Uniaxial versus polyaxial plating in tibial plateau fractures: a pilot prospective randomized controlled trial.

Objectives: Tibial plateau fractures constitute a wide spectrum of severity from simple to complex fracture patterns. Treatment methods such as internal fixation and hybrid external fixation are commonly administered with specific limitations. The present study was designed to evaluate radiological and functional outcome of tibial plateau fractures managed with internal fixation. Methods: Thirty-six cases with tibial plateau fractures above 21 years were recruited. All the study cases were managed with open reduction and internal fixation. The post-operative follow-up was continued till 6 months with proper clinicoradiological evaluation to check range of motion, reduction loss, and fracture union. The functional outcome was assessed by Oxford Knee Society score and operative outcome was assessed by modified Rasmussen clinical and radiological criteria. Results: Functional outcome assessed by Oxford Knee Society score showed both excellent and good outcomes in 91.67% of cases cumulatively. Clinical outcome by modified Rasmussen assessment criteria reported excellent outcome in 33.33%, good in 44.44%, fair in 13.88%, and poor in 8.33%. Radiological outcome was excellent in 16.6%, good in 63.88%, fair in 11.11%, and poor in 8.33%. Conclusion: The post-operative functional, clinical, and radiological outcomes indicate that open or closed reduction and internal fixation had gained excellent results and are effective modalities in the management of tibial plateau fractures.

Tibial plateau fractures, accounting for approximately 1% of adult fractures, are often associated with significant long-term complications such as pain, stiffness, and posttraumatic arthrosis. The optimal treatment approach remains controversial, particularly in resource-limited settings. This study investigated the factors influencing the clinical outcomes of patients with tibial plateau fractures in Ethiopia. Tibial plateau fractures, though common in trauma cases, have been poorly studied in sub-Saharan Africa, particularly in Ethiopia. The primary purpose of this study was to examine the factors influencing the clinical outcomes of patients with tibial plateau fractures and to assess the efficacy of conservative treatment versus surgical intervention. This research aims to provide insights into managing tibial plateau fractures in resource-limited settings, with the hope of contributing to improved clinical practices. A total of 191 patients with tibial plateau fractures were recruited from Tibebe Ghion Referral Hospital and Felegehiwot Specialized Hospital between February 1, 2018, and February 2022. Demographic, clinical, and radiological data were analyzed, and treatment outcomes were assessed via Rasmussen's knee functional outcome score. A correlation analysis was performed to identify factors impacting functional outcomes. Logistic regression was used to identify factors influencing clinical outcomes. The study population was predominantly male (73.8%), with a mean age of 45 years. Road traffic accidents (41.9%) were the most common cause of injury. Schatzker type I fractures (27.2%) were the most common, and compound fractures accounted for 21% of the fractures. The average time to definitive management was 1.59 weeks, with 35% of patients undergoing open reduction and internal fixation (ORIF). The duration of immobilization and weight-bearing significantly influenced functional outcomes. Patients who were immobilized for less than 4 weeks had better outcomes, with functional scores 54 times better than those of patients who were immobilized for more than 8 weeks (p < 0.01). Early initiation of partial weight-bearing also improved outcomes. A strong negative relationship was found between the duration of immobilization and functional outcomes (r = -0.705, p < 0.01). This study highlights the importance of early mobilization and optimal management of tibial plateau fractures for improving functional outcomes. Timely treatment, especially regarding immobilization and weight-bearing, is crucial for achieving better results. These findings emphasize the need for more standardized treatment protocols and further research on tibial plateau fractures in sub-Saharan Africa to increase patient care in resource-limited settings.

Background: Tibial plateau fractures are among some of the most challenging fractures to treat, associated with a high incidence of posttraumatic osteoarthritis later in life. The most commonly used surgical treatment is open reduction and fixation (ORIF) with plates and screws. Objectives: This study was conducted to determine the radiological, clinical, and functional outcomes of patients with tibial plateau fractures treated by ORIF. Materials and Methods: This retroprospective observational study included adult patients operated on for tibial plateau fractures using ORIF. Functional outcome was assessed by patient-reported outcome measures using Short Musculoskeletal Function Assessment, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form-36 Quality of Life questionnaires. Clinical and radiological outcomes were assessed using Modified Rasmussen’s clinical and radiological criteria. Results: The majority of our patients had type 6 fractures (43.59%). We found a statistically significant negative correlation between the type of fracture and the KOOS total score. Clinical assessment using the Modified Rasmussen Criteria showed excellent results in 33.33% of patients, good results in 51.28% of patients, and fair and poor results in 7.69% of patients each, with an overall satisfactory clinical result in 84.61% of patients. The radiological assessment noted excellent results in 23.08% of patients, good results in 56.41% of patients, fair results in 12.82% of patients, and poor results in 7.69% of patients. Conclusions: The preferred treatment of choice for tibial plateau fractures is open reduction internal fixation, with most patients demonstrating satisfactory (excellent to good) clinical and radiological outcomes. Operatively treated tibial plateau fractures result in improved functional outcomes, as it offers excellent anatomical reduction and rigid fixation to restore early movement and articular congruity, in addition to preventing stiffness of the knee. Keywords: Proximal tibia fracture, ORIF, Quality of life, functional outcome, KOOS, SF-36, SMFA.

