Abstract
Introduction
The optimal management of intra-articular tibial plateau fractures with metaphyseal-diaphyseal dissociation remains challenging and controversial. We report results using the technique of limited open reduction with external fixation using a fine wire circular frame.
Method
Between 1994 –2006, 83 eligible patients were identified. Case notes were reviewed; X-Rays and CT scans were examined and used to rank-order the severity of injury. ‘Musculoskeletal Functional Assessment’ (MFA) and ‘Knee Outcome Survey’ (KOS) questionnaires were completed and axial alignment X-Rays were taken to assess functional and radiological outcome.
Results
47 patients were available for follow-up at mean 57 months post injury. All fractures had united. There were 3 cases (6.39%) of pin site infection that necessitated debridement of superficial soft tissues. There were no cases of deep infection.
Functional outcome
The mean MFA score was 24.7 points (range, 2 to 68 points). Leisure & recreation (51.06), mobility (37.02) and emotional score (33.22) were most affected. The mean KOS was 73.11 (range, 18.75 to 96.25).
When compared to control population, our patient cohort still have significant persistent levels of disability.
No correlation was found between severity of injury, nor any patient demographic factors and functional outcome. 26 patients (85.1%) had returned to employment, though 29.8% had either been forced to change occupation or were limited in their original occupation by their injury.
Radiological outcome
Knee subluxation was found to have a significant association with poorer MFA (-0.323 p = 0.028) and KOS scores (0.304 p = 0.04). No other radiological measures correlated with functional outcome.
Conclusion
Treatment of these severe injuries by circular frame and limited internal fixation is a safe and effective operative option. It offers early mobilisation and movement of the knee, with a low complication rate and functional outcome equivalent to other treatment modalities.
