Evaluation of tibial condyle fractures treated with primary Ilizarov with a modified technique

Introduction

Proximal tibia fracture is one of the most common fractures that we deal in the emergency department. With the increment of high speed vehicles the cases of compound fractures and fractures with impending compartment syndrome has increased. The mechanism of the injury contributes to a high rate of complications and it also tends to cause severe soft tissue damage.1, 2, 3, 4, 5, 6

The aim of periarticular fracture fixation include restoration of articular congruity, joint stability and metaphyseal alignment. Open reduction internal fixation with plating is the usual treatment for such fractures. However, these plates, especially when placed under thin or damaged soft tissue, may compromise wound healing.6, 7, 8, 9 Plate irritation occurs with a bone- plate distance of as little as 5mm. Even with staged external fixation and careful soft tissue handling, complication rates of high energy proximal tibia fractures range from ten to thirty percent. Ten percent patients experience hardware related complications, including pain and mechanical symptoms associated with prominent screws and plate.

The Ilizarov ring fixator offers a minimally invasive approach where multiple stab incisions are required for adequate intervention with minimum soft tissue destruction and blood loss. Other advantages of this technique is that adjustments during and after surgery are possible, also it allows early weight bearing.

Materials and Methods

This study was conducted between December 2017 and May 2021 at a tertiary Centre in 54 patients with tibial Condyle fracture. All patients admitted either via Emergency or Out Patient Department were included in this study. Informed consent was taken from all patients. Inclusion criteria were patient more than 20 years, both sexes, all tibial condyle plateau fracture including severely comminuted fractures. Exclusion criteria were pathological fracture of tibia and patient lost for follow up. All patients were evaluated for musculoskeletal and neurological injuries. Time period between trauma and surgery varied from 8 hours to 5 days. Most of the cases were operated in regional anaesthesia.

Aim of our treatment for articular fractures is anatomical restoration of joint surface and absolute stability at the fracture site. At the metaphyseal region we need relative stability.

Case 1

Figure 1

Pre-op clinical

Figure 2

Pre-op

Figure 3

Lifting fragment

Figure 4

Intra op

Figure 5

Immediate post-op AP

Figure 6

ROM extension

Figure 7

Rom flexion

Figure 8

SLR

Figure 9

1 month lateral

Figure 10

1 month lAPl

Figure 11

3 month AP

Figure 12

3 month lateral

Figure 13

6 month AP

Figure 14

6 month lateral

Figure 15

7 month AP

Figure 16

7 month lateral

Case 2

Figure 17

Pre-op

Figure 18

Pre-op lateral

Figure 19

Clinical post-op

Figure 20

1 month AP

Figure 21

1 month lateral

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3 month AP

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3 month lateral

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4 month AP

Figure 25

4 month lateral

Figure 26

6 month final

Results

A total of 54 cases of tibial plateau fractures were included in our study. The results and our observations are shown in tables and graphs.

Graph 1

Age distribution

Same surgeon has operated all the cases. In our study maximum patient were male and of age between 25 and 55 years. Mean time for radiological union was 24.37 weeks (15 to 35 weeks). Ilizarov fixator we have removed 21 days after radiological union. Functional score was calculated using two scores: Hohl and Luck score, and Lyshom’s score. 12 has excellent, 28 good, 14 were fair and no patient with poor result. Mean Lyshom’s score was 81.73. Knee range of movement in maximum patients were 0 to 110 degree. There was few complications, like, Extensor lag which got corrected with physiotherapy. Pin tract infection which healed with few dressings.

Graph 2

Sex distribution

Graph 3

Radilogical union(in weeks)

Graph 4

Holl and luck grading

Graph 5

Lyshom's score

Graph 6

Knee range of movement (one year post suegery

Graph 7

Complications

Discussion

Periarticular fractures need anatomical reduction and early joint range of movement for better results. Ilizarov give both these advantages which has been proven with earlier studies also. George K Dendrinos et al10 (1996) states that Ilizarov is an ideal method of treatment for these fractures when extensive dissection is there, same is stated by Whatson J Tracy et al.11 (1998). Other studies supporting our results are: Barbary H El et al12 (2005), Ranatunga IR et al13 (2010), Sandeep Reddy R et al14 (2014). Studies which show that Ilizarov is better treatment option compared to open reduction internal fixation are: Metcalfe et al15 (2015), Boutefnouchet et al16 (2016), and Tahir et al17(2019).

Our modification gives excellent result as it provide absolute stability at the periarticular area which heals the fracture without callus, and restores joint anatomy. At the same time it gives relative stability at the epiphyseo-metaphyseal region and healing the fracture with abundant callus, and thus allowing patient for early weight bearing.

Conclusions

Ilizarov ring fixator is an excellent option for Tibial Plateau fractures as a definitive surgery especially with damaged soft tissue. And with our modification we can achieve perfect joint alignment and early weight bearing.

Source of Funding

None.

Conflict of Interest

None.