Circular External Fixation in the Treatment of Complex Tibial Plateau Fractures

Complex tibial plateau fractures continue to challenge orthopaedic surgeons because of the difficulty in obtaining an anatomic reduction of the joint, axial alignment of the articular segment, while avoiding complications. Despite overall good results, significant complications persist with internal fixation, particularly in cases with compromised soft tissues, open fractures, bone loss, extensive comminution, compartment syndrome, extensor mechanism disruption, or significant osteopenia. Circular external fixation offers advantages in these situations because of its unique biomechanics, adaptability, and percutaneous techniques. The method limits incisions to only those needed to optimize reduction. Fixation of the articular surface and metaphyseal region is by a combination of small-diameter lag screws and olive wires ± half pins. Fixation of the shaft is with half pins from 1 or 2 rings. The articular fixation block can be connected to the distal ring block by threaded rods, trauma struts, or hexapod struts. Extension of the frame across the knee is useful in selected cases to protect injured soft tissue or extensor mechanism, provide distraction, and prevent a flexion contracture. Excellent results have been achieved with this technique and may have a lower complication rate than internal fixation in complex injuries.