Comparison of Open Reduction and Internal Fixation Versus Ilizarov External Fixation for Schatzker Type V & VI Tibial Plateau Fractures: A Narrative Review with Emphasis on Low-Resource Orthopaedic Practice

Schatzker type V and VI tibial plateau fractures are complex, high-energy injuries involving significant articular and soft tissue damage. Management remains controversial, with open reduction and internal fixation (ORIF) and Ilizarov external fixation (EF) being primary strategies. This narrative review synthesizes evidence on functional recovery, radiological outcomes, complications, cost-effectiveness, and feasibility in low-resource environments such as rural Pakistan. Multiple studies report comparable long-term functional outcomes for both methods. EF offers advantages in early rehabilitation, reduced rates of deep infection, and cost-effectiveness. Hybrid techniques, combining minimal internal fixation with Ilizarov frames, enhance articular stability while preserving soft tissue integrity. Choice of fixation should consider fracture complexity, soft tissue condition, surgeon experience, and institutional resources. EF emerges as a practical and effective option in low-resource settings, ensuring safe and efficient fracture management.