Management Of Complex Tibial Plateau Fractures With Ring External Fixators

Complex tibial plateau fractures are of the most challenging fractures to treat. These injuries are often complicated not only by the severe bony injury but also by the accompanying soft tissue injury.Many classification systems had been evolved for classification of such fractures. The main classifications in common use for proximal tibial fractures are that of Schatzker et al. and the AO/OTA comprehensive. Both are based on the fracture pattern with the degree of injury, and correspondingly challenge of management, rising with increasing type. We found Schatzker classification system easier and more reliable and we prefer to use.Diagnosis of such complex fractures is easy and obvious. Pain, swelling and deformity around the knee are keys for diagnosis. Examination is essential for severity assessment of such fractures. Soft tissue injury is of marked importance as it can change the method of treatment completely. Open fractures are orthopedic emergency and require emergent debridement. Closed soft tissue injuries on the other hand, are not less important than open one as it is usually associated with marked tissue necrosis and devitalization. Examination of the patient must follow the classic protocol of ATLS because such injuries may frequently associate other life threatening injuries.Imaging of tibial plateau completes the picture and personality of the fracture. Plain X-ray must show the whole knee, ankle and leg. Antero-posterior, lateral, plateau and oblique views must be taken to make a good orientation of the fracture. Traction film is very important in those fractures with marked metaphyseal comminution.