Awal Hakeem, Muhammad Siraj, Qaisar Azim.
Management of Tibial Plateau Fracture.
Ophthalmol Update Jan ;16(4):912-7.

Background: Tibial plateau fractures are one of the most challenging problems in orthopaedic surgery. Fractures of the tibial plateau, intra-articular injuries of the knee joint are often complex, difficult to treat and have a high complication rate. The Ilizarov technique solves many problems encountered in management of such fractures and provides a method for closed reduction and fixation that does not necessitate excessive soft-tissue stripping, protecting vascularity, emphasize restoring both joint congruity and the mechanical axis of the limb. Objectives: The main objective of this study is to evaluate functional outcome of tibial plataeu fractures using Ilizarov external fixator . Materials and Methods: This study was conducted in Department of Orthopedics and Trauma, Hayatabad Medical Complex and Khyber Teaching hospital, Peshawar from January 2016 till December 2017. Results: 20 patients were treated, 12 (60%) were male and 8 (40%) female. The mean age was 33.6 years (range: 18 to 54 years). All patients were followed up was 9.6 months (range 7-12) months. Fractures healed with no occurrence of nonunion. Fracture healing time was 12-18 weeks with an average of 14.05 weeks. The time of external fixator removal on average was 17.9(range of 15-22 weeks). The complications which are observed in patients were pin track infection (k-wire and Shawn pin), knee stiffness, enquinus deformity of foot, quality of articular reduction, mal-union and poor compliance. Full weight-bearing was allowed at a mean of 5 months. Using the knee society clinical rating system, 9 knees were rated as excellent, 7 as good, one as fair, and 2 as poor. One patient was lost in follow up. Six patients achieved full extension and eight had an extension deficit of less than 6°. Two had an extension lag of 6° to 10° and three more than 10°. 14 patients achieved flexion of more than 110° and 5 of these were able to flex the knee to more than 130°. All knees were stable. Thigh atrophy of more than 1 cm was noted in only 3 patients. Conclusion: The method is well suited to the management of complex fractures of the tibial plateau when extensive dissection and internal fixation are contraindicated due to the comminuting and soft tissue compromise.

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