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Radiological and Functional Outcomes of Joshi External Stabilization System (JESS) in Proximal Tibia Fractures:
Siddhartha Sinha1, Sandeep Kumar1, Arvind Kumar2
1Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, Guru Ravidas Marg, Hamdard Nagar, New Delhi, 110062 India.
Introduction:
External fixators have a limited role in the management of tibial plateau fractures (TPF). They are typically used as an initial management strategy. The Joshi External Stabilisation System (JESS) is a Kirschner wire-based fixator and has been used in TPF where plating may not be feasible due to poor skin conditions or delayed due to other soft tissue complications. This retrospective case series aimed to evaluate the radiological and functional outcomes of TPF managed using the JESS fixator.
Materials And Methods:
Records of patients operated on with the JESS fixator for TPF between January 2021 and January 2024 were included in the case series. Data for each follow up at 2 weeks, 6 weeks, 12 weeks and 24 weeks was retrospectively collected. Demographic data, fracture classification using the Schatzker and Gustilo-Anderson and assessment of clinical, radiological union and complications on each follow-up were collected. The Knee Society Score (KSS) and visual analogue scale (VAS) were used for functional assessment of the patients.
Results:
Twenty-three patients were included, with an average age of 41 ± 11.18 years. The majority of injuries were due to road traffic accidents (69.6%) and were mostly closed fractures (73.9%). Schatzker type VI injuries were the most common (39.13%). The mean time from injury to surgery was 6.04 ± 2.6 days. Bridging callus was noted in all patients at 6 weeks follow up and complete union was noted in all patients by 14 weeks. VAS scores improved significantly with each follow-up. The KSS increased from 27.8 ± 15.7 at 2 weeks to 83.6 ± 7.5 at 24 weeks. The complication rate was 17.4%, with pin site infection being the most common (13%).
Conclusion:
The JESS is a useful option in high energy fractures with compromised soft tissues consistent with the principles of damage-control orthopaedics for the management of TPF. It offers good functional outcomes with a relatively low complication rate where plating may not be feasible as an early management. More studies with higher levels of evidence are required for validation of the results of this study.
Level Of Evidence:
Level IV.
Supplementary Information:
The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01887-y.
