Results of ring (Ilizarov) fixator in high energy Schatzker type VI fractures of proximal tibia.

BACKGROUND

High-energy fractures of proximal tibia (Schatzker VI) are associated with severe articular depression, separation of both condyles, diaphyseal comminution & dissociation with loss of integrity of the soft-tissue envelope. Complications of plating are well known since last 50years in these difficult fractures. An alternative method was proposed by Ilizarov (ring fixator) and was adopted for the treatment of these complex injuries.

AIM OF STUDY: To analyse the results of patients who had ring fixator for the management of high-energy fractures (Schatzker VI) of the proximal tibia.Material &

Methods

Fifteen patients (mean age of 36years) with high-energy fractures of the proximal tibia (Schatzker VI) by the Ilizarov fixator and transfixion wires. Nine fractures were open and six patients had severe soft tissue injuries. Thirteen were treated by ligamentotaxis and percutaneous fixation. All were followed for a mean of 19.4 months. Using the criteria established by Honkonen & Jarvinen (1992), the outcome was analysed.

RESULTS

Fourteen fractures united, with an average time to healing of 14.6 weeks and one took six months. 12 patients achieved full extension and 8 patients regained more than 110° of flexion. All knees were stable with one patient uniting in mild varus deformity. Normal walking was observed in nine patients and four had a mild limp. All but one knee had an articular step-off of less than 4 mm and all had normal axial alignment except one. The outcome suggested that seven knees were excellent, seven good and one as fair. There were no cases of postoperative skin infection or septic arthritis, but three cases had pin tract infection who were treated successfully.

CONCLUSION

The technique is well suited for the management of complex fractures of the proximal tibia (Schatzker VI) when extensive comminution at the fracture site and compromise of the soft tissue is present.