External Versus Internal Fixation for Bicondylar Tibial Plateau Fractures

Introduction: Bicondylar tibial plateau fractures have an impact on the stability and functionality of the knee. Restoration and preservation of normal knee function are the goals of surgical treatment for condylar tibial plateau fractures. A variety of injuries can result in tibial plateau fractures. Low energy fractures can be treated with closed methods or with conventional internal fixation and open reduction. As a result of the substantial soft tissue damage, fracture comminution, instability, and displacement of articular fragments, high energy tibial plateau fractures typically present treatment challenges. Aim: To compare the results of external fixation by Illizarov ring external fixator versus open reduction and internal fixation by plates and screws in treatment of bicondylar tibial plateau fracture in term of rate of union, knee function, incidence of complications. Patients and methods: Forty patients with bicondylar tibial plateau fractures who underwent surgery at Suez Canal University hospital between June 2018 and January 2022 were included in this prospective comparative clinical analysis. There were two groups of patients. Twenty instances were managed by external fixation in group (A), while twenty cases were managed via plate fixation in group (B). Results: the main follow up time were 24 months Regarding knee score (Knee Society score and scoring grade), incidence of complications, and range of knee joint motion, there was no statistically significant difference between the two groups. There was a statistically significant difference between the time to union in group (B) and the duration of frame in group (A), meaning that patients managed by ORIF in group (B) required less time to obtain full union of fracture than patients managed by Illizarov in group (A). Conclusion: The treatment of bicondylar tibial plateau fractures is still difficult. According to the literature, definite external fixation and ORIF concepts both seem to be widely recognized fixation techniques.