Application of simple Ilizarov ring external fixation technique in treatment of tibial plateau fracture complicated with osteofascial compartment syndrome_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QI Xin ¹ , XU Yongqing ¹ , XIA Shen ² , ZHAO Zeyu ¹ , Lü Qian ¹ , PU Shaoquan ¹ ,  ZHU Yueliang ¹

1. Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China;
2. Graduate School, Kunming Medical University, Kunming Yunnan, 650500, P.R.China;

Corresponding?author：

ZHU Yueliang, Email: 2770157912@qq.com

Keywords：

Tibial plateau fracture; osteofascial compartment syndrome; Ilizarov technique; external fixation

DOI：

10.7507/1002-1892.202003135

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Objective To explore the effectiveness of simple Ilizarov ring external fixation technique in treatment of tibial plateau fractures complicated with osteofascial compartment syndrome.Methods Between September 2013 and March 2017, 30 patients with tibial plateau fractures complicated with osteofascial compartment syndrome were treated with simple Ilizarov ring external fixation technique. There were 23 males and 7 females, with an average age of 34.4 years (range, 23-43 years). The injuries were caused by traffic accident in 12 cases, by falling from height in 4 cases, by falling in 8 cases, and by a crashing object in 6 cases. The time from injury to admission was 1-12 hours (mean, 4.8 hours). According to the Schatzker classification, there was 1 case of type Ⅱ, 3 cases of type Ⅲ, 10 cases of type Ⅳ, 7 cases of type Ⅴ, and 9 cases of type Ⅵ. All patients underwent fasciotomy due to osteofascial compartment syndrome; the interval between fasciotomy and operation was 10-15 days (mean, 12.5 days). Knee Society Score (KSS) and Ilizarov Method Research and Application Association (ASAMI) protocol were used to evaluate knee function.Results The operation time was 110-155 minutes (mean, 123.1 minutes); the intraoperative blood loss was 100-500 mL (mean, 245 mL); the postoperative hospital stay was 3-5 days (mean, 3.8 days). All patients were followed up 20-24 weeks (mean, 22.7 weeks). Except for 2 patients with signs of needle tract infection, no other complication occurred. X-ray films showed that the fractures healed, and the healing time was 10-20 weeks (mean, 14.6 weeks). At last follow-up, the KSS clinical score was 70- 95 with an average of 87.5; the functional score was 70-90 with an average of 79.0. According to ASAMI protocol evaluation, the effectiveness was rated as excellent in 24 cases, good in 3 cases, fair in 2 cases, and poor in 1 case.Conclusion For tibial plateau fractures complicated with osteofascial compartment syndrome, simple Ilizarov ring external fixation technique can basically restore joint function and has fewer complications. It is a relatively safe and effective treatment method.

Citation： QI Xin, XU Yongqing, XIA Shen, ZHAO Zeyu, Lü Qian, PU Shaoquan, ZHU Yueliang. Application of simple Ilizarov ring external fixation technique in treatment of tibial plateau fracture complicated with osteofascial compartment syndrome. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(10): 1248-1252. doi: 10.7507/1002-1892.202003135 Copy

