Clinical and Radiological Outcomes of Schatzker Type V and VI Tibial Plateau Fractures Treated With Internal Fixation and External Fixation.

INTRODUCTION

Tibial plateau fractures are complex injuries involving the articular surface of the proximal tibia and often accompanied by soft-tissue damage. These fractures are challenging due to their potential to disrupt knee joint stability and function. Schatzker classification is widely used to categorize these fractures globally. Several different treatment modalities, focused on stabilizing the knee joint while restoring pain-free motion, are used for treatment. Schatzker type V and VI tibial plateau fractures are treated with two different approaches: open reduction and internal fixation (ORIF) and closed reduction and external fixation (CREF). The primary objective is to assess and compare the clinical and radiological outcomes of ORIF versus CREF for Schatzker type V and VI tibial plateau fractures.

METHODS

This research was done retrospectively at the Aga Khan University Hospital. This study comprised 60 patients with type V and VI tibial plateau fractures who underwent internal fixation or external fixation from 2016 to 2022. Patients were divided into two groups with 30 patients each: the CREF group (patients treated with closed reduction and external fixation using Ilizarov as external fixator), and the ORIF group.

RESULTS

The CREF group consisted of 1 type V and 29 type VI fractures, whereas the ORIF group included 20 type V and 10 type VI fractures. The Oxford Knee Score was 40 points for each group at the 6-month follow-up. At the last follow-up, the Oxford Knee Score was 45 points for the CREF group and 44 points for the ORIF group.

CONCLUSION

In conclusion, our study highlights the benefits of CREF over ORIF for proximal tibial fractures in low- and middle-income countries. CREF showed shorter surgical duration and wait times, reduced blood loss, and fewer complications, particularly infections. Both groups had comparable radiological and functional outcomes, with a slight preference for CREF. These findings emphasize the potential of CREF in resource-constrained settings.

LEVEL OF EVIDENCE: Level 3.