Treatment of complex (Schatzker Type VI) fractures of the tibial plateau with circular wire external fixation: Retrospective case review

Objective: To determine the effectiveness of circular wire external fixation in the treatment of complex (Schatzker Type VI) fractures of the tibial plateau. Design: Retrospective case series. Setting: Fifty-seven complex (Schatzker Type VI) fractures of the tibial plateau were treated with circular wire external fixation at a Level 1 trauma center. Patients: Thirty-five fractures were closed, and twenty-two were open. Intervention: Closed indirect reduction by ligamentotaxis was attempted in all fractures; limited open reduction was performed in seven. Conventional Ilizarov frames using wire fixation were used in thirty-two fractures. The remaining twenty-five fractures were treated with hybrid Ilizarov fixators, which differed from conventional Ilizarov frames only in the use of cortical bone pins rather than wires through the distal rings for fixation of the diaphysis. Main Outcome Measurement: The results were graded according to the Knee Society rating system. Follow-up ranged from 16 to 90 months and averaged 42 months. Results: All fractures united at an average of 173 days (range, 50 to 415 days). Forty-five fractures with anatomic reduction had an average knee score of eighty-three and an average functional score of sixty-nine. In nine fractures with nonanatomic reduction, the average knee score was fifty-two, and the functional score was nineteen. Conclusions: Results perhaps would have been improved by more frequent open reduction, bone grafting, and internal fixation of fractures with severely depressed articular fragments. However, the use of circular external fixation obtained results comparable with other series, and we believe it is appropriate for treatment of these complex tibial fractures, especially those with a poor soft-tissue envelope.