Arthroscopic-Assisted and Minimally Invasive Plate Osteosynthesis of Tibial Plateau Fractures

Abstract

Background: Tibial plateau fractures are relatively rare fractures and have always been a challenge for orthopedic surgeons. These fractures may result in significant limitations postoperatively if not treated properly. The role of arthroscopic-assisted fixation of tibial plateau fractures has been advocated in many pieces of literature in the world during the last decades. Several studies have been published regarding arthroscopically assisted internal fixation of tibial plateau fractures. As it is an intra-articular lesion, surgical management is often challenging. We have very little data regarding these issues. The aim of this study was to assess the clinical and radiological outcome after arthroscopic-assisted minimally invasive plate fixation of tibial plateau fractures. Methods: This was a descriptive observational study which was conducted in a single Specialized Hospital, Dhaka, Bangladesh during the period from January 2015 to December 2019. Totally 38 patients with tibial plateau fractures (Schatzker type I-VI) were enrolled in the study. Radiography and 3D computed tomography were used to assess the fracture patterns. Arthroscopic-assisted minimally invasive plate fixation was done in all fractures under the image intensifier. An immediate postoperative radiograph was done and then repeated at 6 weeks as well as 3, 6, and 12 months after surgery. All data were processed, analyzed, and disseminated by MS Office and SPSS version as per need. Rasmunssen clinical and radiological assessment criteria were used for evaluation. Results: In our study, in analyzing the Rasmunssen clinical outcome we found, the highest number of participants got an “excellent” outcome, which was present in more than 70% (n = 27). Besides these, 21.05% (n = 8) participants got “good” and the rest 7.89% (n = 3) participants got “fair” outcomes. On the other hand, in analyzing the Rasmunssen radiological outcome we found, the highest number of participants got an “excellent” outcome which was more than 50% (n = 22). Besides these, 26.32% (n = 10) participants got “good”, 13.16% (n = 5) participants got “fair” and the rest 2.63% (n = 1) participants got “poor” outcomes. Conclusion: According to the findings of this study we can conclude that arthroscopic-assisted minimally invasive plate fixation of tibial plateau fractures may have a key role in the management of such fractures and is the treatment of choice for associated intra-articular pathology. Clinical and radiological evaluations of the patients were excellent in the large majority of the patients, and poor evaluation was non-existant at clinical evaluation. Radialogical evaluation was unsatisfactory for only a small number of patients. J Curr Surg. 2021;11(4):82-86 doi: https://doi.org/10.14740/jcs448