1.	徐曉, 王雷濤, 賈兆鋒, 等. 脛骨平臺骨折診治的研究進展. 生物骨科材料與臨床研究, 2017, 14(1): 69-72.
2.	Lee MH, Hsu CJ, Lin KC, et al. Comparison of outcome of unilateral locking plate and dual plating in the treatment of bicondylar tibial plateau fractures. J Orthop Surg Res, 2014, 9: 62.
3.	Subramanyam KN, Tammanaiah M, Mundargi AV, et al. Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation. Chin J Traumatol, 2019, 22(3): 166-171.
4.	Thiagarajah S, Hancock GE, Mills EJ, et al. Malreduction of tibial articular width in bicondylar tibial plateau fractures treated with circular external fixation is associated with post-traumatic osteoarthritis. J Orthop, 2019, 16(1): 91-96.
5.	Lali? I, Darabo? N, Stankovi? M, et al. Treatment of complex tibial plateau fractures using Ilizarov technique. Acta Clin Croat, 2014, 53(4): 437-448.
6.	陳丹祎, 劉志鑫. 雙鋼板內固定和 Ilizarov 外固定治療 Schatzker Ⅵ型脛骨平臺骨折的療效比較. 山西醫藥雜志, 2019, 48(23): 2929-2932.
7.	Wu J, Wang Y, Zhou F, et al. Trans-articular Kirschner wire fixation in treating complex tibial plateau fractures complicated by multiple ligaments injuries: A case report and literature review. Injury, 2018, 49(2): 382-385.
8.	吳曉曙, 蔣純志, 費俊梁. 微創復位組合式外固定器在復雜脛骨平臺骨折治療中的應用. 江蘇醫藥, 2016, 42(15): 1702-1704.
9.	Frost HM. Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod, 1994, 64(3): 175-188.
10.	Debnath UK, Jha DK, Pujari PK. Results of ring (Ilizarov) fixator in high energy Schatzker type Ⅵ fractures of proximal tibia. J Clin Orthop Trauma, 2018, 9(2): 186-191.
11.	Tahir M, Kumar S, Shaikh SA, et al. Comparison of postoperative outcomes between open reduction and internal fixation and Ilizarov for Schatzker type Ⅴ and type Ⅵ fractures. Cureus, 2019, 11(6): e4902.
12.	Keightley AJ, Nawaz SZ, Jacob JT, et al. Ilizarov management of Schatzker Ⅳ to Ⅵ fractures of the tibial plateau: 105 fractures at a mean follow-up of 7.8 years. Bone Joint J, 2015, 97-B(12): 1693-1697.
13.	Ganesharajah G, Miramini S, Patel M, et al. Bone fracture healing under Ilizarov fixator: Influence of fixator configuration, fracture geometry, and loading. Int J Numer Method Biomed Eng, 2019, 35(6): e3199.
14.	Wang Y, Luo C, Zhu Y, et al. Updated three-column concept in surgical treatment for tibial plateau fractures—A prospective cohort study of 287 patients. Injury, 2016, 47(7): 1488-1496.
15.	Jabbar Y, Jeyaseelan L, Khaleel A. Staged complete dynamisation of the Ilizarov fixator: the Chertsey experience. European Journal of Orthopaedic Surgery & Traumatology, 2011, 21(7): 521-526.
16.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the knee society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
17.	趙志明, 董桂賢, 于桂泳, 等. 關節鏡下復位結合 Ilizarov 技術治療脛骨平臺 SchatzkerⅣ、Ⅴ型骨折. 臨床骨科雜志, 2016, 19(3): 349-351.
18.	Bove F, Sala F, Capitani P, et al. Treatment of fractures of the tibial plateau (Schatzker Ⅵ) with external fixators versus plate osteosynthesis. Injury, 2018, 49(Suppl 3): S12-S18.
19.	趙志明, 董桂賢, 于桂泳, 等. 撬撥復位結合 Ilizarov 技術治療脛骨平臺 Schatzker Ⅳ~Ⅴ型骨折. 臨床骨科雜志, 2016, 19(2): 211-213.
20.	Raza A, Kumar S, Kumar D, et al. Complex tibial plateau fractures: primary fixation using the Ilizarov external fixator. A two-year study at civil hospital Karachi, Pakistan. Cureus, 2019, 11(8): e5375.
21.	朱躍良, 秦泗河. 以柔克剛, 以慢勝快: Ilizarov 技術的發展與實踐. 醫學與哲學, 2018, 39(10): 83-86.
22.	朱躍良, 徐永清, 秦泗河. Ilizarov 器械、技術和哲學蠡測. 中國修復重建外科雜志, 2018, 32(10): 1238-1240.
23.	顏冰珊, 尹望平, 張新潮, 等. Schatzker Ⅳ型脛骨平臺骨折手術療效分析. 中國修復重建外科雜志, 2017, 31(11): 1305-1310.
24.	Iliopoulos E, Agarwal S, Khaleel A. Walking impairments after severe tibia plateau fractures. A gait pattern analysis. J Orthop Sci, 2020, 25(2): 276-278.
25.	李帥杰, 蔡龍, 劉曉虎, 等. 脛骨平臺骨折合并軟組織損傷的診斷與治療. 中國全科醫學, 2020, 23(11): 1440-1444.
26.	夏燊, 趙澤雨, 徐永清, 等. 后跟部形態學測量及解剖型跟骨外固定器的設計. 中國修復重建外科雜志, 2020, 34(4): 475-481.

