Abstract
Aim:- Aim of this study is to assess the outcome after open reduction and internal fixation using a periarticular raft plating with screw fixation without bone grafting for split – depression tibial plateau fractures. Methods:- 15 patients with 15 knees in 10 male and 5 female were managed by open reduction & internal fixation with, raft locking plate with raft screws through plate without use of bone graft or bone substitute for split depression fracture (> 5 mm.). Proximal tibial fractures (Schatzker type II or Ao / OTA type 4.1 B3) were treated and the result were assessed by radiographs & clinical examination. The Rasmussen radiological score & clinical score, the Lysholm knee score, and the Tegner activity score were also assessed. Result:- The mean follow was 12.5 (rang, 6 -19) months. All patients achieved bone union after a mean of 12.4 (range 8 -24) weaks. The mean range of motion was 116 degree (100o – 130 o). The Rasmussen radiological score was excellent in 10 patients, good in 4, and fair in 1. The Rasmussen clinical score was excellent in 8, good in 6, and fair in 1 patient. The Lysholm was excellent in 9 patients, good in 4, and fair in 2. 13 out of 15 patients recovered to their pre operative Tegner activity scores. Only 1 patients having severe communition had loss of reduction after full weight bearing. Conclusion:- Internal fixation using a periarticular raft locking compression plate without using a bone graft or bone substitute for split depression proximal tibial plateau fractures is a viable option. Keywords: bone graft, raft plate & screws, internal fixation
Highlights
Management for proximal tibial plateau is difficult, especially when metaphyseal communition is associated with osteoporosis 1 and soft tissue injury[2]
The trend of open reduction and internal fixation has become evident in the recent years with good results being obtained with the use of a raft locking plate & screws through the plate in the subchontral bone for providing the support to the articular surface of the lateral and medial condyle of the proximal tibia, irrespective of bone quality and the type of fixation
The aim of this multicentric study conducted between May 2017 to December 2018 is to analyze results of open reduction and internal fixation of closed tibial plateau sprit depression fractures with raft locking compression plate and screws with raft construction, prospectively by clinical, radiological and functional methods
Summary
Management for proximal tibial plateau is difficult, especially when metaphyseal communition is associated with osteoporosis 1 and soft tissue injury[2]. The trend of open reduction and internal fixation has become evident in the recent years with good results being obtained with the use of a raft locking plate & screws through the plate in the subchontral bone for providing the support to the articular surface of the lateral and medial condyle of the proximal tibia, irrespective of bone quality and the type of fixation. This approach prevents collapse, even in the absence of bone grafts or bone substitutes and avoids the potential problem of the bone grafting
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