Functional and Radiological Outcomes of Complex Tibial Plateau Fractures Managed by Ilizarov External Fixation: A Prospective Study

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Background: Complex Schatzker type IV-VI tibial plateau fractures present severe articular comminution, metaphyseal-diaphyseal dissociation, and soft-tissue compromise that complicate conventional internal fixation strategies. Objective: This prospective study evaluated the functional, radiological, and complication outcomes of complex tibial plateau fractures managed by Ilizarov circular external fixation. Methods: A prospective observational study enrolled 112 patients with Schatzker type IV, V, or VI tibial plateau fractures treated by Ilizarov external fixation at Islami Bank Medical College Hospital, Nawdapara, and Rajshahi Medical College Hospital between January 2022 and December 2025, with outcomes analyzed using SPSS v26.0. Results: The cohort comprised 57 females (50.9%) and 55 males (49.1%), mean age 40.5±13.4 years; 52 fractures (46.4%) were open. Schatzker type V predominated (47, 42.0%). Mean operative time was 125.2±32.1 minutes and hospital stay 7.6±3.0 days. Radiological union was achieved in all 112 patients (100%) at 17.7±3.7 weeks, independent of Schatzker subtype (p=0.954). Mean Rasmussen functional and radiological scores were 26.1±2.7 and 16.3±1.4; mean KOOS was 83.9±8.3, and knee range of motion 114.6±14.6°. Final outcome was excellent in 54 (48.2%), good in 57 (50.9%), and fair in 1 (0.9%) patient. Overall complications occurred in 6 patients (5.4%), with no nonunion, malunion, or deep infection recorded (all subgroup comparisons, p>0.05). Conclusion: Ilizarov external fixation achieves universal union, favourable functional recovery, and low complication burden in complex tibial plateau fractures, representing a reliable, resource-appropriate reconstructive strategy for high-energy periarticular injury.

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