Assessment of results of different modalities of treatments in fractures of Tibial plateau

Abstract

Introduction: The knee joint is complex joint and is the commonly injured joint now a day because of increased vehicular trauma and sports related injuries. Being superficial joint and more exposed to external forces, this joint easily gets injured5. Intra-articular fractures of proximal tibia are difficult to treat. Age, skin conditions, osteoporosis further increase the obstacles in the healing process. Material and method: The criterion for selection of the cases was a radiologically demonstrable fracture of the tibial condyle with the fracture line extending into the articular surface of the knee joint. Patients with polytrauma and multiple fractures were excluded from the study. The fractures were classified using the method of Schatzker‟s classification Computerized Tomographic evaluation was done in cases which had more comminution and when x-ray was inconclusive. All of the cases in this study were treated operatively as articular surface reconstruction was the main consideration. Patients were evaluated for one year, with serial x-rays at 1,2,3,6 and 12 months. The results were evaluated using the functional grading of Rasmussen et al. Observations: The RTA is the most common mode of injury present between the age group 22 yrs to 75 yrs with almost equal distribution in males and females. Type II fracture pattern (44.4%) is most common type of fracture followed by type VI (22.2%) then type V (14.8%). The treatment modality varies from CCS fixation, ORIF with fragment elevation with or without bone grafting and unilateral or dual buttress plating according to varying nature of the fracture pattern. Results of surgery are acceptable (92.6%) for the varying type of fractures except complication developed due to infection in terms of decreased ROM and stiffness which lead to poor results (7.4%). It is mandatory to delay the surgical procedure till the soft tissue condition improves. This may decrease the chances of complications like wound dehiscence and infection.Conclusion: In our series type II is the most common type of fracture pattern. CT scan with three dimensional reconstructions gives accurate idea of fracture geometry for preoperative planning for osteosynthesis. Result of various types surgeries are good for various patterns of fracture pattern except when complications developed in elderly patient with type VI fracture pattern in the form infection and stiffness which led to an unacceptable outcome Medial side buttress plating is always desirable in bicondylar fracture pattern with unstable medial condyle as otherwise it collapses into varus.