Advantages of External Hybrid Fixation in Schatzker Type V and VI Tibial Plateau Fractures: A Focused Systematic review of three key studies

Advantages of External Hybrid Fixation in Schatzker Type V and VI Tibial Plateau Fractures: A Focused Systematic review of three key studies | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Advantages of External Hybrid Fixation in Schatzker Type V and VI Tibial Plateau Fractures: A Focused Systematic review of three key studies Dr Thajesh Ram Nanhaa MBBS This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7025593/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Tibial plateau fractures, particularly high energy fractures (Schatzker type V and VI), are among the most complex intra- articular fractures often associated with extensive soft tissue injuries and compromise knee joint functions. While open reduction and internal fixation (ORIF) has been considered the standard approach, some recent evidences have highlighted the advantages of external hybrid fixation (EHF), especially in with soft tissue compromise. This focused systematic review evaluates the effectiveness and safety of external hybrid fixation in managing these fracture types from three high quality studies. The findings support the use of external hybrid fixators for early mobilization, soft tissue preservation, and lower complication rates in selected patients. Orthopedics Hybrid external fixation tibial plateau fracture Schatzker type V and VI bicondylar fracture systematic review Figures Figure 1 1. Introduction Tibial plateau fractures constitute about 1–2% of all long bones fractures in adults, with Schatzker type V and VI being the most severe forms involving bicondylar and metaphyseal-diaphyseal injuries. These fractures often present from high-energy trauma and pose significant management challenges due to the involvement of both bone and soft tissue structures compromising the normal knee joint function. Mostly, Open reduction and internal fixation (ORIF) has been used, but its invasive nature often leads to complications like infection, soft tissue necrosis, and delayed wound healing. In recent years, EHF—a combination of minimal internal fixation with an external fixator—had emerged as a less invasive alternative procedure that maintains fracture stability while minimizing soft tissue disruption showing better outcomes. This focused review aims to answer whether external hybrid fixation offers better outcomes in Schatzker type V and VI fractures. 2. Methods 2.1 Search Strategy Databases searched: PubMed, Cochrane, and Google Scholar Keywords: "Hybrid external fixation", "Schatzker V VI", "tibial plateau", "external fixator", "bicondylar fracture" Date range of included studies: Jan 2000– Dec2024 Language: English Inclusion criteria: Clinical studies reporting functional and radiological outcomes, clinical trials, cohort studies, or meta- analyses and RCTs on adult patients with Schatzker type V or VI fractures treated with hybrid fixation. Exclusion criteria: Animal studies, case reports, reviews without data, non-hybrid fixator studies. 2.2 Study selection (PRISMA Flow): A total of 312 records were identified. After removing 61 duplicates, 251 titles and abstracts were screened. 17 full-text articles were assessed, and finally, 3 studies met all eligibility criteria and were included for qualitative synthesis. This follows PRISMA 2020 guidelines and this framework was followed for systematic selection. PRISMA-based Summary of Study Selection PRISMA Stage Number of Records Records identified through database searching (2000–2024) 312 Duplicates removed 61 Records screened (titles and abstracts) 251 Full-text articles assessed for eligibility 17 Studies included in qualitative synthesis 3 3. Results 3.1 Study Characteristics Study (Year) Design Sample Fracture Type Fixation Outcomes Tripathy SK et Systematic 1,191 fractures Schatzker V–VI External fixation Better ROM, al. (2021) review/meta- (EF vs ORIF) (various) shorter surgery, ↓ analysis blood loss; ↑ superficial infections; similar deep infection Subash Y ( 2021 ) Prospective 30 patients Schatzker V–VI Hybrid external Union ~ 12 cohort fixation weeks; ROM 0– 100°; 90% good- excellent outcomes Galanakos SP et Prospective 55 fractures (20 Schatzker V–VI Hybrid ± Union ~ 15.5 al. (2018) cohort V, 35 VI, incl. 8 minimal internal weeks; articular open) fixation congruity in 14%; 65% aligned within 5°; AKSS function improved 3.2 Key Findings Across the studies, EHF was associated with: Early mobilization (ROM up to 100°). Reduced surgical duration and blood loss. Fewer deep infections compared to ORIF. Common complications included superficial pin tract infections, usually managed conservatively. Associated with shorter hospital stays and lower overall treatment expenses compared to traditional methods. Quicker discharge and reduced antibiotic usage. Galanakos et al. demonstrated improved alignment and CT-confirmed congruity in 65% of patients (reference 3). Subash et al. reported 90% of patients achieving good-to-excellent functional outcomes with early mobilization (reference 2). Tripathy’s meta-analysis further supported the use of EHF over ORIF for selected high-risk patients (reference 1). 4. Discussion This focused review supports the advantages of EHF in type V and VI fractures, particularly in cases with poor soft tissue. Advantages: -Minimally invasive: Especially useful in high-energy fractures with compromised soft tissue. Early mobilization: Allows earlier knee motion and partial weight-bearing. Lower complication rates: Particularly infections and wound necrosis compared to dual plating. Cost-effective: Avoids expensive implants and reduces hospital stay. However, challenges remain: Pin tract infections Patient discomfort due to external frame Technique-dependent outcomes 5. Limitations Small number of included studies (n = 3) Heterogeneity in fixation techniques and outcome measures Meta-analysis not feasible due to limited comparable data Risk of bias in observational cohorts 6. Conclusion External hybrid fixation presents a valuable alternative procedure to ORIF in type V and VI tibial plateau