&lt;p&gt;Background: Isolated lateral locked plating does not provide sufficient fixation to resist collapse of the medial condyle, leading to loss of axial alignment of the limb, producing varus deformity and poor long-term outcome. dual locked plating of bicondylar tibial plateau fractures are required to reduces the risk of mal-reduction and loss of reduction and prevents post traumatic osteoarthritis. Hence we evaluated functional and radiological outcome of dual locking plates in proximal tibial plateau fractures Schatzker type V and VI.&lt;/p&gt; &lt;p&gt;Material &amp; Methods: Twenty-two cases of tibial plateau fractures Schatzker type V and VI treated with dual locking plates, antero-lateral and medial buttress plating were evaluated for functional outcome using Knee Society Score and radiological outcome was evaluated for union and alignment by modified Rasmussen radiological assessment score.&lt;/p&gt; &lt;p&gt;Results: A total of 22 patients with mean age 34 years (range 22 to 49 years) were included in the study. 16 were male and 6 were female. The mean delay in surgery was 5.3 days (range 3 to 9 days). All Fractures were united at mean duration of 14.4 weeks, and the mean time to full weight-bearing was 12 weeks. The mean range of knee motion was 121&deg;. The mean knee severity score was 85. 18 patients had excellent results, 2 had good results, 1 had fair result and 1 had poor result as per Knee severity score. As per Rasmussen radiological assessment score 20 had excellent and one each had good and fair results and none of the patient had poor results. Two with superficial infection and one had hardware prominence but none of the patients had non-union, arthritis or secondary loss of reduction.&lt;/p&gt; &lt;p&gt;Conclusion: Schatzker type V and VI fractures require double plate fixation for optimal stability, which prevents secondary loss of reduction and varus/ valgus collapse of the fracture and provides excellent radiological and function outcome.&lt;/p&gt;

