Impact of early emergency placement of transarticular external fixation on knee function and bone metabolism indicators in patients with Schatzker type Ⅵ tibial plateau fractures

Liu Bin; Guo Lihui; Li Hongqiang; Liu Geng

doi:10.3969/j.issn.1002-1949.2026.02.008

Abstract：Objective To analyze the influence of early emergency placement of transarticular external fixation on knee joint function and bone metabolism indicators in patients with Schatzker type Ⅵtibial plateau fractures.Methods A total of 164 patients with Schatzker type Ⅵ tibial plateau fractures admitted to Harbin Fifth Hospital from January 2020 to January 2024 were all treated with transarticular external fixation in the first stage.They were divided into an early emergency(within 12 h)placement group(n=82)and a delayed(12-72 h)placement group(n=82)according to the timing of first-stage fixation at a 1∶1 ratio.The surgical indicators,knee joint function at immediate postoperative,3 months and 12 months postoperative,pain stress at preoperative and 7 days postoperative,bone metabolism indicators at preoperative and 3 months postoperative,and complications during the 12 months postoperative period were compared between the two groups.Results The first-stage operation time,second-stage operation time,interval between the first and second stages,postoperative rehabilitation time,and fracture healing time in the early placement group were shorter than those in the delayed placement group(P＜0.05).The knee joint function scores in both groups showed an increasing trend at immediate postoperative,3 months and 12 months postoperative.At 3 months postoperative,the knee joint function score in the early placement group was higher than that in the delayed placement group(P＜0.05).Compared with preoperative,the levels of serum neuropeptide Y(NPY),substance P(SP),prostaglandin E2(PGE2),and bradykinin(BK)at 7 days postoperative were increased in both groups,but the levels in the early placement group were lower than those in the delayed placement group(P＜0.05).Compared with preoperative,the levels of serum alkaline phosphatase(ALP),bone gla protein(BGP),total type Ⅰ procollagen N-terminal propeptide(T-PINP),and β-Crosslaps at 3 months postoperative were increased in both groups,and the levels in the early placement group were higher than those in the delayed placement group(P＜0.05).12 months postoperative,the complication rate in the early placement group was lower than that in the delayed placement group[6.10％(5/82)vs 17.07％(14/82),P＜0.05].Conclusions Early placement of external fixation across the joint in the emergency department can improve the surgical-related indicators of patients with Schatzker type Ⅵ tibial plateau fractures,inhibit pain stress,improve knee joint function in the short term after surgery,regulate bone metabolism indicators,and reduce the incidence of complications.