fractures, particularly when soft tissue integrities are compromised. Results from these three focused studies show comparable union and functional outcomes with fewer complications and lower healthcare costs. Surgeons should consider patient-specific factors such as soft tissue condition, fracture pattern, and other comorbidities before selecting the fixation method. However, further large-scale randomized trials are required to confirm these findings and guide definitive treatment protocols. Declarations Conflict of Interest The author declares no conflict of interest. Funding Statement This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethics Approval: Not applicable. This is a review of published studies. Author Contributions: Dr. Thajesh Ram Nanhaa, MBBS – Conceptualization, Methodology, Literature Review, Data Curation, Formal Analysis, Manuscript Writing, and Final Approval of the Manuscript. Disclaimer This preprint has not been peer-reviewed and should not be used to guide clinical practice. References Tripathy SK, Varghese P, Panigrahi S, Sen RK (2021) External fixation versus open reduction and internal fixation in complex tibial plateau fractures: a systematic review and meta-analysis. Acta Orthop Traumatol Turc. ;55(5):444–456. 10.5152/j.aott.2021.20350 . PMID: 34730533 Subash Y (2021) Evaluation of functional outcome following hybrid external fixation in Schatzker type V and VI tibial plateau fractures: a prospective study of 30 patients. Malays Orthop J 15(1):48–54 PMID: 33880148 PMCID: PMC8043647 Galanakos SP, Sakellariou VI, Macheras GA et al (2018) Complex tibial plateau fractures treated by hybrid external fixation system: CT-derived quality of reduction correlated with clinical results. Indian J Orthop 52(2):161–169. 10.4103/ortho.IJOrtho_300_16 PMID 29576644 PMCID: PMC5858210 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7025593","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":479402046,"identity":"2356eda0-35bf-4d61-b81f-e82f3a90eeb7","order_by":0,"name":"Dr Thajesh Ram Nanhaa MBBS","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYLACxgYGBjb5gw0HPgA5bOwEVPPAtPBJMDc+nAHSwkysFjkJ9mZjMI+QFnvpswc/F+6wk2eTbmyTtvm1TZ6PmYHxw8ccPLbw5SVLzzyTbNgmc7BNOrfvtmEbMwOz5MxteLTw8BhI87YxM7YxJAK19NxmBGphY+bFr8X4N29bvT1Yi2XPbXtitJgBbTmc2CaR2GzM8ON2ImEtZ3jMrHnbjie38RxsfNjbcDsZ6MhmvH5h7+Exvs3bVm07v739wYEff24DGc0HP3zEowUVAAOBARJNxIM/pCgeBaNgFIyCkQIA9GJKV3yigG8AAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0008-3976-1356","institution":"Independent researcher","correspondingAuthor":true,"prefix":"Dr","firstName":"Thajesh","middleName":"Ram Nanhaa","lastName":"MBBS","suffix":""}],"badges":[],"createdAt":"2025-07-02 05:57:50","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7025593/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7025593/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85996140,"identity":"8da404b7-1bdb-437f-8cc5-d09c17149561","added_by":"auto","created_at":"2025-07-04 06:09:36","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":138913,"visible":true,"origin":"","legend":"\u003cp\u003eX: PRISMA Flow Diagram\u003c/p\u003e\n\u003cp\u003eRecords identified through database searching (PubMed, Cochrane, Google Scholar): n = 312\u003c/p\u003e\n\u003cp\u003eRecords after duplicates removed: n = 251 Records screened by title/abstract: n = 251 Full-text articles assessed for eligibility: n = 17 Studies included in qualitative synthesis: n = 3\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7025593/v1/b7de1eec42e01d74b8f4d6a7.jpeg"},{"id":85996142,"identity":"3b285153-454d-49ad-ad8c-12c81ad0fc81","added_by":"auto","created_at":"2025-07-04 06:09:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":593791,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7025593/v1/f0dc0482-73cd-4a0d-9c5c-d970743a49ea.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eAdvantages of External Hybrid Fixation in Schatzker Type V and VI Tibial Plateau Fractures: A Focused Systematic review of three key studies\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTibial plateau fractures constitute about 1\u0026ndash;2% of all long bones fractures in adults, with Schatzker type V and VI being the most severe forms involving bicondylar and metaphyseal-diaphyseal injuries. These fractures often present from high-energy trauma\u003c/p\u003e \u003cp\u003eand pose significant management challenges due to the involvement of both bone and soft tissue structures compromising the normal knee joint function.\u003c/p\u003e \u003cp\u003eMostly, Open reduction and internal fixation (ORIF) has been used, but its invasive nature often leads to complications like infection, soft tissue necrosis, and delayed wound healing. In recent years, EHF\u0026mdash;a combination of minimal internal fixation with an external fixator\u0026mdash;had emerged as a less invasive alternative procedure that maintains fracture stability while minimizing soft tissue disruption showing better outcomes.\u003c/p\u003e \u003cp\u003eThis focused review aims to answer whether external hybrid fixation offers better outcomes in Schatzker type V and VI fractures.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Search Strategy\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eDatabases searched: PubMed, Cochrane, and Google Scholar\u003c/p\u003e \u003cp\u003eKeywords: \"Hybrid external fixation\", \"Schatzker V VI\", \"tibial plateau\", \"external fixator\", \"bicondylar fracture\"\u003c/p\u003e \u003cp\u003eDate range of included studies: Jan 2000\u0026ndash; Dec2024 Language: English\u003c/p\u003e \u003cp\u003eInclusion criteria: Clinical studies reporting functional and radiological outcomes, clinical trials, cohort studies, or meta- analyses and RCTs on adult patients with Schatzker type V or VI fractures treated with hybrid fixation.\u003c/p\u003e \u003cp\u003eExclusion criteria: Animal studies, case reports, reviews without data, non-hybrid fixator studies.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study selection (PRISMA Flow):\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA total of 312 records were identified. After removing 61 duplicates, 251 titles and abstracts were screened. 