The Journal of Bone and Joint Surgery, Vol 77, Issue 5 661-673, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
External fixation and limited internal fixation for complex fractures of the tibial plateau
JL Marsh, ST Smith and TT Do
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242-1088, USA.
Twenty-one complex fractures of the tibial plateau in twenty patients were
treated with closed reduction, interfragmental screw fixation of the
articular fragments, and application of a unilateral half-pin external
fixator. The average duration of external fixation was twelve weeks (range,
three to twenty weeks). The fixator was left in situ until the fracture had
united in all but two patients. All of the fractures healed. The
complications with this technique were attributable primarily to the
proximal half-pins of the external fixator. Seven patients needed
antibiotics for an infection at a pin site, and two had septic arthritis
that necessitated arthrotomy and debridement. The average duration of
follow-up was thirty-eight months. The range of motion of nineteen of the
twenty-one knees was at least a 115-degree arc. Laxity was evident in seven
knees, but no patient complained of instability of the knee. Radiographs
showed malalignment of more than 6 degrees in three knees compared with the
normal, contralateral knee and evidence of post-traumatic osteoarthrosis in
five knees. The Iowa knee score, determined for nineteen patients, averaged
87 points (range, 55 to 100 points). The SF-36 general health survey
demonstrated that most patients had function close to that of age-matched
controls. We concluded that external fixation with limited internal
fixation is a satisfactory technique for the treatment of selected complex
fractures of the tibial plateau.
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