1. 徐曉, 王雷濤, 賈兆鋒, 等. 脛骨平臺骨折診治的研究進展. 生物骨科材料與臨床研究, 2017, 14(1): 69-72.
2. Lee MH, Hsu CJ, Lin KC, et al. Comparison of outcome of unilateral locking plate and dual plating in the treatment of bicondylar tibial plateau fractures. J Orthop Surg Res, 2014, 9: 62.
3. Subramanyam KN, Tammanaiah M, Mundargi AV, et al. Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation. Chin J Traumatol, 2019, 22(3): 166-171.
4. Thiagarajah S, Hancock GE, Mills EJ, et al. Malreduction of tibial articular width in bicondylar tibial plateau fractures treated with circular external fixation is associated with post-traumatic osteoarthritis. J Orthop, 2019, 16(1): 91-96.
5. Lali? I, Darabo? N, Stankovi? M, et al. Treatment of complex tibial plateau fractures using Ilizarov technique. Acta Clin Croat, 2014, 53(4): 437-448.
6. 陳丹祎, 劉志鑫. 雙鋼板內固定和 Ilizarov 外固定治療 Schatzker Ⅵ型脛骨平臺骨折的療效比較. 山西醫藥雜志, 2019, 48(23): 2929-2932.
7. Wu J, Wang Y, Zhou F, et al. Trans-articular Kirschner wire fixation in treating complex tibial plateau fractures complicated by multiple ligaments injuries: A case report and literature review. Injury, 2018, 49(2): 382-385.
8. 吳曉曙, 蔣純志, 費俊梁. 微創復位組合式外固定器在復雜脛骨平臺骨折治療中的應用. 江蘇醫藥, 2016, 42(15): 1702-1704.
9. Frost HM. Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod, 1994, 64(3): 175-188.
10. Debnath UK, Jha DK, Pujari PK. Results of ring (Ilizarov) fixator in high energy Schatzker type Ⅵ fractures of proximal tibia. J Clin Orthop Trauma, 2018, 9(2): 186-191.
11. Tahir M, Kumar S, Shaikh SA, et al. Comparison of postoperative outcomes between open reduction and internal fixation and Ilizarov for Schatzker type Ⅴ and type Ⅵ fractures. Cureus, 2019, 11(6): e4902.
12. Keightley AJ, Nawaz SZ, Jacob JT, et al. Ilizarov management of Schatzker Ⅳ to Ⅵ fractures of the tibial plateau: 105 fractures at a mean follow-up of 7.8 years. Bone Joint J, 2015, 97-B(12): 1693-1697.
13. Ganesharajah G, Miramini S, Patel M, et al. Bone fracture healing under Ilizarov fixator: Influence of fixator configuration, fracture geometry, and loading. Int J Numer Method Biomed Eng, 2019, 35(6): e3199.
14. Wang Y, Luo C, Zhu Y, et al. Updated three-column concept in surgical treatment for tibial plateau fractures—A prospective cohort study of 287 patients. Injury, 2016, 47(7): 1488-1496.
15. Jabbar Y, Jeyaseelan L, Khaleel A. Staged complete dynamisation of the Ilizarov fixator: the Chertsey experience. European Journal of Orthopaedic Surgery & Traumatology, 2011, 21(7): 521-526.
16. Insall JN, Dorr LD, Scott RD, et al. Rationale of the knee society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
17. 趙志明, 董桂賢, 于桂泳, 等. 關節鏡下復位結合 Ilizarov 技術治療脛骨平臺 SchatzkerⅣ、Ⅴ型骨折. 臨床骨科雜志, 2016, 19(3): 349-351.
18. Bove F, Sala F, Capitani P, et al. Treatment of fractures of the tibial plateau (Schatzker Ⅵ) with external fixators versus plate osteosynthesis. Injury, 2018, 49(Suppl 3): S12-S18.
19. 趙志明, 董桂賢, 于桂泳, 等. 撬撥復位結合 Ilizarov 技術治療脛骨平臺 Schatzker Ⅳ~Ⅴ型骨折. 臨床骨科雜志, 2016, 19(2): 211-213.
20. Raza A, Kumar S, Kumar D, et al. Complex tibial plateau fractures: primary fixation using the Ilizarov external fixator. A two-year study at civil hospital Karachi, Pakistan. Cureus, 2019, 11(8): e5375.
21. 朱躍良, 秦泗河. 以柔克剛, 以慢勝快: Ilizarov 技術的發展與實踐. 醫學與哲學, 2018, 39(10): 83-86.
22. 朱躍良, 徐永清, 秦泗河. Ilizarov 器械、技術和哲學蠡測. 中國修復重建外科雜志, 2018, 32(10): 1238-1240.
23. 顏冰珊, 尹望平, 張新潮, 等. Schatzker Ⅳ型脛骨平臺骨折手術療效分析. 中國修復重建外科雜志, 2017, 31(11): 1305-1310.
24. Iliopoulos E, Agarwal S, Khaleel A. Walking impairments after severe tibia plateau fractures. A gait pattern analysis. J Orthop Sci, 2020, 25(2): 276-278.
25. 李帥杰, 蔡龍, 劉曉虎, 等. 脛骨平臺骨折合并軟組織損傷的診斷與治療. 中國全科醫學, 2020, 23(11): 1440-1444.
26. 夏燊, 趙澤雨, 徐永清, 等. 后跟部形態學測量及解剖型跟骨外固定器的設計. 中國修復重建外科雜志, 2020, 34(4): 475-481.

Chinese Journal of Reparative and Reconstructive Surgery

Application of simple Ilizarov ring external fixation technique in treatment of tibial plateau fracture complicated with osteofascial compartment syndrome

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