COMPARATIVE OUTCOMES OF ILIZAROV EXTERNAL FIXATION VERSUS DUAL PLATING IN COMPLEX TIBIAL PLATEAU FRACTURES
DOI:
https://doi.org/10.37762/jgmds.13-1.794Keywords:
Tibial Plateau Fracture,, Ilizarov Fixation,, Dual Plating, , Functional Outcome,, Quasi-Experimental StudyAbstract
ABSTRACT
OBJECTIVES
This study aimed to compare radiological union, functional outcomes, and complication rates between Ilizarov external fixation and dual plating in patients with complex tibial plateau fractures.
METHODOLOGY
This prospective quasi-experimental study was conducted at the Department of Orthopedic Surgery at Nishtar Hospital, Multan. Sixty patients aged 20-70 years with isolated closed Schatzker type V or VI tibial plateau fractures were enrolled using non-probability purposive sampling and allocated into two groups: Ilizarov fixation (n=30) and dual plating (n=30). Functional outcomes were assessed using the Lysholm Knee Scoring Scale, and radiological union was evaluated on biplanar radiographs and classified according to the Hammer criteria. Complications, including infection, were recorded. Data were analyzed using SPSS version 24, with chi-square and independent t-tests applied; p-values ≤0.05 were considered statistically significant.
RESULTS
The dual plating group demonstrated significantly higher Lysholm scores compared to the Ilizarov group (86.0 ± 8.44 vs 54.26 ± 8.73; p < 0.001). Radiological union was achieved more frequently in the dual plating group (96.7%) than in the Ilizarov group (73.3%) (p=0.01). Infection rates were significantly higher in the Ilizarov group (20.0% vs 3.3%; p=0.044). Functional outcome categories also favored dual plating (p=0.037).
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Gunasinghe WK, Warushahannadi J. Trends and patterns of long bone fractures in relation to road traffic accidents, assaults, and falls among patients admitted to the emergency treatment unit in Teaching Hospital Karapitiya. Medico-Legal J Sri Lanka. 2023;11(1):1–8. https://doi.org/10.4038/mljsl.v11i1.7459 DOI: https://doi.org/10.4038/mljsl.v11i1.7479
Haruno LS, Schroeder IG, Rockov ZA, Lin CA, Little MT. Medial and bicondylar tibial plateau fractures. In: Operative Techniques in Orthopedic Trauma: A Practical Guide to Fracture Care. Cham: Springer Nature Switzerland; 2025. p. 523–35. https://doi.org/10.1007/978-3-031-57428-5_45 DOI: https://doi.org/10.1007/978-3-031-80825-8_39
Gahr P, Kopf S, Pauly S. Management of proximal tibial fractures: current concepts review. Front Surg. 2023;10:1138274. https://doi.org/10.3389/fsurg.2023.1138274. PMID: 37066001 DOI: https://doi.org/10.3389/fsurg.2023.1138274
Chana-Rodríguez F, Teixidor-Serra J, Boluda-Mengod J, Gómez-Vallejo J, Carrera-Fernández I, Martínez AD, Miclau T III. Current concepts in tibial plateau fracture management: a Spanish Orthopaedic Trauma Association review. OTA Int. 2025;8(3S):e392. https://doi.org/10.1097/OI9.0000000000000392 DOI: https://doi.org/10.1097/OI9.0000000000000392
Tahir M, Kumar S, Shaikh SA, Jamali AR. Comparison of postoperative outcomes between open reduction and internal fixation and Ilizarov for Schatzker type V and type VI fractures. Cureus. 2019;11(1):e3945. https://doi.org/10.7759/cureus.3945 DOI: https://doi.org/10.7759/cureus.4902
Ortho VJSSM, Ortho D. Clinical and radiological outcome analysis of Schatzker type V and type VI tibial plateau fractures by MIPPO effectively on fracture table. Int J Orthop Sci. 2023;9(1):101–6
Zafir MB, Mahmood T, Rasool A, Ahmad AA, Shafee M, Khan AM, Gill KA, Safdar S. Outcome of two-ring hybrid Ilizarov fixator in the management of proximal tibial fractures in adults. J Pak Orthop Assoc. 2021;33(2):47–52
Ali AM. Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Eur J Orthop Surg Traumatol. 2013;23(3):349–55. https://doi.org/10.1007/s00590-012-0976-8. PMID: 23011334 DOI: https://doi.org/10.1007/s00590-012-0989-9
Stefanelli F, Cucurnia I, Grassi A, Pizza N, Di Paolo S, Casali M, et al. Postoperative complications of tibial plateau fractures treated with screws or hybrid external fixation. Musculoskelet Surg. 2021;105(3):295–300. https://doi.org/10.1007/s12306-020-00696-2. PMID: 33428151
