Evaluation of Complex Tibial Plateau Fracture Treated with Ilizavor External Fixator

Background: Complex tibial plateau fractures provide a significant challenge in orthopaedic surgery. The Ilizarov technique addresses common issues in fracture therapy and allows for closed reduction and fixation without significant soft tissue stripping. Aim of the study: The purpose of this study was to evaluate the outcomes of treating complicated tibial plateau fractures with the Ilizarov technique in conjunction with minimal internal fixation. Methods & Materials: This retrospective study was conducted in the Department of Orthopedic Surgery, Barind Medical College, Rajshahi, TMSS Medical College, Bogura, Cumilla Medical College, Cumilla and East West Medical College, Dhaka, Bangladesh. The study included 30 Schatzker type VI tibial plateau fractures in 29 individuals, whose mean age ranged from 20 to 76 years. Nine fractures were open and twenty-one were closed. Tscherne and Gotzen's classification of soft tissue injury was used for closed fractures, while Gustilo and Anderson's classification was used for open fractures. Rasmussen's method and the Knee Society clinical assessment score were used for radiographic, clinical, and functional evaluations. Results: Except for one with varus malunion, all fractures healed. The frame was removed after an average of 16.3 weeks (range 14-24). Only 28 patients (29 fractures) were available for follow-up. The average follow-up period was 27 months (range 16–36). The radiographic reduction of fractures was excellent in 18 cases and good in 12. Using the Knee Society clinical assessment method, 18 knees were classified as exceptional, seven as good, one as fair, and two as poor. Five patients demonstrated clinically significant grade 2+ medial-lateral instability. Only two were symptomatic, although they had no functional limitations. Eleven individuals reported no pain, while the rest 18 experienced mild or intermittent pain. Eight individuals had difficulty walking, and six need walking assistance. There was a strong association (P<0.005) between the existence of accompanying injuries and the final outcome, with the most significant being a concurrent distal femoral fracture. Conclusion: This study emphasizes the Ilizarov method's therapeutic success and minimal morbidity rate. The technique is ideally suited to the treatment of difficult tibial plateau fractures in which comminution would necessitate extensive dissection and internal fixation with plates and screws, further compromising the soft tissue.