Study of functional outcomes of juxta articular fractures around the knee and ankle joints managed by hybrid external fixators

Abstract

Background: The compound juxta-articular fractures around the knee and ankle are associated with high energy trauma and difficulty in treating due to poor soft tissue conditions. They present a great therapeutic challenge to an orthopedic surgeon. The development of a hybrid external fixator and the constant improvements in the design of the constructs have led to a better outcome in the therapy since the periosteal blood supply is retained better than plate fixation. Method and materials: We prospectively analyzed the functional and radiological outcomes of 20 surgically treated juxta-articular fractures around the knee and ankle. Preoperative radiographs and CT were taken. The hybrid external fixator was used as the definitive treatment modality. All the patients were followed for 36 months. The functional outcome was evaluated with modified Rasmussen’s criteria. Results: After treating with a hybrid external fixator, All patients were started with partial-weight bearing walking on POD 1 along with QSE and knee range of movement exercises and full weight-bearing by POD 7. The fractures of the proximal tibia united with an average of 16 weeks (14 - 18 weeks). The fractures of the distal tibia united with an average of 15 weeks (14 - 22 weeks). Functional scoring of the knee by Rasmussen’s criteria shows excellent outcomes in 9 patients (45%), Good in 6 patients (30%), Fair in 3 patients (15%) and poor in 2 patients (10%). Overall 75% of patients have an acceptable outcome.