Management of Complex Tibial Plateau Fractures with the Ilizarov External Fixator

Abstract

Summary Disillusionment with the results of classical open techniques in the management of complex tibial plateau fractures has led to a move toward methods of indirect reduction and subsequent stabilization with external fixation. Stabilization of these complex articular injuries with the Ilizarov method, in combination with indirect reduction maneuvers such as ligamentotaxis, offers many advantages over conventional open reduction and internal fixation with plates. Smooth olive wires stabilize the joint fracture in the sagittal plane, and percutaneous cannulated screws can be added, when indicated, for fracture lines in the coronal plane. A three- or four-ring circular frame construct ensures adequate fixation of the metadiaphyseal junction, which is usually very unstable. Experience with this method has demonstrated that it provides sufficient stability to allow early joint motion while preserving the soft tissue envelope, with a low rate of complications secondary to surgical fixation.

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