Complex Tibial Plateau Fractures Treated with Ilizarov Ring Fixator

We treated 40 tibial plateau fractures [1] in 39 patients with a mean age of 41.2 (2070) years with Ilizarov ring fixator. All fractures were the result of high energy trauma, and 18 patients had associated injuries [2]. 38 fractures were available for long term follow up after 28 (16-38) months. Using the Knee Society Clinical Rating System, 28 knees were rated as excellent, 9 as good, 2 as fair and 1 as poor. The most significant concomitant injuries were distal femoral fractures and massive soft tissue injury. This study emphasizes the clinical success and low morbidity associated with the use of Ilizarov fixator. Research Article Volume 1 Issue 2 2014 Bari MM*, Islam Shahidul, Shetu NH and Mahfuzer RM Department of Orthopaedics Bari-Ilizarov Orthopaedic Centre Dhaka Bangladesh *Corresponding author: Bari MM, Chief Consultant, Bari-Ilizarov Orthopaedic Centre, Visiting and Honored Professor Russian Ilizarov Scientific Centre, Kurgan, Russia, Tel: 8801819211595; Email: Received: August 08, 2014 | Published: September 17, 2014 Closed Fractures (Tscherne) Open Fractures (GustiloAnderson) Total 0 1 2 3 I II IIIA IIIB IIIC Cases 5 8 12 5 4 3 3 2 40 Table 1: Grading of soft-tissue injuries for closed and open fractures. Table 2: Relationship between the quality of reduction and the functional outcome. Functional Quality of Reduction Outcome Anatomical Good Fair Poor Total Excellent 19 10 29 Good 7 1 08 Fair 1 1 2 Poor Total 27 12 39 Complex Tibial Plateau Fractures Treated with Ilizarov Ring Fixator Citation: Bari MM, Shahidul I, Shetu NH, Mahfuzer RM (2014) Complex Tibial Plateau Fractures Treated with Ilizarov Ring Fixator. MOJ Orthop Rheumatol 1(2): 00009. DOI: 10.15406/mojor.2014.01.00009 Copyright:  2014 Bari et al. 2/3 Discussion Management of complex tibial plateau fracture is very difficult for orthopaedic surgeons [5,11,12,]. Restoration of articular congruity is mandatory, careful treatment of soft tissues is as important as the bone [7,11]. We cannot reduce the fracture fragments with ligamentotaxis alone and a limited open reduction with minimal periosteal stripping is sometimes necessary [13,14]. Ilizarov ring fixator allows a better choice of treatment in these difficult cases. In our series limited open reduction through a 5-7 cm incision was needed in 8 cases, whereas bone grafting to support the elevated articular surface was needed in 4 cases. Morandi and Pears [1,11]. Reported elevation and bone grafting in 26% of cases in a series of 50 complex tibial plateau fractures treated with Ilizarov fixator. We did not used any half pins or internal fixation in our series. The average duration fixation in our series was 15.2 weeks. Using Rasmussen criteria for x-ray assessment, excellent to good reduction was achieved in all our cases [15,16]. The mean range of movement (ROM) was reported by Morandi and Pearse [11] was 113°. The average range of motion in our series was greater than comparable studies, despite presence of 5 cases of knee stiffness. There is little reported information that focuses on the results of treatment of high energy tibial plateau fractures. In recent study, two variables had a direct correlation with the final range of motion: knee distraction and associated distal femoral fracture. Fair and poor results were present in polytrauma patients, mainly those with concomitant ipsilateral femoral fractures [17,18]. The magnitude of soft-tissue injury also plays an important role in the functional outcome. In our series open injuries were responsible for 55% of unsatisfactory results [19,20]. Figure 1: Closed right complex tibial plateau fracture with subluxation, CT scan in a 55 year-old male treated with closed reduction, ligamentotaxis and fixation with Ilizarov’s apparatus. Figure 2: Smiling patient with Ilizarov fixatior in situ. Figure 4: After 1 month follow up. Patient can flex the knee up to 90°. Figure 3: Radiograph of right knee just after removal of Ilizarov fixator. Figure 5: Radiograph of tibial plateau after 7 months follow up. Figure 6: Final follow up after 7 months. Patient can squat easily. Complex Tibial Plateau Fractures Treated with Ilizarov Ring Fixator Citation: Bari MM, Shahidul I, Shetu NH, Mahfuzer RM (2014) Complex Tibial Plateau Fractures Treated with Ilizarov Ring Fixator. MOJ Orthop Rheumatol 1(2): 00009. DOI: 10.15406/mojor.2014.01.00009 Copyright:  2014 Bari et al. 3/3