Provisional Dynamic Hinged External Fixation Enables Arthroscopy‐Assisted Circular Frame Reconstruction of Complex Tibial Plateau Fractures

Purpose To describe the surgical technique and early operative outcomes of using a provisional dynamic external fixator to facilitate arthroscopic‐assisted reduction of complex tibial plateau fractures. Methods Between 2014 and 2024, we conducted a retrospective single‐center case series of Schatzker IV‐VI tibial plateau fractures treated with provisional dynamic external fixation and arthroscopy‐assisted circular frame fixation, with a minimum 1‐year follow‐up. The dynamic fixator permitted knee flexion during definitive surgery, facilitating arthroscopic reduction. Collected variables included perioperative metrics, hospitalization course, 1‐year radiographic outcomes, complications, time to union, and knee range of motion. Results Eleven patients met criteria and were predominantly healthy middle‐aged (mean 46.27 years) men (78%). Continuous passive motion began immediately after provisional fixation. Median operative time was 1 hour and 17 minutes for the dynamic frame and 3 hours and 4 minutes for the arthroscopy‐assisted definitive procedure, with low estimated blood loss at both stages (median 5 to 25 mL). Definitive fixation occurred a median of 5 days after injury; median hospital stay was 12 days; 83% were discharged home. At 1 year, mean articular depression was 2.25 mm, condylar widening 0.25 mm, and angulation of 4.46°; the median Rasmussen score was 12. Median time to union was 13 weeks and 3 months for full weight‐bearing. After 1 year, range of motion was 0° to 115° on average. Complications within 1 year, included infection in 5/11 (45%)—4 pin‐site infections treated with oral antibiotics, and 1 deep infection requiring debridement, foot drop 1/11 (9%) and chronic pain 1/11 (9%); no revision surgeries occurred. Conclusions This case series shows that provisional fixation with a dynamic hinged external fixator for complex tibial plateau fractures permitted knee motion during the interval before definitive surgery and preserved access for arthroscopy‐assisted reduction without requiring frame removal. At 1 year, radiographic outcomes were good, knee range of motion was near full, and there was a low rate of serious complications. Level of Evidence Level IV, retrospective therapeutic case series.