Small wire external fixation of high energy tibial plateau fractures

Open plate osteosynthesis for high energy tibial plateau fractures with dis sociation between the metaphysis and diaphysis has been plagued with freque nt soft tissue complications. The Harbor-University of California at Los An geles Medical Center's experience with small wire external fixation supplem ented by limited internal fixation is examined. This alternative method of adequate stable fixation offers the advantage of minimal soft tissue compro mise. Twenty-four patients with Schatzker Type VI tibial fractures were tre ated with small wire external fixation. Supplementary limited internal fixa tion was used with percutaneous screws in 10 patients and with open reducti on in one patient. Sixteen patients had isolated fractures, and eight other s suffered multiple injuries. Minimum followup was 12 months. All fractures healed. Complications included one septic knee, two infections at screw si tes, and one 100 knee flexion contracture. One knee had Grade 3 radiographi c arthrosis, five had Grade 2, 10 had Grade I, and eight showed no arthrosi s. The outcomes (Knee Society clinical rating system) of this study compare favorably with outcomes described in reports published previously for this type of fracture, despite inclusion of eight multiply injured patients. Th is technique preserves the goals of early range of motion and stable fixati on for these devastating injuries, while decreasing the observed major woun d complications and nonunion rates. However, longer followup may reveal hig her arthrosis rates, specifically in those fractures that were not anatomic ally reduced.