Tibial Tuberosity Fixation in Complex Proximal Tibia Fractures Using Thin Profile Distal Fibular Plate: A Prospective Study with 12-month Outcomes

Abstract

Introduction: Proximal tibial plateau fractures are common intra-articular injuries that result from either direct axial compressive trauma or indirect coronal trauma. The standard fixation method is bi-columnar dual plating. In cases with additional tibial tuberosity fractures, a thin-profile distal fibular plate can be used for repair. Aim: To assess the clinical outcomes of a combined posteromedial, anterolateral, and thin distal fibular plating of the tibial tuberosity fractures, and also to assess the radiological outcome in complex proximal tibia Schatzker type 5 and 6 fractures with additional tibial tuberosity fractures. Materials and Methods: This prospective study was carried out at the Orthopaedics Department of Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India from January 2017 to January 2022, on 18 patients with tibial plateau fractures (Schatzker type V or VI) associated with tibial tuberosity avulsion fractures. These fractures were fixed with thin-profile distal fibular plates. The functional outcome of the knee joint was assessed after one year, using the Knee Society score. Descriptive statistics were used to compute means, Standard Deviations, and ranges. Student’s t-tests and One-way Analysis of Variance (ANOVA) were used to compare the means. The p-value of ≤0.05 was considered statistically significant. Results: The average age of the study population was 39.4±5.6 years. Road traffic accidents were the most frequent mode of injury in 14 (77%) individuals. No perioperative complications were noted. The average duration of surgery was 114±10.4 minutes, and the average blood loss was 146±40 mL, throughout the procedure. The Knee Society score at 12 months postoperatively was excellent at 93.6 (range 92 to 98). Radiographic bone union was observed after an average of 12.4 weeks. Conclusion: Multiplanar complicated proximal tibia Schatzker type V and VI fractures with tibial tuberosity avulsion fractures may be effectively treated using a novel technique of thin-profile distal fibular plating. The bi-columnar plates combined with open reduction and internal fixation through two incisions with thin distal fibular plates showed satisfactory results.