Tibial plateau fractures in a limited-resource setting: A prospective study of surgical techniques and outcome over three years

Abstract

Introduction: Tibial plateau fractures form a wide spectrum of injuries accounting for 1.2% of all fractures and a prevalence of 10 cases per 100,000 inhabitants. Methodology: A prospective consecutive multicentre study from May 2018 to May 2021 was carried out in Yaounde. All consenting cases of tibial plateau fracture underwent surgical treatment while patients with pathologic fractures, previous knee osteoarthritis, medically unfit for surgery, and discharging against medical advice were excluded. Data was analysed with SPSS 26.0 and the level of significance set at p<0.05. Results:Eighty-four (84) cases of tibial plateau fractures were sampled and 68 consented to surgery. The mean age was 42 ±13.6 years and sex ratio 2.4. Estimated prevalence was 2.2 cases per 100,000 inhabitants. Schatzker type II fractures were most represented (33.3%). The left leg was affected in 57.1%. Motorbike accidents were the main cause of injury (66.7%). Of the 68 operated, 63.3% by plating osteosynthesis, 32.4% by external fixation, and 4.4% by screws fixation. Tricortical iliac bone graft was realised in 4 cases. The minimum follow-up was 6 months, with a median of 18 months (5 to 37 months). Plating osteosynthesis (p<0.001), operative time between 60 to 120 minutes (p<0.02) and a good radiologic fracture healing (p<0.04) were associated with a satisfactory outcome. Poor prognosis was seen with open fractures (p<0.001), bridging external fixation (p<0.001), and Schatzker VI fractures (p<0.02). Complications included post-traumatic osteoarthritis (64.7%), post-traumatic osteomyelitis (29.4%), knee ankylosis (5.9%), and limb malalignment (30.9%). Conclusion:The prevalence of tibial plateau fractures remains lower than reported in literature but it is projected to rise. Plating remains a viable treatment option. A larger scale study will establish the burden of this entity in our context.