From the Guidelines
External fixation for tibial plateau fractures is indicated in cases of open fractures with significant soft tissue damage, compartment syndrome, polytrauma, or severe comminution with soft tissue compromise, as it provides temporary stabilization and minimizes additional trauma to compromised tissues. The primary goal of external fixation in these scenarios is to maintain length, alignment, and rotation while allowing for soft tissue recovery before definitive internal fixation, as suggested by the AAOS clinical practice guideline summary 1. Some key points to consider when deciding on external fixation for tibial plateau fractures include:
- Open fractures with significant soft tissue damage, where external fixation can help reduce the risk of infection and promote wound healing
- Compartment syndrome requiring fasciotomy, where external fixation can provide temporary stabilization while allowing for soft tissue recovery
- Polytrauma patients who cannot tolerate definitive surgery, where external fixation can serve as a bridge to definitive fixation once the patient's condition stabilizes
- Severe comminution with soft tissue compromise, where external fixation can help maintain alignment and stability while minimizing additional trauma to compromised tissues. The technique of external fixation typically involves placing pins in the distal femur and proximal tibia, connected by external bars, and can be maintained for 1-3 weeks until soft tissues recover sufficiently for definitive fixation, as supported by the moderate strength of recommendation for temporizing external fixation in the treatment of open fractures in major extremity trauma 1. Overall, external fixation for tibial plateau fractures is a viable option in specific clinical scenarios, providing a temporary stabilization method that minimizes additional trauma to compromised tissues and reduces the risk of infection, ultimately improving long-term outcomes.
From the Research
Indications for External Fixation of Tibial Plateau Fractures
The decision to use external fixation for tibial plateau fractures is based on several factors, including the severity of the fracture, the condition of the soft tissues, and the overall health of the patient. Some of the key indications for external fixation include:
- Complex fracture patterns, such as Schatzker V and VI fractures 2, 3
- Severe soft tissue damage or compromise 3, 4
- High-risk of infection or wound complications 5
- Need for staged treatment, with external fixation as a temporary measure before definitive osteosynthesis 4
- Patient factors, such as poor bone quality or medical comorbidities that make internal fixation risky 6
Benefits and Drawbacks of External Fixation
External fixation for tibial plateau fractures has several benefits, including:
- Reduced risk of soft tissue complications, such as infection and wound breakdown 3, 5
- Ability to stabilize complex fracture patterns and allow for early mobilization 3, 4
- Minimally invasive technique, which can reduce blood loss and operative time 4 However, external fixation also has some drawbacks, including:
- Higher risk of pin site infections and other complications related to the external fixator 5
- Limited ability to achieve anatomical reduction and stable fixation, particularly in complex fracture patterns 2, 5
- Need for careful patient selection and monitoring to minimize risks and optimize outcomes 6
Comparison with Open Reduction and Internal Fixation
External fixation is often compared with open reduction and internal fixation (ORIF) as a treatment option for tibial plateau fractures. Some studies have found that external fixation can produce similar outcomes to ORIF, particularly in terms of functional results and patient satisfaction 3, 5. However, other studies have noted that ORIF may be associated with a higher risk of soft tissue complications, such as infection and wound breakdown 2, 4. Ultimately, the choice between external fixation and ORIF depends on the individual patient and fracture characteristics, as well as the surgeon's preference and experience 5, 6.