17 full-text articles were assessed, and finally, 3 studies met all eligibility criteria and were included for qualitative synthesis. This follows PRISMA 2020 guidelines and this framework was followed for systematic selection.\u003c/p\u003e \u003c/div\u003e \u003cp\u003e \u003cb\u003ePRISMA-based Summary of Study Selection\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePRISMA Stage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Records\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecords identified through database searching (2000\u0026ndash;2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuplicates removed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecords screened (titles and abstracts)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFull-text articles assessed for eligibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudies included in qualitative synthesis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Study Characteristics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy (Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDesign\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSample\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFracture Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFixation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTripathy SK et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystematic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,191 fractures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchatzker V\u0026ndash;VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExternal fixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBetter ROM,\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eal. (2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ereview/meta-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(EF vs ORIF)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(various)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eshorter surgery, \u0026darr;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eanalysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eblood loss; \u0026uarr;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003esuperficial\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003einfections;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003esimilar deep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003einfection\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubash Y (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProspective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchatzker V\u0026ndash;VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHybrid external\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnion\u0026thinsp;~\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003efixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eweeks; ROM 0\u0026ndash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100\u0026deg;; 90% good-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eexcellent\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eoutcomes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGalanakos SP et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProspective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 fractures (20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchatzker V\u0026ndash;VI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHybrid \u0026plusmn;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnion\u0026thinsp;~\u0026thinsp;15.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eal. (2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eV, 35 VI, incl. 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eminimal internal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eweeks; articular\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eopen)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003efixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003econgruity in\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14%; 65%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ealigned within\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u0026deg;; AKSS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003efunction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eimproved\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Key Findings\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAcross the studies, EHF was associated with:\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eEarly mobilization (ROM up to 100\u0026deg;).\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eReduced surgical duration and blood loss.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFewer deep infections compared to ORIF.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCommon complications included superficial pin tract infections, usually managed conservatively.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAssociated with shorter hospital stays and lower overall treatment expenses compared to traditional methods.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQuicker discharge and reduced antibiotic usage.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eGalanakos et al. demonstrated improved alignment and CT-confirmed congruity in 65% of patients (reference 3). Subash et al. reported 90% of patients achieving good-to-excellent functional outcomes with early mobilization (reference 2).\u003c/p\u003e \u003cp\u003eTripathy\u0026rsquo;s meta-analysis further supported the use of EHF over ORIF for selected high-risk patients (reference 1).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e \u003c/p\u003e\u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis focused review supports the advantages of EHF in type V and VI fractures, particularly in cases with poor soft tissue.\u003c/p\u003e \u003cp\u003eAdvantages:\u003c/p\u003e \u003cp\u003e-Minimally invasive: Especially useful in high-energy fractures with compromised soft tissue.\u003c/p\u003e \u003c/div\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eEarly mobilization: Allows earlier knee motion and partial weight-bearing.