gms | German Medical Science

Objectives: The treatment of bicondylar tibial plateau fractures remains a complex and challenging issue for orthopedic surgeons despite numerous treatment alternatives. In this report we aimed to present clinical and radiological outcome of patients with tibia plateau fractures who were treated with hybrid external fixators. Schanz screws were applied synchronously and used as joystick for fracture reduction

Methods: The study included 72 patients (49 male and 23 female) with bicondylar tibial plateau fractures classified as type 41-C2 according to the AO classification. Two Schanz screws were placed vertical to the medial and lateral fracture fragments synchronously with two separate motors under fluoroscopic guidance. The Schanz screws were placed on the ends of the fracture fragments. After checking the movability of the fracture fragments using the Schanz screws under fluoroscopy, the screws adapted for the motor were used as joysticks, and reduction was performed. When the best anatomical reduction was obtained, the Schanz screws were passed through the opposite cortexes synchronously

Results and Conclusion: The median age of the patients was 39 (21-67) years, and the median follow-up time was 21 (12-35) months. The etiologies of the fractures were traffic accidents for 45 patients (62.5%), falls from heights for 17 patients (23.6%) and falls for 10 patients(13.8%).The median operation duration was 47 (25-68) minutes. Blood transfusions were not needed for any of the patients during the postoperative period. Mean knee flexion and extension were 105' (80'-125') and 0' (5'-7'), respectively. Mean varus laxity and valgus laxity were 4.30 (2'-7') and 3.10 (2'-5'), respectively. Four patients experienced leg shortness from 0.4-1.1 cm (mean=0.72cm). After confirming full radiological fracture healing, the external fixators were removed between 8 and 16 weeks (mean=8 weeks) postoperatively. The KSS scores at the end of one year were “excellent” for 48 patients, “good” for 29 patients, and "inadequate" for 5 patients.

With the applied technique, we obtained stable reductions over a short period using synchronously applied Schanz screws under fluoroscopic guidance. None of the patients experienced major complications, which enabled early weight bearing and a return to daily living activities.

Hybrid external fixation using Schanz screws via the “joystick method” should be considered as a rapid, easy-to-apply method with low morbidity and successful results for treating bicondylar tibial plateau fractures.