Koushik Narayan Subramanyam,Madhusudhan Tammanaiah,Abhishek Vasant Mundargi,Ritesh Nilakanthrao Bhoskar,Patllola Siddharth Reddy.[J].中华创伤杂志英文版,2019,22(3):166-171
Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation
  
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KeyWord: Tibial plateau fracturesSchatzker's classificationIlizarov techniquesRing fixator
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Koushik Narayan Subramanyam Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prashanthigram, Puttaparthi, Andhra Pradesh 515134, India 
Madhusudhan Tammanaiah Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prashanthigram, Puttaparthi, Andhra Pradesh 515134, India 
Abhishek Vasant Mundargi Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prashanthigram, Puttaparthi, Andhra Pradesh 515134, India 
Ritesh Nilakanthrao Bhoskar Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prashanthigram, Puttaparthi, Andhra Pradesh 515134, India 
Patllola Siddharth Reddy Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prashanthigram, Puttaparthi, Andhra Pradesh 515134, India 
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Abstract:
      Purpose: To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation. Methods: This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures; 15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up. Results: Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10 . At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. 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.
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