Outcome Analysis of Dual Plating in Management of Unstable Bicondylar Tibial Plateau Fracture - A Prospective Study.

Raj M,Gill Sps,Singh Ks,Verma Ks,Rajput A

doi:10.5704/moj.2111.005

Abstract

Introduction:Bicondylar tibial plateau fractures account for 10-30% of tibial plateau fractures. Despite recent advancements in the management of unstable bicondylar tibial plateau fractures, the outcomes are often poor. The present study aimed to evaluate the functional outcomes and complications of internal fixation of bicondylar tibial plateau fractures with the dual plating using two incisions.Materials and methods:The present study included 30 patients (26 males; 4 females, mean age 35.6 years; range, 19 to 65 years) with bicondylar tibial plateau fractures who were treated with dual plating between January 2017 to August 2019. Out of 30 patients, 5 patients had Schatzker type (V) and 25 patients had Schatzker type (VI) bicondylar tibial plateau fracture. All patients were treated with dual plating using two incisions. In all patient’s similar standard physical rehabilitation therapy was followed. All complications including intra and post-operative were assessed and recorded. The patients were followed-up for over 24 months. Functional outcomes were assessed with Rasmussen’s functional grading system, Oxford knee score, and range of motion of knee joint. Radiological outcomes were evaluated using Rasmussen’s radiological scoring system.Result:All fractures united with a mean time of 18 weeks. The average knee range of motion was 1.5° - 130° (range: 0° - 10° for extension lag, range: 100° -135° for flexion). Mean Rasmussen's functional grading score at the final follow-up was 26.75. All patients showed excellent or good radiographic results according to Rasmussen’s radiological scoring with a mean score of 8.5 (range 6-10). The post-operative radiographs showed mean MPTA was 84.3° and the mean PPTA was 6.2°. In the present study, complications were encountered in five patients. However, there were no cases of secondary loss of reduction, failure of the implant, malunion, or non-union.Conclusion:The surgical treatment of bicondylar tibial plateau fractures with dual locking represents a significant treatment option and provides rigid fixation in these fractures with good functional and radiological outcomes.

Highlights

Bicondylar tibial plateau fractures account for 10-30% of tibial plateau fractures
If we look through the literature, many treatment modalities have been proposed
A total of 30 patients which includes 26 males and 4 females with bicondylar tibial plateau fractures were managed with dual plating

Summary

Introduction

Bicondylar tibial plateau fractures account for 10-30% of tibial plateau fractures. Despite recent advancements in the management of unstable bicondylar tibial plateau fractures, the outcomes are often poor. The present study aimed to evaluate the functional outcomes and complications of internal fixation of bicondylar tibial plateau fractures with the dual plating using two incisions. Traditional techniques of external fixation or hybrid fixator as a means of realigning the metaphysio-diaphyseal anatomy gained some popularity, it was associated with its unique complications such as the potential for septic arthritis of the knee, the risk of pin site infection, and poor patient compliance[5,6]. Modern instrumentation such as a locking plate system and newer techniques of internal fixation like MIPO (minimally invasive plate osteosynthesis) had changed the nature of the treatment of these high-energy tibial plateau fractures

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Discussion

Conclusion