Arthroscopy-assisted tibial plateau fracture surgery - Minimum 2 years follow up results

Abstract

BackgroundAccurate anatomical reduction plays a crucial role in the surgical management of tibial plateau fractures. Arthroscopic visualization of the articular surface can allow for a precise reduction. ObjectivesTo evaluate the outcome of arthroscopy-assisted reduction and internal fixation for tibial plateau fractures, Schatzker Type III to VI. MethodsThirty-five patients with tibial plateau fractures treated by arthroscopy-assisted fixation were enrolled in this prospective study. According to the Schatzker classification, the fractures types were as follows: type III (n=15); type IV (n=6); type V (n=8); type VI (n=6). The mean age was 36 years (range 24–58 years). The mean follow-up period was 38 months (range, 26–72 months). During surgery, initial arthroscopic evaluation was done, followed by provisional reduction using fluoroscopy. Subsequently, a final arthroscopic confirmation was done before definitive fixation. Bone grafting was done in all except 6 patients. Clinical and radiologic outcomes were scored by the Knee society score and Rasmussen system. ResultsThe Knee society functional score and Knee society knee score assessed at 6 months, 1 year and 2 years. Final follow up results showed good to excellent outcome in three out of four patients. With increasing severity of injury (from Schatzker types III to VI), the functional score deteriorated. The Rasmussen’s Radiological Score at 24 months showed good to excellent scores in 86% individuals. The association between the condylar widening and functional score was found to be significant (p value < 0.05). The radiological and functional scoring was found to have a percentage agreement of 24%. Persistence of condylar widening had a less favorable functional outcome. Postoperative wound breakdown and infection are among major complications. ConclusionsArthroscopic assisted fracture fixation for complex tibial plateau fractures with associated soft-tissue injuries is a safe and effective procedure that provides good functional outcomes.