Management of Proximal Tibia Fractures Using Wire Based Circular External Fixator

Introduction: Management of high grade proximal tibia or tibial plateau fractures is often associated with complications. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications.

Aim: To assess the outcome of treatment of such fractures by the use of Joshi's external stabilization system (JESS), which is a wire based, circular external fixator system.

Materials and methods: A prospective, uncontrolled study was done using JESS on 20 consecutive patients of high energy fractures of the tibial plateau, classified according to the Schatzker's classification as type VI.

Results: In this series, road traffic accidents accounted for most of the injuries (n=12), while pedestrian accidents (n=4), injury due to fall from height (n=3) and injury due to fall while playing (n=1) were the other modes of injury. The mean patient age was 39.4 years. The mean follow up period was 24 weeks. In this study, using Knee society score evaluation, excellent results were seen in 12 patients (60%), good results were seen in 5 patients (25%), fair in 2 patients (10%) and bad in 1 patient (5%). Complications seen were, pin tract infections in two cases (10%) which resolved with dressings and oral antibiotics and one case of non-union (5%), in which the tibial plateau fracture extended into proximal 1/3 of the tibial shaft with severe comminution. No other complication was encountered.

Conclusion: JESS is a simple, inexpensive and useful technique in the management of high grade tibial plateau fractures.