Functional Outcome of Bicondylar Tibial Fractures Schatzker Type V and VI Treated with Ilizarov External Fixator
DOI:
https://doi.org/10.61581/MJSP.VOL06/01/02Keywords:
Bicondylar Fracture, External Fixation, Ilizarov, Karlström-Olerud Score, Tibial PlateauAbstract
Objective: To determine the mean functional outcome of Schatzker type V and VI bicondylar tibial plateau fractures treated with Ilizarov external fixation.
Methodology: Prospective descriptive study conducted at department of Orthopedic Surgery, Nishtar Hospital Multan, from February 20, 2024 to August 20, 2024. Fifty-nine patients with closed Schatzker type V or VI tibial plateau fractures treated with Ilizarov external fixation within 14 days of injury were included. Fractures were reduced via closed or mini-open techniques under fluoroscopic guidance, and fixed with a three or four ring external fixator. Postoperatively, patients underwent supervised physiotherapy. Functional outcomes were assessed using the Karlström-Olerud (KO) score at the final follow-up. Data was analyzed using IBM SPSS, and an independent samples T-test was used to compare mean functional outcome scores.
Results: The mean age of the 59 patients, of whom 79.7% were male, was 37.3 ± 14.1 years. The mean KO score was 28.33 ± 3.2, with 11.9% achieving excellent, 39.0% good, 25.4% satisfactory, 15.3% moderate, and 8.5% poor results. Schatzker type VI fractures had significantly lower KO scores than type V fractures (p<0.001). A significant negative correlation was found between the duration from injury to surgery and the KO score (p=0.01).
Conclusion: While Ilizarov external fixation can be an effective tool for managing complex bicondylar tibial plateau fractures, the functional outcomes are variable. The complexity of tibial plateau fractures requires a tailored management plan for each patient.
Keywords: Bicondylar Fracture, External Fixation, Ilizarov, Karlström-Olerud Score, Tibial Plateau
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1. Bagherifard A, Mirkamali S, Rashidi H, Naderi N, Hassanzadeh M, Mohammadpour M. Functional outcomes and quality of life after surgically treated tibial plateau fractures. BMC Psychol. 2023;11(1):146.
2. Wei G, Niu X, Li Y, Chang T, Zhang J, Wag H, et al. Biomechanical analysis of internal fixation system stability for tibial plateau fractures. Front Bioeng Biotechnol. 2023;11(1):1199944.
3. Baloch SR, Rafi MS, Junaid J, Shah M, Siddiq F, Ata-Ur-Rahman S, et al. Ilizarov fixation method of tibia plateau fractures: a prospective observational study. Cureus. 2020;12(10):e11277.
4. Ramos T, Ekholm C, Eriksson BI, Karlsson J, Nistor L. The Ilizarov external fixator-a useful alternative for the treatment of proximal tibial fractures A prospective observational study of 30 consecutive patients. BMC musculoskeletal disorders. 2013 Dec;14:1-2.
5. AbouSeif S, Kotb MI, Abass AM. Fixation of Tibial Plateau Fractures Type 5, 6 by Ilizarov Apparatus: A Systematic Review of Outcomes and Complications. QJM: An International Journal of Medicine. 2024 Oct;117(Supplement_2):175-652.
6. Vendeuvre T, Gayet LÉ. Percutaneous treatment of tibial plateau fractures. Orthopaedics & Traumatology: Surgery & Research. 2021 Feb 1;107(1):102753.
7. Oguzkaya S, Misir A, Kizkapan TB, Eken G, Ozcamdalli M, Basilgan S. A comparison of clinical, radiological, and quality-of-life outcomes of double-plate internal and Ilizarov external fixations for Schatzker type 5 and 6 tibia plateau fractures. European Journal of Trauma and Emergency Surgery. 2022 Apr 1:1-8.
8. Kawoosa AA, Mantoo SA, Ali N, Dar GN. Clinico - radiological results of tibial bicondylar fractures managed with Ilizarov technique with or without minimal internal fixation. Malays Orthop J. 2022;16(1):18-27.
