Closed Reduction and Percutaneous Screws Fixation in Tibial Plateau Fractures

Abstract

Purpose:To evaluate treatment outcomes of closedreduction and percutaneous screw fixation for tibialplateau fractures. Methods:18 men and 4 women aged 21 to 64 (mean, 38.1) years underwent closed reduction and percutaneous screw fixation for closed tibial plateaufractures. According to theSchatzker classification, patients were classifiedinto type I (n=6), type III (n=10), type IV (n=4), andtype V (n=2). Closed reduction was achieved usingmanual ligamentotaxis with traction in extensionunder image intensifier control. Reduction was fixedpercutaneously with cancellous screws (6.5 mm) andwashers. Functional outcome (pain, walking capacity,extension lag, range of motion, stability and return to daily activity) wasevaluated using the Modified Hospital for Special Surgery Score. A total score of 55 to 60 was considered as excellent, 45 to 54 as good, 35 to 44 as fair, and Results:Patients were followed up for a mean of 8 (range, 6–12) months. The mean length of hospitalstay was 2 (range, 1–3) days. All the fracture unitedradiographically after a mean of 3 (range, 2.5–3.5)months. Respectively in Schatzker types-I, -III, -IV, and-V fractures, outcomes were excellent in 4, 1, 1, and 0 patients, good in 2, 6, 2, and 0 patients, fair in 0, 3, 0, and 1 patients, and poor in 0, 0, 1, and 1 patients. Outcome was satisfactory (good-to-excellent) in 100%, 70%, 75%, and 0% of the respective fracture typesof patients. The mean Modified-HSS score was 46.2 for all patients; it was 53.3 for type I, 40.3 for typeIII, 45 for type IV, and 36 for type V fractures. One patient had metal failure due to early weight bearing at 5 weeks. No patient had infection or wound dehiscence. Conclusion:Closed reduction and percutaneous screw fixation for tibial plateau fractures is minimally invasive. It reduces the length of hospitalstay and costs, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes.