Current treatment strategies for hyperextension fractures of the tibial plateau: A systematic review and proposal of a treatment algorithm

Abstract

ObjectiveAnalyze the current evidence on the treatment and outcomes of hyperextension fractures of the tibial plateau and propose a treatment algorithm. MethodsAn electronic search at PubMed/MEDLINE, Cochrane Library, Embase, and Google Scholar database from December 24th, 2023 to June 26th, 2024 was carried out. The terms for the database search included “Hyperextension AND Tibial plateau fractures” and “Reversed Tibial Slope AND Tibial Plateau Fractures”. The research inclusion criteria were scientific articles written in English that addressed hyperextension fractures of the tibial plateau. Studies that have not specifically addressed hyperextension fractures of the tibial plateau or published in a different language than English were excluded. Considering that hyperextension fractures of the tibial plateau are relatively rare and the literature is scarce, studies with all levels of evidence were included. Critical analysis of titles, abstracts, inclusion and exclusion criteria of all potentially eligible articles was performed. A treatment algorithm based on the literature and authors perspective was proposed. ResultsThe search identified 34 potentially eligible studies. After application of inclusion and exclusion criteria, 22 articles were carefully analyzed in terms of the most relevant topics related to hyperextension fractures of the tibial plateau. An analysis of the risk of bias of the selected studies was performed according to the Cochrane Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I). ConclusionThere is no consensus regarding the gold standard treatment method for this challenging fracture pattern. The hyperextension mechanism is a predictor of worse functional outcome and life quality comparing to other types of tibial plateau fractures. Study designSystematic review of the literature (Level of evidence:1)