The Role Of The Jess (Joshi'S External Stabilization System) Fixator In The Management Of Tibial Plateau Fractures Which Are Associated With Severe Soft Tissue Injuries

OBJECTIVES: The treatment of high-energy tibial plateau fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi's External Stabilization System (JESS) by using the principle of ligamentotaxis for managing high-energy tibial plateau fractures which were associated with severe soft tissue injuries.MATERIAL AND METHODS: Between July 2007 and June 2009 (24 months), 21 consecutive patients who were aged 21-50 (mean, 26) years, underwent the JESS fixation for high-energy tibial plateau fractures which were associated with severe soft tissue injuries. 13 of them had injured the right knee and 8 of them, the left knee. 14 were closed and 7 were open injuries (compound grade II-4 cases; compound grade III-3 cases). The closed fractures were associated with bruising and marked swelling in 8, blebs formation in 5 and compartment syndrome in one. The injury mechanisms were motor vehicle accidents (n=15) and fall from a height (n=6). The fractures were classified according to Schatzker's classification system.RESULTS: There were 9 type-VI and 12 type-V Schatzker's tibial plateau fractures. The mean interval between the injury and surgery was 4 (range, 0-14) days. The mean hospital stay was 13 (range, 7-22) days. The mean interval between the surgery and full weight bearing was 16 (range, 13-19) weeks. The mean range of knee flexion was 130 degrees (range: 100-140). The normal extension of the knee was observed in 16 patients, and an extensor lag of 5-10 degrees was noted in five patients. The complications included superficial infections (n=3), pin tract infections (n=2), the restricted range of knee movement (n=1) and non-union (n=1).CONCLUSION: JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high-energy tibial plateau fractures which are associated with severe soft tissue injuries.