A study on surgical management of Bicondylar fracture tibia

Abstract

Background: The knee joint is complex joint and being superficial joint is more exposed to external forces. It is the commonly injured joint now a day because of increased vehicular trauma and sports related injuries. Bicondylar tibial plateau fractures usually occur in a bimodal age distribution. The most important factor in deciding the timing and modality of definitive management is the status of local soft tissue. Adequate fixation and early achievement of post-operative range of motion are important for a good prognosis and adequate postoperative functioning. Surgical fixation of Bicondylar tibial plateau fractures is challenging because of geographic complexity and compromise of the soft tissue envelope. In this small study, our aim is to outline the various principles of surgical management of Bicondylar fracture tibia as practiced in our institution and to evaluate the results while having an insight into contemporary literature related to the topic.Materials and Methods: A prospective, observational study conducted on 34 patients satisfying the inclusion criteria from June 2016 to June 2018 to study different methods of surgical management of bicondylar fracture tibia.Result: According to Modified Rasmussen Scoring System, clinically we had 06(17.65%) excellent, 23(67.65%) good, 4(11.76%) fair and 01(2.94%) poor results and radiologically 10(29.41%) excellent, 16(47.06%) good, 08(23.53%) fair and none poor results. We also used Oxford Knee Score in our study where we had 8(23.52%) excellent results, 19(55.88%) good results, 7(20.58%) fair results and 00(00%) poor results.Conclusion: Pre-op planning is must. CT scan gives exact anatomy of fracture pattern and helps in deciding type of implant and also guides about the surgical approach to be used. To reduce skin related problems and to achieve reasonable alignment, spanning external fixator should be applied at early stage and kept till acute phase is over. Bicondylar tibial plateau fractures having bone defects must be filled with iliac crest autograft / bone substitutes after reduction of articular fragments. Medial side buttress plating is always desirable in bicondylar fracture pattern with unstable medial condyle to prevent delayed medial collapse and undesirable varus deformity. Early mobilization not only gives good knee ROM but also restores patient’s confidence resulting in better compliance.