Berven H, Brix M, Izadpanah K, Kubosch EJ, Schmal H. Treatment of proximal tibia fractures with complete metaphyseal component: fixation with Ilizarov frame versus locking plates – a two-centre case–control study. J Orthop Surg Res. 2018;13(1):121. https://doi.org/10.1186/s13018-018-0834-z. PMID: 29793462 DOI: https://doi.org/10.1186/s13018-018-0792-3
Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med. 2009;37(5):890–7. https://doi.org/10.1177/0363546508330133. PMID: 19261899 DOI: https://doi.org/10.1177/0363546508330143
Whelan DB, Bhandari M, McKee MD, Guyatt GH, Kreder HJ, Stephen D, Schemitsch EH. Interobserver and intraobserver variation in assessing tibial fracture healing after intramedullary fixation. J Bone Joint Surg Br. 2002;84(1):15–8. https://doi.org/10.1302/0301-620X.84B1.0840015. PMID: 11837829 DOI: https://doi.org/10.1302/0301-620X.84B1.0840015
Malik S, Herron T, Mabrouk A, Rosenberg N. Tibial plateau fractures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470593/
Reátiga Aguilar J, Rios X, González Edery E, De La Rosa A, Arzuza Ortega L. Epidemiological characterization of tibial plateau fractures. J Orthop Surg Res. 2022;17(1):317. https://doi.org/10.1186/s13018-022-03260-8. PMID: 35845268 DOI: https://doi.org/10.1186/s13018-022-02988-8
Kumar V, Singhroha M, Arora K, Sahu A, Beniwal R, Kundu A. A clinico-radiological study of bicondylar tibial plateau fractures managed with dual locking plates. J Clin Orthop Trauma. 2021;21:101563. https://doi.org/10.1016/j.jcot.2021.101563. PMID: 34363634 DOI: https://doi.org/10.1016/j.jcot.2021.101563
Ortho VJSSM, Ortho D. Clinical and radiological outcome analysis of Schatzker type V and type VI tibial plateau fractures by MIPPO effectively on fracture table. Int J Orthop Sci. 2023;9(1):101–6
Oguzkaya S, Misir A, Kizkapan TB, Eken G, Ozcamdalli M, Basilgan S. Comparison of clinical, radiological, and quality-of-life outcomes of double-plate internal and Ilizarov external fixations for Schatzker type 5 and 6 tibial plateau fractures. Eur J Trauma Emerg Surg. 2022;48(2):1185–93. https://doi.org/10.1007/s00068-021-01629-8. PMID: 33844140 DOI: https://doi.org/10.1007/s00068-021-01713-0
Ahmed MN, Hegazy MO, Hamdy HM. Ilizarov fixator versus plates and screws for treatment of high-energy tibial plateau fractures. SVU Int J Med Sci. 2025;8(1):262–75 DOI: https://doi.org/10.21608/svuijm.2025.337130.2022
Ghori FS, Ahmed K, Khan KM. Plating versus Ilizarov technique for complex tibial plateau fractures: a comparative study on functional outcome and patient satisfaction. Allied Med Res J. 2023;1(1):70–83 DOI: https://doi.org/10.59564/AMRJ/01.01/008
Jafree B, Hamid A, Uddin S, Afghan S, Saleem S, Syed MK. Comparison of functional outcome between locking plate technique versus hybrid Ilizarov technique in patients with complex tibial plateau fractures. Biomedica. 2024;41(1):1–7 DOI: https://doi.org/10.24911/BioMedica/5-1138
Zafir MB, Mahmood T, Rasool A, Ahmad AA, Shafee M, Khan AM, Gill KA, Safdar S. Outcome of two-ring hybrid Ilizarov fixator in the management of proximal tibial fractures in adults. J Pak Orthop Assoc. 2021;33(2):47–52
Gawalkar R, Keerthi CYR, Kumar RK, Gawalkar V. Functional outcome of open reduction and internal fixation with plate versus closed reduction and fixation with hybrid Ilizarov in the treatment of tibial plateau fractures. Res J Med Sci. 2025;19(1):101–5. DOI: https://doi.org/10.36478/makrjms.2025.2.101.105
Tripathy SK, Varghese P, Panigrahi S, Panda BB, Srinivasan A, Sen RK. External fixation versus open reduction and internal fixation in the treatment of complex tibial plateau fractures: a systematic review and meta-analysis. Acta Orthop Traumatol Turc. 2021;55(5):444–56. https://doi.org/10.5152/j.aott.2021.20338. PMID: 34545890 DOI: https://doi.org/10.5152/j.aott.2021.20350
Rudran B, Little C, Wiik A, Logishetty K. Tibial plateau fracture: anatomy, diagnosis, and management. Br J Hosp Med (Lond). 2020;81(4):1–9. https://doi.org/10.12968/hmed.2020.0191. PMID: 32270893 DOI: https://doi.org/10.12968/hmed.2020.0339
Li Z, Wang P, Li L, Li C, Lu H, Ou C. Comparison between open reduction with internal fixation and circular external fixation for tibial plateau fractures: a systematic review and meta-analysis. PLoS One. 2020;15(5):e0232911. https://doi.org/10.1371/journal.pone.0232911. PMID: 32407448 DOI: https://doi.org/10.1371/journal.pone.0232911
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