A Retrospective Analysis of Long-Term Outcomes in Patients with Schatzker Type V–VI Tibial Plateau Fractures Treated with Ilizarovtype External Fixator Osteosynthesis

Abstract

Background: Tibial plateau fractures (TPF) are complex intra-articular injuries that account for 1–2% of all fractures. High-energy Schatzker type V–VI fractures are particularly difficult to manage because of comminution, soft-tissue compromise, and a high risk of postoperative complications. The Ilizarov-type circular external fixator has been proposed as a valuable alternative to open reduction and internal fixation (ORIF) in the management of such injuries, especially in patients with severe soft-tissue damage. This technique is preferred because it requires a smaller surgical incision, is associated with lower rates of deep infection, enables accurate restoration of the lower-limb mechanical axis, and allows early mobilization. Aims: This study aimed to evaluate the long-term clinical and radiological outcomes of patients with high-energy Schatzker type V–VI TPF treated with Ilizarov-type external fixator osteosynthesis. Methods: This single-center retrospective study included 42 patients (43 knees) with high-energy type V–VI fractures treated using Ilizarov-type external fixation. Demographic data, fracture patterns, complications, and functional and radiological outcomes were analyzed. The Knee Society Knee Score (KSKS) was used for functional evaluation, and post-traumatic osteoarthritis was graded radiographically. Results: The mean follow-up was 36 months. Pin tract infection occurred in 57.1% of patients and was the most common complication. Anatomical reduction was achieved in 23.3% of cases. Functional results were excellent or good in 65%, and osteoarthritic changes were absent in 23.3%. Conclusions: Circular external fixation with minimal internal fixation provides a stable construct and satisfactory long-term outcomes in high-energy Schatzker type V–VI TPF. Although reduction loss and suboptimal anatomical alignment remain the main limitations, this technique minimizes deep infection risk and preserves soft-tissue integrity, making it a reliable option for complex fractures.

Keywords

• Ilizarov Technique; Tibial Plateau Fractures
• Retrospective Studies; External Fixators
• Fracture Fixation
• External; Treatment Outcome

Ethical Statement

This study was designed as a retrospective descriptive study. Prior to data collection, ethical approval was obtained (Decision number: 62/18, 17.10.2025).

Schatzker Tip V-VI Kırıklarında İlizarov Tipi External Fiksatörle Osteosentezi Gerçekleştirilen Olguların uzun dönem sonuçlarının Retrospektif İncelemesi

Abstract

Giriş: Tibial plato kırıkları, tüm kırıkların yaklaşık %1–2’sini oluşturan karmaşık eklem içi yaralanmalardır. Yüksek enerjili Schatzker tip V–VI kırıkları, parçalanma ve eşlik eden yumuşak doku hasarı nedeniyle tedavisi en zor kırık tipleri arasındadır. Bu yaralanmalarda İlizarov tipi sirküler eksternal fiksatör, yumuşak dokunun korunmasını sağladığı için açık redüksiyon ve internal fiksasyona (ARİF) alternatif bir yöntem olarak kullanılmaktadır. Bu yöntem, daha az cerrahi insizyon gerektirmesi, daha az derin enfeksiyon oranı, doğru alt ekstremite mekanik eksenin restorasyonunu sağlaması ve erken mobilizasyon imkânı sağlaması nedeniyle tercih edilmektedir. Amaç: Bu çalışmanın amacı, yüksek enerjili Schatzker tip V–VI tibia plato kırıklarında İlizarov tipi eksternal fiksatör ile tedavi edilen vakaların uzun dönem klinik ve radyolojik sonuçlarını değerlendirmektir. Yöntemler: Tek merkezli retrospektif bu çalışmaya, yüksek enerjili Schatzker tip V–VI tibia plato kırığı nedeniyle İlizarov tipi eksternal fiksatör ve minimal internal fiksasyon ile tedavi edilmiş 42 hasta (43 diz) dâhil edildi. Bulgular: Hastaların yaş ortalaması 39 (22–69) yıl ve ortalama takip süresi 36 aydı. En yaygın komplikasyon %57,1 oranla tel dibi enfeksiyonuydu. Anatomik redüksiyon %23,3 hastada sağlandı. Fonksiyonel sonuçlar %30,2 mükemmel, %34,9 iyi, %9,3 orta ve %25,6 kötü olarak değerlendirildi. Hastaların %23,3’ünde son kontrolde osteoartrit bulgusu saptanmadı. Sonuç: Yüksek enerjili Schatzker tip V–VI tibia plato kırıklarında minimal internal fiksasyon ile sirküler eksternal fiksatör uygulaması, stabil tespit ve tatmin edici uzun dönem sonuçlar sağlamaktadır. Redüksiyon kaybı ve anatomik hizalanma yetersizliği en önemli sınırlayıcı faktörler olmakla birlikte, bu yöntem derin enfeksiyon riskini azaltması ve yumuşak dokuları koruması açısından güvenilir bir seçenektir.

Keywords

• İlizarov tekniği
• Tibia kırıkları
• Eksternal fiksatörler
• Retrospektif çalışmalar.

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