The Efficacy of External Fixation Change to Internal Fixation in Staged Management of High-energy Tibial Plateau Fractures

Abstract：Objective To study the clinical efficacy of external fixation change to internal fixation in staged management of high-energy tibial plateau fractures. Methods Twenty-one patients with high-energy tibial plateau fractures were managed from May 2010 to January 2014. Their average age was 43. 8 years. All the patients were treated by temporary external fixator in the early stage. Then they were replaced by strong internal fixation through open reduction or close reduction when general con-ditions were controlled and the soft tissues improved in different time. Postoperative orthopaedic evaluation included X-rays and the Rasmussen's functional knee score. Results The mean duration of external fixation was 11. 8 days. All the external fixa-tions were changed to internal fixations,eighteen patients were directly replaced(85. 7%),and two patients were delayed re-placed because of poor wound condition and one of pintract infection. After a mean follow up of 16. 3 months,all the operative wounds finally healed,but one(4. 7%)case occurred local skin necrosis,two cases(9. 5%)endured superficial infections and healed after treatment. No deep infection,compartment syndrome or osteomyelitis occurred in this study. All bone fractures unit-ed. The average X-ray healing time was 6 months. The average range of motion of knee joint at final follow-up was 99°. The Rasmussen's functional knee score received an excellent-and-good rate of 85. 7%. Conclusion In the management of high-energy tibia plateau fractures,the strategy of Staged Management,involving immediate temporary external fixation and delayed change to definitive internal fixation on right time,can effectively reduce soft tissue complications and improve the outcome.