Background: Proper knee function is essential for daily activity. Since almost all complex tibial plateau fractures involve soft tissue compromise, there is some controversy as to the best treatment method. Currently, progress toward indirect reduction and external fixation, such as the hybrid external fixator, with minimal complications is underway. Herein we evaluate the outcomes of complex tibial plateau function repaired with hybrid external fixation at one of the most important trauma centers in Iran. 

Methods: This case-series study involved the postoperative follow up (>6 months) of 20 patients with complex tibial plateau fracture repaired using hybrid external fixator at Sina Hospital from 2002-2004. We evaluated surgery complications and outcomes including soft tissue and skin necrosis, knee range of motion, degenerative joint disease, infection, neurovascular injury, union time, and knee score at final visit, among others.

Results: Of the original 20 cases enrolled in this study, five dropped out. All subjects were men, with a mean age 38.6 (18-74) years. The most common injury mechanism was motor vehicle accident; mean time from trauma to surgery was 4.7 (1-15) days. Mean follow up duration was 11.6 (6-26) months. At the end of the study, 80% had good knee range of motion (>90 flexion), with knee scores of 80 or more for 60% of the subjects. Although all patients had had soft tissue injury, there was no postoperative soft tissue compromise. Two patients (11%) had postoperative infection, but ultimately recovered. Less time between trauma and surgery, less periarticular soft tissue injury, less operative manipulation of soft tissues, better articular congruency, and more stable and anatomical knee alignment are associated with better outcome and prognosis.

Conclusions: This procedure reduces operative complications, especially infection and soft tissue necrosis, and requires less rest, all of which results in a stable, aligned and functional knee joint. Furthermore, adding minimal open reduction and internal fixation (ORIF) may promote even better results.