported pain being present. nine (27.3%) patients developed arthritis on follow-up assessment. Eleven (30.6%) patients developed pin-tract infections. Those with pain trended to have more open fractures, limited function, decreased stability, minimal/no pin-tract infection, and decreased ROM (≤ 20°). Those with postoperative arthritis (versus no arthritis) tended to need additional screws (22.2% vs 8.3%), additional pins (100% vs 0%), and additional wires (77.8% vs 22.2%). Patients with closed fractures (77.7% vs 22.2%) and limited function (66.7% vs 33.3%) also trended toward higher onset of arthritic complications. Pin-tract infection also appeared more frequently in closed fractures (54.5% vs 45.5%). Infection was present with increased ROM (> 20°), normal stability (> 79 points), as well as with limited (< 79 points) or normal function (> 79 points). However, with appropriate screws, pins, and wires the trend was towards more frequent infection: 90.9%, 90.9%, and 81.8% respectively.
Conclusion The study describes the complications associated with Schatzker Type V and VI fractures with hybrid external fixation. The trend towards less infection, less post-traumatic arthritis, and more pain is present. This technique yielded encouraging clinical results.
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