Provisional Dynamic Hinged External Fixation Enables Arthroscopy-Assisted Circular Frame Reconstruction of Complex Tibial Plateau Fractures.

PURPOSE: To describe the surgical technique and early operative outcomes of using a provisional dynamic external fixator to facilitate arthroscopic-assisted reduction of complex tibial plateau fractures.

METHODS

Between 2014 and 2024, we conducted a retrospective single-center case series of Schatzker IV-VI tibial plateau fractures treated with provisional dynamic external fixation and arthroscopy-assisted circular frame fixation, with a minimum 1-year follow-up. The dynamic fixator permitted knee flexion during definitive surgery, facilitating arthroscopic reduction. Collected variables included perioperative metrics, hospitalization course, 1-year radiographic outcomes, complications, time to union, and knee range of motion.

RESULTS

Eleven patients met criteria and were predominantly healthy middle-aged (mean 46.27 years) men (78%). Continuous passive motion began immediately after provisional fixation. Median operative time was 1 hour and 17 minutes for the dynamic frame and 3 hours and 4 minutes for the arthroscopy-assisted definitive procedure, with low estimated blood loss at both stages (median 5 to 25 mL). Definitive fixation occurred a median of 5 days after injury; median hospital stay was 12 days; 83% were discharged home. At 1 year, mean articular depression was 2.25 mm, condylar widening 0.25 mm, and angulation of 4.46°; the median Rasmussen score was 12. Median time to union was 13 weeks and 3 months for full weight-bearing. After 1 year, range of motion was 0° to 115° on average. Complications within 1 year, included infection in 5/11 (45%)-4 pin-site infections treated with oral antibiotics, and 1 deep infection requiring debridement, foot drop 1/11 (9%) and chronic pain 1/11 (9%); no revision surgeries occurred.

CONCLUSIONS

This case series shows that provisional fixation with a dynamic hinged external fixator for complex tibial plateau fractures permitted knee motion during the interval before definitive surgery and preserved access for arthroscopy-assisted reduction without requiring frame removal. At 1 year, radiographic outcomes were good, knee range of motion was near full, and there was a low rate of serious complications.

LEVEL OF EVIDENCE: Level IV, retrospective therapeutic case series.