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.	徐晓, 王雷涛, 贾兆锋, 等. 胫骨平台骨折诊治的研究进展. 生物骨科材料与临床研究, 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.	Lalić I, Daraboš N, Stanković M, et al. Treatment of complex tibial plateau fractures using Ilizarov technique. Acta Clin Croat, 2014, 53(4): 437-448.
6.	陈丹祎, 刘志鑫. 双钢板内固定和 Ilizarov 外固定治疗 Schatzker Ⅵ型胫骨平台骨折的疗效比较. 山西医药杂志, 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.	吴晓曙, 蒋纯志, 费俊梁. 微创复位组合式外固定器在复杂胫骨平台骨折治疗中的应用. 江苏医药, 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.	赵志明, 董桂贤, 于桂泳, 等. 关节镜下复位结合 Ilizarov 技术治疗胫骨平台 SchatzkerⅣ、Ⅴ型骨折. 临床骨科杂志, 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.	赵志明, 董桂贤, 于桂泳, 等. 撬拨复位结合 Ilizarov 技术治疗胫骨平台 Schatzker Ⅳ~Ⅴ型骨折. 临床骨科杂志, 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.	朱跃良, 秦泗河. 以柔克刚, 以慢胜快: Ilizarov 技术的发展与实践. 医学与哲学, 2018, 39(10): 83-86.
22.	朱跃良, 徐永清, 秦泗河. Ilizarov 器械、技术和哲学蠡测. 中国修复重建外科杂志, 2018, 32(10): 1238-1240.
23.	颜冰珊, 尹望平, 张新潮, 等. Schatzker Ⅳ型胫骨平台骨折手术疗效分析. 中国修复重建外科杂志, 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.	李帅杰, 蔡龙, 刘晓虎, 等. 胫骨平台骨折合并软组织损伤的诊断与治疗. 中国全科医学, 2020, 23(11): 1440-1444.
26.	夏燊, 赵泽雨, 徐永清, 等. 后跟部形态学测量及解剖型跟骨外固定器的设计. 中国修复重建外科杂志, 2020, 34(4): 475-481.

1. 徐晓, 王雷涛, 贾兆锋, 等. 胫骨平台骨折诊治的研究进展. 生物骨科材料与临床研究, 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. Lalić I, Daraboš N, Stanković M, et al. Treatment of complex tibial plateau fractures using Ilizarov technique. Acta Clin Croat, 2014, 53(4): 437-448.
6. 陈丹祎, 刘志鑫. 双钢板内固定和 Ilizarov 外固定治疗 Schatzker Ⅵ型胫骨平台骨折的疗效比较. 山西医药杂志, 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. 吴晓曙, 蒋纯志, 费俊梁. 微创复位组合式外固定器在复杂胫骨平台骨折治疗中的应用. 江苏医药, 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. 赵志明, 董桂贤, 于桂泳, 等. 关节镜下复位结合 Ilizarov 技术治疗胫骨平台 SchatzkerⅣ、Ⅴ型骨折. 临床骨科杂志, 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. 赵志明, 董桂贤, 于桂泳, 等. 撬拨复位结合 Ilizarov 技术治疗胫骨平台 Schatzker Ⅳ~Ⅴ型骨折. 临床骨科杂志, 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. 朱跃良, 秦泗河. 以柔克刚, 以慢胜快: Ilizarov 技术的发展与实践. 医学与哲学, 2018, 39(10): 83-86.
22. 朱跃良, 徐永清, 秦泗河. Ilizarov 器械、技术和哲学蠡测. 中国修复重建外科杂志, 2018, 32(10): 1238-1240.
23. 颜冰珊, 尹望平, 张新潮, 等. Schatzker Ⅳ型胫骨平台骨折手术疗效分析. 中国修复重建外科杂志, 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. 李帅杰, 蔡龙, 刘晓虎, 等. 胫骨平台骨折合并软组织损伤的诊断与治疗. 中国全科医学, 2020, 23(11): 1440-1444.
26. 夏燊, 赵泽雨, 徐永清, 等. 后跟部形态学测量及解剖型跟骨外固定器的设计. 中国修复重建外科杂志, 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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