Internal versus external fixation of bicondylar tibial plateau fractures

Comminuted bicondylar tibial plateau fractures remain a difficult problem for the orthopaedic surgeon. Treatment has ranged from traction to cast immobilization to open reduction and internal fixation; none of these has emerged as ideal. Recently, one of the senior authors (DJC) used a technique of indirect reduction followed by application of a hybrid circular external fixator, noting a stability similar to that of an open reduction and internal fixation but with fewer complications. This paper reviews both the authors' experience and citations from the literature with regard to this problematic fracture.