Functional Outcome of High Energy Schatzker Type V and VI Tibial Plateau Fractures Treated with Hybrid External Fixator: A Prospective Interventional Study

Introduction: High-energy Schatzker type V and VI tibial plateau fractures are severely injured intra-articular fractures commonly accompanied by serious soft-tissue injury and instability. Conventional internal fixation may be problematic because of the serious risk of infection and soft-tissue complications. Hybrid external fixators provide a less invasive option, hoping to stabilise the fracture without compromising soft-tissue integrity and facilitating functional recovery. Aim: To evaluate the functional results of hybrid external fixation of bicondylar tibial plateau fractures. Materials and Methods: The present prospective interventional study was conducted at Government Doon Medical College, Dehradun, Uttarakhand, India over a period of 12 months from September 2021 to August 2023, focusing on high-energy Schatzker type V and VI tibial plateau fractures. A total of 41 patients were treated using a hybrid external fixator; however, three patients were lost to follow-up. Two-plane radiographs were taken in all the cases, and radiographs taken immediately after surgery were assessed to check the quality of fixation and reduction. All the patients were checked at six weeks, six months, and twelve months, and functional results were scored by the Modified Hospital for Special Surgery (MHSS) knee scoring system. Removal of the fixator was done at a mean of 2.5±0.5 months from the time of surgery. Data were analysed via statistical tests used Chi-square test or Analysis of Variance (ANOVA), with significance at p<0.05. Results: Thirty-eight patients (31 men, 7 women) who had followup were included in the study. There were 13 Schatzker V fractures and 25 Schatzker VI fractures. All patients exhibited good coronal and sagittal plane alignment and preserved articular width on supine X-rays of the knee in Anteroposterior (AP) and lateral views. Good to excellent results were achieved in 36 (94.73%) patients based on the MHSS knee score. The average range of knee flexion was 115.79±21.29 degrees, and the average MHSS score was 80.34±10.30 at final follow-up. 2 (5.26%) patients got superficial infections after external fixation whereas 1 (2.63%) patients had nonunion, and another (2.63%) developed varus deformity. A total of 36 (94.74%) patients went back to their previous level of work and activity. No cases of deep infection were observed. Conclusion: Hybrid external fixator in Bicondylar tibial plateau fractures gives a favourable functional outcome as it provides rigid fixation and allows immediate knee mobilisation.