MANAGEMENT OF HIGH VELOCITY TIBIAL PLATEAU FRACTURES BY LIGAMENTOTAXIS USING ILIZAROV EXTERNAL FIXATOR

Abstract

Background: Tibial plateau fractures resulting from high energy trauma, typically Schatzker type IV, V and VI pattern fractures are dif\uf001cult to deal\nwith due to poor overlying soft tissue cover. Ligamentotaxis with ilizarov ring \uf001xator can be a suitable de\uf001nitive treatment option for such injuries\nwith fewer associated complications as compared to internal \uf001xation.\nPatients and Methods: 30 patients within the age group of 18-80 years with Schatzker type IV, V and VI pattern injuries were included in the study.\nA four ring ilizarov assembly was used with knee spanning with a proximal femoral ring. The patients were followed for 12 months and evaluation\nwas analyzed as per Rasmussen clinical and radiological criteria.\nResults: The mean age of patients in our study was 39.76 years. Twenty cases were Schatzker type VI, 7 cases were Schatzker type IV (with\nextensive soft tissue swelling following high velocity trauma) and only 3 cases were type V. The mean duration of surgery was 47±12 mins without\nbone grafting and 72±14 mins with bone grafting. The mean interval from injury to surgery was 2.36 days (range 1-5 days). Rasmussen total\nanatomical outcome was excellent in 14 patients(46.66%) and good in 16 patients(53.33%). Rasmussen total functional outcome was excellent in\n21 patients(70%) and good in 9 patients(30%). Final Outcome was excellent in 22 patients(73.33%) and good in 8 patient(26.66%).\nDiscussion: High velocity tibial plateau fractures, when treated with internal \uf001xation and plating, carry a higher risk of associated complications\nranging from deep infections to even compartment syndrome. The rate of re-operation following internal \uf001xation in such injuries has been high\nwith most of the re-surgeries being required within one year of primary \uf001xation which adds to the morbidity of the patient. Ligamentotaxis with\nilizarov ring \uf001xation as de\uf001nitive treatment in such cases can be a fruitful operation with lesser complications and early return to previous level of\nactivity.