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLower complication rates: Particularly infections and wound necrosis compared to dual plating.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCost-effective: Avoids expensive implants and reduces hospital stay.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eHowever, challenges remain:\u003c/p\u003e \u003c/div\u003e \u003cp\u003e\u003c/p\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePin tract infections\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatient discomfort due to external frame\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTechnique-dependent outcomes\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e "},{"header":"5. Limitations","content":"\u003cul\u003e \u003cli\u003e \u003cp\u003eSmall number of included studies (n = 3)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHeterogeneity in fixation techniques and outcome measures\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMeta-analysis not feasible due to limited comparable data\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eRisk of bias in observational cohorts\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eExternal hybrid fixation presents a valuable alternative procedure to ORIF in type V and VI tibial plateau fractures, particularly when soft tissue integrities are compromised. Results from these three focused studies show comparable union and functional outcomes with fewer complications and lower healthcare costs.\u003c/p\u003e \u003cp\u003eSurgeons should consider patient-specific factors such as soft tissue condition, fracture pattern, and other comorbidities before selecting the fixation method. However, further large-scale randomized trials are required to confirm these findings and guide definitive treatment protocols.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict\u0026nbsp;of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;author\u0026nbsp;declares\u0026nbsp;no\u0026nbsp;conflict\u0026nbsp;of\u0026nbsp;interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis\u0026nbsp;research\u0026nbsp;received\u0026nbsp;no\u0026nbsp;specific\u0026nbsp;grant\u0026nbsp;from\u0026nbsp;any\u0026nbsp;funding\u0026nbsp;agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eApproval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot\u0026nbsp;applicable.\u0026nbsp;This\u0026nbsp;is\u0026nbsp;a\u0026nbsp;review\u0026nbsp;of\u0026nbsp;published\u0026nbsp;studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Thajesh Ram Nanhaa, MBBS \u0026ndash; Conceptualization, Methodology,\u0026nbsp;Literature\u0026nbsp;Review,\u0026nbsp;Data\u0026nbsp;Curation,\u0026nbsp;Formal\u0026nbsp;Analysis, Manuscript Writing, and Final\u0026nbsp;Approval of the Manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis preprint has not been peer-reviewed and should not be used to guide clinical practice.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTripathy SK, Varghese P, Panigrahi S, Sen RK (2021) External fixation versus open reduction and internal fixation in complex tibial plateau fractures: a systematic review and meta-analysis. Acta Orthop Traumatol Turc. ;55(5):444\u0026ndash;456. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5152/j.aott.2021.20350\u003c/span\u003e\u003cspan address=\"10.5152/j.aott.2021.20350\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 34730533\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSubash Y (2021) Evaluation of functional outcome following hybrid external fixation in Schatzker type V and VI tibial plateau fractures: a prospective study of 30 patients. Malays Orthop J 15(1):48\u0026ndash;54 PMID: 33880148 PMCID: PMC8043647\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalanakos SP, Sakellariou VI, Macheras GA et al (2018) Complex tibial plateau fractures treated by hybrid external fixation system: CT-derived quality of reduction correlated with clinical results. Indian J Orthop 52(2):161\u0026ndash;169. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ortho.IJOrtho_300_16\u003c/span\u003e\u003cspan address=\"10.4103/ortho.IJOrtho_300_16\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e \u003cspan\u003ePMID 29576644 PMCID: PMC5858210\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Independent Researcher","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hybrid external fixation, tibial plateau fracture, Schatzker type V and VI, bicondylar fracture, systematic review","lastPublishedDoi":"10.21203/rs.3.rs-7025593/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7025593/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTibial plateau fractures, particularly high energy fractures (Schatzker type V and VI), are among the most complex intra- articular fractures often associated with extensive soft tissue injuries and compromise knee joint functions. While open reduction and internal fixation (ORIF) has been considered the standard approach, some recent evidences have highlighted the advantages of external hybrid fixation (EHF), especially in with soft tissue compromise. This focused systematic review evaluates the effectiveness and safety of external hybrid fixation in managing these fracture types from three high quality studies. The findings support the use of external hybrid fixators for early mobilization, soft tissue preservation, and lower complication rates in selected patients.\u003c/p\u003e","manuscriptTitle":"Advantages of External Hybrid Fixation in Schatzker Type V and VI Tibial Plateau Fractures: A Focused Systematic review of three key studies","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-04 06:01:31","doi":"10.21203/rs.3.rs-7025593/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9d7e8c25-fe54-44ee-bcbb-a180e5a91bcc","owner":[],"postedDate":"July 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50903341,"name":"Orthopedics"}],"tags":[],"updatedAt":"2025-07-04T06:01:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-04 06:01:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7025593","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7025593","identity":"rs-7025593","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}