External fixation and limited internal fixation for complex fractures of the tibial plateau

Twenty-one complex fractures of the tibial plateau in twenty patients were treated with closed reduction, interfragmental screw fixation of the articular fragments, and application of a unilateral half-pin external fixator. The average duration of external fixation was twelve weeks (range, three to twenty weeks). The fixator was left in situ until the fracture had united in all but two patients. All of the fractures healed. The complications with this technique were attributable primarily to the proximal half-pins of the external fixator. Seven patients needed antibiotics for an infection at a pin site, and two had septic arthritis that necessitated arthrotomy and débridement. The average duration of follow-up was thirty-eight months. The range of motion of nineteen of the twenty-one knees was at least a 115-degree arc. Laxity was evident in seven knees, but no patient complained of instability of the knee. Radiographs showed malalignment of more than 6 degrees in three knees compared with the normal, contralateral knee and evidence of post-traumatic osteoarthrosis in five knees. The Iowa knee score, determined for nineteen patients, averaged 87 points (range, 55 to 100 points). The SF-36 general health survey demonstrated that most patients had function close to that of age-matched controls. We concluded that external fixation with limited internal fixation is a satisfactory technique for the treatment of selected complex fractures of the tibial plateau.