Proximal tibial fractures with high energy trauma are extremely complex injuries with significant associated soft-tissue damage. This Retrospective study was used to evaluate the results of staged management of high-energy proximal tibia fractures regards of soft-tissue management, development of complications and functional outcomes.
Materials and Methods: This retrospective study includes 50 patients who had sustained high energy Proximal tibial fractures were managed at our institute. In all patients, we placed immediate temporary distraction external fixation with management of soft-tissue injuries with delayed definitive fixation. The mean clinical and radiographic follow-up was 4 year (range 36-72 months) and functional outcome was assessed by knee society score.
Results: The mean follow-up is minimum 4 year (range 36-72 months) with KSS was good in 33 cases (66%), fair in 12 cases (24%) and poor in 5 (10%) at latest follow-up. The complications includes 7 patients (14%) suffered superficial infection, deep infection was observed in 5 patients (10%), 2 patients had developed compartment syndrome. 2 patients had deep venous thrombosis. Malalignment included 5 (10%) cases of residual varus and 4 (8%) cases of residual valgus deformity.
Conclusion: Mid-term results shows use of staged management protocol, with the initial application of a temporary distraction external fixator followed by delayed internal fixation, is suggested for treatment of high energy tibial plateau fractures. The benefit of this protocol includes bony stabilization, access to soft tissues and prevention of further articular damage and relatively low rates of complications in patients who sustain high-energy proximal tibia fractures.