Treatment of fractures of the tibial plateau (Schatzker VI) with external fixators versus plate osteosynthesis

Introduction The purpose of this study was to determine the effectiveness of circular external fixation (CEF) as a definitive treatment option for patients with complex tibial plateau fractures (Schatzker VI) compared with the outcomes of a fixed angle locking plates’ group. Methods Level III evidence. Retrospective, comparative study in a Level I Trauma Center. Fourteen patients treated with CEF (Group A) were compared to fourteen patients treated with minimal invasive angle locking plates (Group B). The mean time from fractures to surgery was 19 days for Group A with a mean ISS of 24 and 7 days for Group B with a mean ISS of 14. The main outcome measures were clinical and radiographic. Results Complete union was obtained in Group A at an average of 22 weeks and at 17 weeks in Group B. Two patients developed non-union, one in each group. Normal alignment was observed in both groups, no statistical differences were observed in Paley’s anatomical posterior proximal tibial angle (aPPTA) and mechanical medial proximal tibial angle (mMPTA) between two groups. Results based on the Association for the Study and Application of the Method of Ilizarov criteria for Group A: 71% excellent and 29% good as far as bone outcomes are concerned and as 57% excellent, 37% good, and 7% fair for functional outcomes. Conclusions Definitive fixation with circular external fixator is effective in complex Schatzker VI tibial plateau fractures. Advantages include maintaining the frame till union, reduced risk of infection, early mobilization, restoration of the normal lower extremity alignment, versatility, and improved union rate in patients with multiple traumatic injuries, infection, and soft tissue injuries.