Tibial plateau fracture management: ARIF versus ORIF – clinical and radiological comparison

Abstract

IntroductionArthroscopy has enabled minimally invasive procedures to be developed to treat tibial plateau fracture. The aim of the present study was to assess and compare clinical and radiological results between arthroscopically assisted reduction and internal fixation (ARIF) and open reduction and internal fixation (ORIF) procedures. The study hypothesis was that, in selected tibial plateau fractures, ARIF provides (1) clinical results comparable to those of ORIF, and (2) satisfactory reduction and stable fixation. Material and methodA retrospective multicenter study included adult patients with tibial plateau fracture (Schatzker I to III), over the period January 2010 to December 2014, enabling a minimum 2 years’ follow-up. Clinical and radiological data (RoM, IKDC, HSS, Lysholm) were collected at 3, 6 and 12 months and at last follow-up. A total of 317 patients (317 fractures), aged 48±14 years (range, 18–82 years) were followed up for 38±23 months (range, 24–90 months), with 77 fractures (24%) in the ARIF group and 240 (76%) in the ORIF group. ResultsClinically, there were no significant inter-group differences for active flexion, passive or active extension or Lysholm and IKDC scores, with significant differences for HSS (ARIF: 74±29; ORIF: 70±31; p<0.01) and passive flexion (ARIF: 130±19° (range, 80–160°); ORIF: 130±15.965° (range, 60–140°); p<0.05). Radiologically, there were no significant inter-group differences for reduction quality, lower-limb mechanical axis or signs of osteoarthritis. There were no secondary displacements. There were 7 complications (7/77, 9%) in the ARIF group and 18 (18/240, 8%) in the ORIF group, and 6 surgical revisions for early infection (2 ARIF, 4 ORIF), with no significant inter-group differences. DiscussionThe study hypothesis was confirmed: in Schatzker I–III fractures, ARIF provided clinical results comparable to those of ORIF, with satisfactory reduction and stable fixation. ARIF has its place in the treatment of tibial plateau subsidence and/or separation fracture. Level of evidenceIII, retrospective comparative study.