Management of Comminuted Tibial in Adults Plateaue Fractures by Ligamentotaxis with Minimal Internal Fixation

Abstract Purpose To evaluate the clinical and radiological outcome of complex tibial plateau fractures treated with external fixation with or without minimal internal fixation. Methods This prospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov or LRS external fixation between September 2021 to February 2023 with the minimum follow-up duration of 18 months. There were 15 patients: 10 males and 5 females, mean age 36.7 years, four of them were open fractures; 13 cases were Schatzker type V fractures and two cases were type VI. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final followup. Results Out of the 15 cases, mini-open reduction was performed in 6 cases, minimal internal fixation in 8 cases. Mean duration of external fixation was 10.2 weeks. All fractures united except one case. Pin tract infections in 7 and common peroneal neuropathy was detected in one patient and was self limiting. Two patients had axial malalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS is 75.2 and mean RRS is 12.8. On statistical analysis; Schatzker type of fractures, use of minimal internal fixation and knee spanning did not influence the final outcome. Conclusion Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.