![]() We do hybrid external fixation by a closed reduction with the help of bedside radiography (C-Arm). Of course, this was avoided by the authors. Multiple bullae (blisters) arise around the traumatized compartment surface. This study has been reported per the SCARE 2020 criteria. With hybrid external fixation, we successfully achieved early knee joint rehabilitation movement without waiting for the soft tissue compromised to subside. This study reports three patients with a tibial plateau fracture concomitant with soft tissue compromise. Knee joint injuries treated by delaying joint movement will lead to stiffness. This condition is maintained for two weeks or more, sufficient time for fibrotic tissue to develop in the knee joint, which will complicate reduction in subsequent surgery. The orthopaedic surgeon must first wait for the compromised soft tissue to improve while the patient is immobilized with skin traction, slab, or trans-articular external fixation. On the other hand, soft tissue compromise that occurs in trauma makes definitive management with internal fixation will be delayed because it will be catastrophic if postoperative wound dehiscence occurs as a complication. This condition adds to the dilemma in managing tibial plateau fractures because orthopaedic surgeons need to immediately obtain joint congruity to reduce pain for initiating movement in knee joint rehabilitation. The knee joint should remain mobile to maintain its health and avoid stiffness. The tibial plateau is one of the constituents of the knee joint, one of the main joints in weight-bearing and walking a human. Other studies have mentioned that one of the body parts prone to compartment syndrome is the proximal tibia and the forearm compartment. The trauma results in reduced perfusion to surrounding tissues, resulting in tissue necrosis and facilitating infection, making postoperative wound dehiscence always a complication of this condition. These injuries are referred not only to the ligaments of the knee joint, such as the anterior-posterior cruciate ligament and lateral-medial collateral ligament, but also to the integumentary layer that covers the joint, starting from the cutaneous, subcutaneous, fascia, and muscle itself. Previous literature has suggested that type IV, V, and VI tibial plateau fractures are closely associated with soft tissue injury. This study will discuss the tibial plateau fracture due to high-energy trauma. This fracture is also common in the left knee. While types IV, V, and VI mainly occur in young men with high-energy trauma. Based on the Schatzker classification, previous literature found that types I, II, and III are common in elderly patients with low-energy trauma. However, the incidence has changed to be more common in older women compared to older men in the age group above 50 years old. These fractures are more common in men than women, with peak incidence at 30–49 years. Tibial plateau fractures have unique epidemiology with two peak incidences. As age increases and bones become weaker due to osteoporosis or other diseases, a tibial plateau fracture can occur with only low-energy trauma. At a young age, direct injury to the knee with high energy is the leading cause of tibial plateau fracture. This fracture type can occur with high and low-energy trauma. Management of a tibial plateau fracture poses a challenge for orthopaedic surgeons.
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