9. Catagni MA, Ottaviani G, Maggioni M. Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma. 2007;63(5):1043-53.
10. Ferreira N, Marais LC. Bicondylar tibial plateau fractures treated with fine-wire circular external fixation. Strategies in Trauma and Limb Reconstruction. 2014 Apr;9:25-32.
11. Subasi M, Kapukaya A, Arslan H, Ozkul E, Cebesoy O. Outcome of open comminuted tibial plateau fractures treated using an external fixator. J Orthop Sci. 2007 Jul;12(4):347-53.
12. Reátiga Aguilar J, Rios X, González Edery E, De La Rosa A, Arzuza Ortega L. Epidemiological characterization of tibial plateau fractures. Journal of orthopaedic surgery and research. 2022 Feb 19;17(1):106.
13. Wang Z, Zheng Z, Ye P, Tian S, Zhu Y, Chen W, Hou Z, Zhang Q, Zhang Y. Treatment of tibial plateau fractures: a comparison of two different operation strategies with medium-term follow up. Journal of orthopaedic translation. 2022 Sep 1;36:1-7.
14. Verma A, Venkateshaiah S, Gajapurada S. Outcomes in Schatzker Type 5 and Type 6 Tibial Plateau Fractures Treated with Ilizarov External Fixator: Follow-up in 30 Patients. International Journal of Recent Surgical and Medical Sciences. 2020 Jun;6(01):04-11.
15. Reddy SR, Shah HM, Godhasiri P. Outcome of tibial plateau fractures treated by hybrid and Ilizarov external fixation. Int J Res Orthop. 2019 Sep;5(5):894
16. Yao P, Gong M, Shan L, Wang D, He Y, Wang H, Zhou J. Tibial plateau fractures: three dimensional fracture mapping and morphologic measurements. International Orthopaedics. 2022 Sep;46(9):2153-63.
17. Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. Journal of orthopaedic trauma. 2004 Nov 1;18(10):649-57.
18. Unno F, Lefaivre KA, Osterhoff G, Guy P, Broekhuyse HM, Blachut PA, O'Brien P. Is early definitive fixation of bicondylar tibial plateau fractures safe? An observational cohort study. Journal of orthopaedic trauma. 2017 Mar 1;31(3):151-7.
19. Haller JM, Holt D, Rothberg DL, Kubiak EN, Higgins TF. Does early versus delayed spanning external fixation impact complication rates for high-energy tibial plateau and plafond fractures?. Clinical Orthopaedics and Related Research.2016 Jun;474:1436-44.
20. Wier J, Duong AM, Gary JL, Patterson JT. Early external fixation of tibial plateau fractures is associated with an increased risk of compartment syndrome. Injury. 2024 Nov 1;55(11):111879.
21. Henkelmann R, Frosch KH, Mende M, Gensior TJ, Ull C, Braun PJ, Katthagen C, Glaab R, Hepp P. Risk factors for deep surgical site infection in patients with operatively treated tibial plateau fractures: a retrospective multicenter study. Journal of orthopaedic trauma. 2021 Jul 1;35(7):371-7.
22. Berto L, Palma GH, Silva AC, Rodrigues MR, Amorim R, Cardoso GS. Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods. Revista Brasileira de Ortopedia. 2024 Jun 17;59(2):206-12.
23. Ahmed MN, Hegazy MO, Hamdy HM. Ilizarov fixator versus plates and screws for treatment of high-energy tibial plateau fractures. SVU-International Journal of Medical Sciences. 2025 Jan 1;8(1):262-75.
24. Gencer B, Doğan Ö, Çalışkan E, İğdir V, Biçimoğlu A. Single versus double plating for bicondylar tibia plateau fractures: Comparison of range of motion, muscle strength, clinical outcomes and accelerometer-measured physical activity levels. The Knee. 2022 Jan 1;34:187-94.
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