Suresh Bora, Jishnu Prakash Baruah, Aritra Bidyananda
BACKGROUND Displaced bicondylar tibial platue fractures (Schatzker V and VI) are otherwise known as high grade Schatzker type tibial platue fractures. They are always associated with soft tissue injury which possess a challenge for orthopaedic surgeons due to higher rate of post-operative infections, skin necrosis and wound dehiscence. Circular external fixator is a good option. However, delayed ORIF reduces the chance of infection & maintains articular congruity resulting in better functional outcome. MATERIALS AND METHODS We performed a prospective randomised control trial from August 2015 to July 2016 in which delayed ORIF (Group A) were compared with primary circular external fixator (Group B) in bicondylar tibial platue fracture with compromised soft tissue.30 fractures (21 men and 9 women) were randomised to operative treatment (15 Group A, 15 Group B). Outcome measures included Rasmussen functional knee score, clinical complications, hospital stay. RESULTS 13(92%) anatomical reductions were achieved in group A compared to 11 (76%) in group B. Superficial infections were commonly seen in group B (30%); whereas deep infections leading to plate exposure encountered in 2 cases (13%) in group A. The mean Rasmussen score was statistically significant (p<.05) in ORIF group. Patients in group B spent less time in hospital (9.9 days and 23.4 days, respectively; p = 0.024). Associated posteromedial/lateral fragment can be better dealt with group A patients. CONCLUSION Primary Ilizarov gives better functional results, decreases chance of infection, provides early rehabilitation and negates the requirement of second surgical procedure compared to delayed IF in closed bicondylar tibial platue fracture with soft tissue compromise.
