From Fracture Stabilization to Functional Recovery: A Prospective Clinical–Radiological Study of Hybrid External Fixation in Schatzker V and VI Tibial Plateau Fractures

Abstract

Background: Tibial plateau fractures involving both condyles, particularly Schatzker type V and VI injuries, are high-energy periarticular fractures that may be accompanied by extensive metaphyseal comminution and soft-tissue compromise. Achieving stable fixation while limiting additional soft-tissue injury remains a major treatment consideration. Hybrid external fixation combines a periarticular ring component with diaphyseal half-pin fixation and can provide stability with limited surgical exposure. Aim: To evaluate the functional and radiological outcomes of Schatzker type V and VI tibial plateau fractures treated with a hybrid external fixator, and to document operative characteristics, fracture union, and perioperative complications. Methods: This prospective observational study framework included 30 adults aged 18–60 years with Schatzker type V or VI tibial plateau fractures treated using hybrid external fixation. The source dataset recorded clinical and radiological assessment at baseline and at 1, 3, 6 months and 1 year. Functional outcome was assessed using the Rasmussen clinical score and radiological outcome using the Rasmussen radiological score. Descriptive statistics were expressed as mean±SD or frequency and percentage. Statistical significance was set at p<0.05. Results: Among 30 participants, 22 (73.3%) were male and 8 (26.7%) were female. The commonest age group was 20–40 years (46.7%). Road traffic accidents accounted for 56.7% of injuries. Schatzker type VI fractures constituted 63.3% of cases. Mean hospital stay was 10.0±3.3 days and mean operative duration was 49.0±6.6 minutes. Mean time to radiological union was 12.4±1.6 weeks and mean intraoperative blood loss was 74.2±13.6 mL. The mean Rasmussen functional score increased from 12.1±5.1 at baseline to 27.1±1.6 at 1 year (p<0.001), while the mean Rasmussen radiological score increased from 9.8±1.4 to 17.5±0.8 (p<0.001). Twenty-one participants (70.0%) had an excellent functional grade at 1 year and 16 (53.3%) had an excellent radiological grade. Conclusion: In the source dataset, hybrid external fixation was associated with progressive improvement in functional and radiological Rasmussen scores over one year, with fracture union occurring at a mean of approximately 12 weeks and relatively few recorded complications. These findings describe the observed cohort and should not be interpreted as evidence of superiority over alternative fixation methods without a comparative design. Keywords: Tibial plateau fracture; Schatzker type V, Schatzker type VI, hybrid external fixation, Rasmussen functional score, Rasmussen radiological score, fracture union, periarticular fracture