Ulus Travma Acil Cerrahi Derg. 2018; 24(3): 263-267 | DOI: 10.5505/tjtes.2017.27848

Application of hybrid external fixation by the “joystick method” in bicondylar tibial plateau fractures: Technical note

Ersin Kuyucu¹, Adnan Kara¹, Ferhat Say², Mehmet Erdil¹, Murat Bülbül¹, Barýþ Gülenç^1
1Department of Orthopedics and Traumatology, Ýstanbul Medipol University Faculty of Medicine, Ýstanbul-Turkey
²Department of Orthopedics and Traumatology, Ondokuz Mayýs University Faculty of Medicine, Samsun-Turkey

BACKGROUND: This study aimed to present clinical outcomes in patients with tibial plateau fractures who were treated with hybrid external fixators and describe the details of our technique. Schanz screws were synchronously applied and used as a joystick for fracture reduction.
METHODS: The study population included 72 patients with bicondylar tibial plateau fractures classified as type 41-C2 according to the AO classification. Joint reduction was maintained using Schanz screws transmitted through tibial condyles as a joystick under fluoroscopy. The patients then underwent surgery with these Schanz screws and a hybrid external fixation system.
RESULTS: The median age of the patients was 39 (21–67) years, and the median follow-up time was 21 (12–35) months. The mean knee flexion and extension were 105° (80°–125°) and 0° (−5°–7°), respectively. The mean varus laxity and valgus laxity were 4.30° (2°–7°) and 3.10° (2°–5°), respectively. Four patients had leg shortness of 0.4–1.1 cm. The external fixators were removed between 8 and 16 weeks (mean = 11 weeks) postoperatively. The KSS scores at the end of 1 year were “excellent” for 48 patients, “good” for 19 patients, and “inadequate” for 5 patients.
CONCLUSION: With the synchronous application of the two Schanz screws of 6.5-mm thickness and the two-drill technique under fluoroscopic guidance, we obtained stable reductions over a short period. No patient experienced major complications, and this enabled early weight bearing and a return to daily living activities.

Keywords: Fracture complication, hybrid external fixation; tibial plateau fracture.

---

Tibia plato kýrýklarýnda “joystik yöntemi” ile hibrid eksternal fiksatör uygulamasý: Teknik not

Ersin Kuyucu¹, Adnan Kara¹, Ferhat Say², Mehmet Erdil¹, Murat Bülbül¹, Barýþ Gülenç^1
1Istanbul Medipol Üniversitesi, Ortopedi Ve Travmatoloji Anabilim Dalý, Istanbul
²Ondokuz Mayýs Üniversitesi, Ortopedi Ve Travmatoloji Anabilim Dalý, Istanbul

AMAÇ: Tibia plato kýrýklarýnda, hibrid eksternal fiksatör uyguladýðýmýz hastalarýmýzýn klinik sonuçlarýný sunmayý ve uyguladýðýmýz joystik tekniðinin detaylarýný sunmayý amaçladýk. Tekniðimizde Shanz çivileri eþzamanlý joystik olarak kullanýlmakta ve redüksiyon saðlanmaktadýr.
GEREÇ VE YÖNTEM: Çalýþmamýz AO sýnýflama sistemine göre tip 41-C2 olan 72 bikondiler tibia plato kýrýklý hastayý içermektedir. Eklem redüksiyonu, kondillerden geçen shanz çivilerinin floroskopi eþliðinde eþ zamanlý yapýlmasý ilksine dayanmaktadýr. Daha sonra hybrid eksternal fiksatör sistemine adapte edilmektedir.
BULGULAR: Ortalama hasta yaþý 39 (21–67) ve ortalama takip süresi 21 (12–35) ay idi. ortalama diz fleksiyon ve ekstansiyon deðerleri sýrasý ile 105 (80–125) ve 0 (-5–7) dereceydi, ortalama varus ve valgus laksitesi 4.3 (2–7) ve 3.1 (2–5) dereceydi. Dört hastada 0.4–11 cm arasýnda deðiþen ekstremite kýsalýðý mevcuttu. Knee Society Clinical Rating System (KSS) skoru birinci yýl sonunda 48 hasta için mükemmel ve 19 hasta için iyiydi. Beþ hasta için yetersizdi.
TARTIÞMA: 6.5 mm kalýnlýðýnda Shanz çivileri ile eþ zamanlý yapýlan tekniðimizle kýsa cerrahi sürede hastanýn kýrýðý floroskopi eþliðinde redükte edilmekte ve fiksasyonu saðlanmaktadýr. Hiçbir hastada majör komplikasyon geliþmedi, erken yük verme ve hareket ile günlük yaþama çabuk döndüler.

Anahtar Kelimeler: Hybrid eksternal fiksasyon, kýrýk komplikasyonu; tibia plato kýrýðý.

---

CITE