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DOS Kongressen 2017 ·
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Retrospective analysis for treatment of proximal
tibial fractures with a complete metaphyseal com-
ponent in two centers with different distinct strat-
egies: Open reduction and internal fixation (ORIF) and Ilizarov
frame (Odense, Denmark) versus ORIF an
Haakon Berven, Michael Brix, Kaywan Izadpanah, Eva Johanna Kubosch, Hagen
Schmal
Department of Orthopedics and Traumatology, Odense University Hospital; De-
partment of Orthopaedics and Traumatology, Odense University Hospital; De-
partment of Orthopedics and Trauma Surgery, Albert-Ludwigs University Medi-
cal Center Freiburg, Germany; Department of Orthopedics and Trauma Surgery,
Albert-Ludwigs University Medical Center Freiburg, Germany; Department of
Orthopaedics and Traumatology, Odense University Hospital
Background:
The optimal method for fixation of proximal tibial fractures with a
complete metaphyseal component is unknown.
Purpose / Aim of Study:
The purpose of this study was to compare external
fixation with the Ilizarov wire frame and internal fixation with locking plates.
Materials and Methods:
We carried out a retrospective cohort study with
patients from two level 1 trauma centers treated with either external fixation
or internal fixation. Adult patients with nonpathological fractures classified as
Schatzker type VI or OA 41 A2-A3, C1-C3 were included. Combined clinical
and radiological bone healing was the primary outcome. Secondary outcomes
included infection rate, range of motion of the knee, axial alignment of the knee,
re-operation rate after 6 months, heterotopic ossification and signs of post-
traumatic osteoarthritis. Minimum follow up time was 3 months. All data was
gathered from patient records and radiographs.
Findings / Results:
62 patients were treated with external fixation and 68 with
plate fixation. Time of healing was slightly shorter in the plate fixation group
concerning a higher proportion of patients healed after 3-6 months compared
to external fixation (67.7% vs 47.1%, p=.017). No difference was seen in the
rates of non-union (p=.099). Heterotopic ossification was more prevalent fol-
lowing plate fixation (13.2% vs 1.6%, p=.013). External fixation was associated
with a higher rate of superficial infections (40.4% vs 2.9%, p=.000). The initial
displacement and the injury severity (ISS) significantly influenced the incidence
of non-unions in both groups.
Conclusions:
Locking plates might have a shorter time of healing, but other-
wise these methods are comparable with different complication profiles.
No conflicts of interest reported
149.