Bicondylar tibial plateau fracture osteosynthesis with double-plate fixation: Similar complication rates and clinical results but improved radiographic outcomes with dual compared to single approach

Abstract

IntroductionAssociating posteromedial and anterolateral approaches should improve fracture line visualization and optimize bicondylar tibial plateau fracture reduction compared to a single midline approach. The present study aimed to compare postoperative complications rates and functional and radiographic results after double-plate fixation via either a single or a dual approach. The study hypothesis was that double-plate fixation using a dual approach provides equivalent complications rates with improved radiographic results compared to a single approach. Material and methodsA retrospective 2-center study compared bicondylar tibial plateau fractures treated by double-plate fixation on a single versus a dual approach between January 2016 and December 2020. Comparison focused on major complications requiring surgical revision, radiographic measurements of medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA); change from their respective baseline values of 87° and 83° (deltaMPTA and deltaPPTA), and functional results on KOOS, SF12 and EQ5D-3L self-reported questionnaires. ResultsMajor complications occurred in 2 of the 20 single approach group patients (10%) [1 surgical site infection (SSI) (5%), and 1 skin complication (5%)], and in 3 of the 39 dual approach group patients (7.69%) (p=0.763), at an average 29 months’ follow-up. In the sagittal plane, deltaPPTA was significantly lower with dual than single approach (respectively, 4.67° versus 7.43°; p=0.0104). There were no significant intergroup differences in deltaMPTA or functional results at last follow-up. ConclusionThe present study suggests an absence of significant difference in major complications, between single and dual approach for double-plate osteosynthesis of bicondylar tibial plateau fractures. Using a dual approach enabled improved anatomic restoration in the sagittal plane, without significant differences observed in the frontal plane or functional scores at an average 29months’ follow-up. Level of evidenceIII; case-control study.