Bilateral fixation for complex tibial plateau fractures

Abstract

Objective To evaluate clinical efficacy of the bilateral fixation used for the complex tibial plateau fractures. Methods From July 2003 to October 2006, 43 patients with complex tibial plateau fracture were treated with bilateral fixation. According to the Schatzker classification, 26 cases were of type Ⅴ and 17 of type Ⅵ. Bilateral incisions and dual plating at one stage were adopted in 28 patients. Nine patients were fixed by plating at one side and Kirschner wire plus external fixation at the other. Two patients were fixed with external fixation initially, but with bilateral incisions and dual plating at the second stage after soft tissue recovery. Four patients were treated with external fixation and Kirschner wire. Results All patients were followed up for a mean duration of 18.4 months (range, 12 to 28 months) . Bone union was observed in all cases after an average of 4. 5 months. The mean time for full weight bearing was 5.5 months.The mean knee territory was 95°. According to HSS scoring, the knee functions were excellent (> 85) in 29cases, good (70 to 84) in 8 cases, and fair (60 to 69) in 6 cases, with a good to excellent rate of 86. 0%. There were no significant differences between immediate postoperation and one year postoperation in the tibial plateau angle (TPA), posterior slope angle (PA) and femorotibial angle (FTA) ( P>0.05 ). Conclusion Although complex tibial plateau fracture should be treated basically with bilateral fixation, it should be used flexibly according to the condition of the soft tissue, because correct judgment of the condition of the soft tissue can directly influence the final efficacy of the treatment. Key words: Tibial fracture; Fracture fixation, internal; Knee joint; Treatment outcome