Evaluation of functional and radiological outcome of tibial plateau fractures Schatzker type V and VI treated with dual plating

Abstract

Objective: High-energy tibial plateau fractures remains a challenge to orthopaedics surgeons, with the bicondylar type (Schatzker type V) and the comminuted type (Schatzker type VI) fractures being the most difficult to treat. Treatment goals of high-energy tibial plateau fractures are to restore the joint stability, congruity, and alignment with minimal soft tissue dissection to allow early joint motion and weight bearing. However, these aims may be difficult to achieve because of the high complication rates and the poor outcomes associated with the surgical treatment in literature, there are multiple modalities of treatment for tibial plateau fractures and the literature has not definitively established a standard for the type of fixation. But there has been a growing support and evidence that dual plating is required in high energy bicondylar tibial plateau fractures. In this study, we evaluated functional and radiological outcomes of 30 patients with high-energy tibial plateau fractures (Schatzker type V and type VI) treated with the double-buttress plate fixation through a medial and a lateral incisions using Rasmussen’s functional & anatomical grading system. Material and mathods: 30 patients (26 males and 4 females) with type V and VI Schatzker tibial plateau fractures (10 case were type V and 20 case were type VI) were treated by double-buttress plate fixation through a medial and a lateral incisions between august 2013 to august 2016 at deen dayal upadhyay hospital, New Delhi. Functional and radiological outcomes evaluated by using Rasmussen’s functional & anatomical grading system. Results: according to Rasmussen’s functional & anatomical grading system results were as follows; functional outcome were excellent in 10 patients(33.33%),good-18 patients (60%), fair-2 patients (6.7%) with mean score 25.17±2.95 and radiological outcome excellent in 19 patients(63.33%),good-11 patients (36.67%) with mean score of 16.80±1.79 Conclusion: double-buttress plate fixation through a medial and a lateral incisions is an excellent treatment option as it provides stable and rigid fixation and restore the joint stability, congruity, and alignment with minimal soft tissue dissection to allow early joint motion and weight bearing stable. These fractures are commonly associated with posteromedial fragment and fixation of fractured fregment during treatment of these fractures has a major role to play to resist rotational forces and prevention of varus deformity and malunion.