Bicondylar tibial plateau fractures are serious injuries to a major weight-bearing joint. These injuries are often associated with severe soft tissue injuries that complicate surgical management. We reviewed 54 consecutive patients who sustained bicondylar tibial plateau fractures that were treated with limited open reduction and cannulated screw fixation combined with fine-wire circular external fixation. Forty-six patients met the inclusion criteria of this retrospective review. Eight patients were excluded because they did not complete a minimum of 1-year follow-up. Thirty-six patients had Schatzker type-VI, and ten patients had Schatzker type-V fractures. All fractures were united without loss of reduction; there were no incidences of wound complications, osteomyelitis or septic arthritis. The average Knee Society Clinical Rating Score was 81.6, translating to good clinical results. Minor pin track infection was the most common complication encountered. This review concludes that fine-wire circular external fixation, combined with limited open reduction and cannulated screw fixation, consistently produces good functional results without serious complications.
Kulkarni GS, Kulkarni MG, Kulkarni SG, Kulkarni RM, Kulkarni VS, Shah AN (2001) Surgical treatment of tibial plateau fractures. Orthop Traumatol 9:263-272. doi:10.1007/s00065-001-1028-2
Barei DP, Nork SE, Mills WJ, Bradford Henley M, Benirschke SK (2004) Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a twoincision technique. J Orthop Trauma 18:649-657
Weigel DP, Marsh JL (2002) High-energy fractures if the tibial plateau. J Bone Jt Surg 84-A:1541-1551
Ferreira N, Senoge ME (2011) Functional outcome of bicondylar tibial plateau fractures treated with the Ilizarov circular external fixator. SA Orthop J 10(3):80-84
Gaston P, Will EM, Keating JF (2005) Recovery of knee function following fracture of the tibial plateau. J Bone Jt Surg (Br) 87-B:1233-1236
Moore TM, Patzakis MJ, Harvey JP (1987) Tibial plateau fractures, definition, demographics, treatment rationale and long term results of closed traction management or operative reduction. J Orthop Trauma 1(2):97-119
Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23:149-154
The Canadian Orthopaedic Trauma Society (2006) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg 88:2613-2623
Lee JA, Papadakis SA, Moon C, Zalavras CG (2007) Tibial plateau fractures treated with the less invasive stabilisation system. Int Orthop (SICOT) 31:415-418
Jiang R, Luo C, Wang M, Yang T, Zeng B (2008) A comparative study of less invasive stabilization system (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee 8:139-143
Ries MD, Meinhard BP (1990) Medial external fixation with lateral plate internal fixation in metaphyseal tibia fractures. A Report of eight cases associated with severe soft tissue injury. Clin Orthop 256:215-223
Marsh JL, Smith ST, Do TT (1995) External fixation and limited internal fixation for complex fractures of the tibial plateau. J Bone Jt Surg Am 77:661-673
Kataria H, Sharma N, Kanojia RK (2007) Small wire external fixation for high-energy tibial plateau fractures. J Orthop Surg 15(2):137-143
Ali AM, Burton M, Hashmi M, Saleh M (2003) Outcome of complex fractures of the tibial plateau treated with beam-loading ring fixation system. J Bone Jt Surg (Br) 85-B:691-699
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. Inj Int J Care Inj 36:1467-1475
Dendrinos GK, Kontos S, Katsenis D, Dalas A (1996) Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator. J Bone Jt Surg (Br) 78-B:710-717
Gustilo R, Mendoza R, Williams D (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742-746
Tscherne H, Gotzen L (1984) Fractures with soft tissue injuries. Springer, Berlin
Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res 138:94-104
Checketts RG, MacEachern AG, Otterburn M (2000) Pin track infection and the principles of pin site care. In: De Bastiani A, Graham Apley A, Goldberg A (eds) Orthofix external fixation in trauma and orthopaedics. Springer, Berlin, pp 97-103
Insall JN, Dorr LD, Scott RD, Normal Scott W (1989) Rationale of the Knee Society clinical rating system. Clin Orthop 248: 13-14
Apley AG (1956) Fractures of the lateral tibial condyle treated by skeletal traction and early mobilization: a review of sixty cases with special reference to the long-term results. J Bone Jt Surg (Br) 38-B:699-708
Apley AG (1979) Fractures of the tibial plateau. Orthop Clin N Am 10:61-74
Yang EC, Weiner L, Strauss E et al (1995) Metaphyseal dissociation fractures of the proximal tibia. An analysis of treatment and complications. Am J Orthop 244:695-704
Fragomen AT, Rozbruch SR (2007) The mechanics of external fixation. HSSJ 3:13-29
Watson JT, Ripple S, Hoshaw SJ, Fyhrie D (2002) Hybrid external fixation for tibial plateau fractures: clinical and biomechanical correlation. Orthop Clin N Am 33:199-209
Mikulak SA, Gold SM, Zinar DM (1998) Small wire external fixation of high-energy tibial plateau fractures. Clin Orthop Relat Res 365:230-238
Kumar A, Whittle AP (2000) Treatment of complex (Schatzker type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma 14(5): 339-344
Subasi M, Kapukaya A, Arslan H, Ozkul E, Cebesoy O (2007) Outcome of open comminuted tibial plateau fractures treated using an external fixator. J Orthop Sci 12:347-353
Katsenis D, Dendrinos G, Kouris A, Savas N, Schoinochoritis N, Pogiatzis K (2009) Combination of fine wire fixation and limited internal fixation for high-energy tibial plateau fractures: functional results at minimum 5-year follow-up. J Orthop Trauma 23:493-501
Bibbo C, Brueggeman J (2010) Prevention and management of complications arising from external fixation pin sites. J Foot Ankle Surg 49:87-92
Rogers LC, Bevilacqua NJ, Frykberg RG, Armstrong DG (2007) Predictors of postoperative complications of Ilizarov external ring fixators in the foot and ankle. J Foot Ankle Surg 46(5):372-375
Cavusoglu AT, Er MS, Inal S, Ozsoy MH, Dincel VE, Sakaogullari A (2009) Pin site care during circular external fixation using two different protocols. J Orthop Trauma 23:724-730
DeJong ES, DeBerardino TM, Brooks DE, Nelson BJ, Campbell AA, Bottoni CR, Pusateri AE, Walton RS, Guymon CH, McManus AT (2001) Antimicrobial efficacy of external fixator pins coated with a lipid stabilized hydroxyapatite/chlorhexidine complex to prevent pin tract infection in a goat model. J Trauma 50:1008-1014
Mostafavi HR, Tornetta P III (1997) Open fractures of the humerus treated with external fixation. Clin Orthop Relat Res 337:187-197
Parameswaran AD, Roberts CS, Seligson D, Voor M (2003) Pin tract infection with contemporary external fixation: How much of a problem? J Orthop Trauma 17:503-507
Patterson MM (2005) Multicentre pin care study. Orthop Nurs 24(5):349-360
Ferreira N, Marais LC (2012) Pin tract sepsis: incidence with the use of circular fixators in a limb reconstruction unit. SA Orthop J 11(1):10-18
Ferreira N, Marais LC (2012) Prevention and management of external fixator pin tract sepsis. Strateg Trauma Limb Reconstr 7:67-72. doi:10.1007/s11751-012-0139-2