Mid-Term Radiological and Functional Outcomes of Bicondylar Tibial Plateau Fractures Managed with Open Reduction and Internal Fixation Using Dual Plates.

Angelo V Vasiliadis,Anastasios Mpeletsiotis,Frideriki Poutoglidou,Dimitrios Metaxiotis

doi:10.18295/squmj.4.2021.059

Abstract

ObjectivesThis study aimed to evaluate the mid-term radiological and functional outcome of tibial plateau fractures treated by plating.MethodsThis study was conducted at the General Hospital of Thessaloniki ‘Papageorgiou’, Thessaloniki, Greece. Patients with Schatzker type V and VI tibial plateau fractures who were managed with open reduction and internal fixation using dual plates between January 2011 and December 2018 were included in this retrospective study. The functional evaluation of the patients was carried out with the visual analogue scale (VAS), the health-related quality of life status was measured using the Short Form-36 and the dimensions of pain, stiffness and function were assessed using the Western Ontario and McMaster Universities Arthritis Index. For the radiological outcome evaluation, the modified Rasmussen criteria were used.ResultsFifty-seven patients (30 male and 27 female) were included in the study with a mean follow-up of 50.88 months. There were 23 Schatzker type V and 34 type VI fractures. The majority of patients (86%) had a good to excellent radiological outcome. The mean VAS score was 1.65 for all the patients. The functional outcome was excellent in the majority of the patients. Among them, 5.3% (n = 3) suffered wound infection and all wounds healed after different treatments. All patients returned to their pre-injury activities of daily living and employment status, while 53% of the patients returned to sporting activities.ConclusionThe findings support previous literature which has demonstrated that bicondylar tibial plateau fractures can provide good-to-excellent radiological and functional outcomes if they are treated with open reduction and internal fixation with dual plating.

Highlights

Tibial plateau fractures comprise approximately 2% of all fractures and tend to have a bimodal age distribution
Advances in Knowledge: The findings of the present study show that bicondylar tibial plateau fractures treated operatively with open reduction and internal fixation with dual plates had good to excellent mid-term radiological and functional (SF-36 and WOMAC) outcomes at mid-term follow-up
2 Open reduction and internal fixation is the gold standard for the management of bicondylar tibial plateau fractures,[8] despite the high rates of compartment syndrome, infection and wound necrosis being reported following placement of dual plating.[1,2,3]

Summary

Introduction

Tibial plateau fractures comprise approximately 2% of all fractures and tend to have a bimodal age distribution. Tibial plateau fractures are usually a result of low energy trauma in females, around the age of 70.1 These injuries are often associated with soft tissue damage such as vasculature, nerves, ligaments and meniscus.[2] Schatzker proposed a classification system based on the two-dimensional radiological features, dividing tibial plateau fractures into six types, from type I to VI.[3] Luo et al.[4], in 2010, as a supplement to the Schatzker. Classification, introduced the three-column classification, based on the computed tomography scan images and the three-dimensional reconstruction, increasing the ability to identify the posteromedial fragment. These types of fractures, which pose a challenge even to a senior orthopaedic surgeon, still yield unsatisfactory results, even with the appropriate surgical treatment, due to their complexity and the associated soft tissue disruption.[2,3]

Methods

Results

Discussion

Conclusion