BackgroundGap and stepoff measurements provide information about fracture displacement and are used for clinical decision-making when choosing either operative or nonoperative management of tibial plateau fractures. However, there is no consensus about the maximum size of gaps and stepoffs on CT images and their relation to functional outcome in skeletally mature patients with tibial plateau fractures who were treated without surgery. Because this is important for patient counseling regarding treatment and prognosis, it is critical to identify the limits of gaps and stepoffs that are well tolerated.Questions/purposes(1) In patients treated nonoperatively for tibial plateau fractures, what is the association between initial fracture displacement, as measured by gaps and stepoffs at the articular surface on a CT image, and functional outcome? (2) What is the survivorship of the native joint, free from conversion to a total knee prosthesis, among patients with tibial plateau fractures who were treated without surgery?MethodsA multicenter cross-sectional study was performed in all patients who were treated nonoperatively for a tibial plateau fracture between 2003 and 2018 in four trauma centers. All patients had a diagnostic CT scan, and a gap and/or stepoff more than 2 mm was an indication for recommending surgery. Some patients with gaps and/or stepoffs exceeding 2 mm might not have had surgery based on shared decision-making. Between 2003 and 2018, 530 patients were treated nonoperatively for tibial plateau fractures, of which 45 had died at follow-up, 30 were younger than 18 years at the time of injury, and 10 had isolated tibial eminence avulsions, leaving 445 patients for follow-up analysis. All patients were asked to complete the validated Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire consisting of five subscales: symptoms, pain, activities of daily living (ADL), function in sports and recreation, and knee-related quality of life (QOL). The score for each subscale ranged from 0 to 100, with higher scores indicating better function. A total of 46% (203 of 445) of patients participated at a mean follow-up of 6 ± 3 years since injury. All knee radiographs and CT images were reassessed, fractures were classified, and gap and stepoff measurements were taken. Nonresponders did not differ much from responders in terms of age (53 ± 16 years versus 54 ± 20 years; p = 0.89), gender (70% [142 of 203] women versus 59% [142 of 242] women; p = 0.01), fracture classifications (Schatzker types and three-column concept), gaps (2.1 ± 1.3 mm versus 1.7 ± 1.6 mm; p = 0.02), and stepoffs (2.1 ± 2.2 mm versus 1.9 ± 1.7 mm; p = 0.13). In our study population, the mean gap was 2.1 ± 1.3 mm and stepoff was 2.1 ± 2.2 mm. The participating patients divided into groups with increasing fracture displacement based on gap and/or stepoff (< 2 mm, 2 to 4 mm, or > 4 mm), as measured on CT images. ANOVA was used to assess whether an increase in the initial fracture displacement was associated with poorer functional outcome. We estimated the survivorship of the knee free from conversion to total knee prosthesis at a mean follow-up of 5 years using a Kaplan-Meier survivorship estimator.ResultsKOOS scores in patients with a less than 2 mm, 2 to 4 mm, or greater than 4 mm gap did not differ (symptoms: 83 versus 83 versus 82; p = 0.98, pain: 85 versus 83 versus 86; p = 0.69, ADL: 87 versus 84 versus 89; p = 0.44, sport: 65 versus 64 versus 66; p = 0.95, QOL: 70 versus 71 versus 74; p = 0.85). The KOOS scores in patients with a less than 2 mm, 2 to 4 mm, or greater than 4 mm stepoff did not differ (symptoms: 84 versus 83 versus 77; p = 0.32, pain: 85 versus 85 versus 81; p = 0.66, ADL: 86 versus 87 versus 82; p = 0.54, sport: 65 versus 68 versus 56; p = 0.43, QOL: 71 versus 73 versus 61; p = 0.19). Survivorship of the knee free from conversion to total knee prosthesis at mean follow-up of 5 years was 97% (95% CI 94% to 99%).ConclusionPatients with minimally displaced tibial plateau fractures who opt for nonoperative fracture treatment should be told that fracture gaps or stepoffs up to 4 mm, as measured on CT images, could result in good functional outcome. Therefore, the arbitrary 2-mm limit of gaps and stepoffs for tibial plateau fractures could be revisited. The survivorship of the native knee free from conversion to a total knee prosthesis was high. Large prospective cohort studies with high response rates are needed to learn more about the relationship between the degree of fracture displacement and functional recovery after tibial plateau fractures.Level of EvidenceLevel III, prognostic study.

PurposeTo carry out a systematic review of the literature on arthroscopic-assisted management (all types) of tibial plateau fractures to gain a more comprehensive understanding of clinical outcomes with this surgical technique, specifically to determine whether this may be a viable technique for the management of tibial plateau fractures.MethodsMEDLINE, Cochrane, and EMBASE databases were searched until July 2013 using combinations of the search terms: tibial plateau, fractures, and arthroscopically/arthroscopic/arthroscopy/percutaneous/minimally invasive. Inclusion criteria were observational study, patients with tibial plateau fractures, and clinical and radiological outcomes assessed using Rasmussen scoring system. The outcome measures of interest were clinical and radiological Rasmussen scores and the prevalence of secondary osteoarthritis.ResultsA total of 12 studies, 5 prospective and 7 retrospective, involving 353 patients were included in the review. The majority of patients in most studies had Schatzker type I–III fractures. The graft material used varied between studies. The length of the follow-up was typically between 34 and 38 months. Mean clinical Rasmussen scores ranged from 25.5 to 28.4. In each study, the majority (≥80 %) of patients had excellent/good clinical Rasmussen scores. In each study, the majority (≥63 %) of patients had excellent/good radiological Rasmussen scores. The proportion of patients who experienced secondary osteoarthritis was variable, ranging from 0 to 47.6 %.ConclusionsThe results of this systematic review indicate that arthroscopic-assisted management of tibial plateau fractures can be effective. Surgeons should consider using this approach when treating patients with tibial plateau fractures.Level of evidenceIII.

Background: Isolated lateral locked plating does not provide sufficient fixation to resist collapse of the medial condyle in bicondylar tibial plateau fractures, leading to loss of axial alignment of the limb, producing varus deformity and poor long-term outcomes. Dual locked plating of bicondylar tibial plateau fractures are required to reduce the risk of mal-reduction and loss of reduction and prevents secondary post traumatic osteoarthritis. Hence we evaluated functional and radiological outcome of dual locking plates in proximal tibial plateau fractures Schatzker type V and VI. Material &amp; Methods: Twenty-two cases of tibial plateau fractures Schatzker type V and VI treated with dual locking plates, antero-lateral and medial buttress plating were evaluated for functional outcome using Knee Society Score and radiological outcome was evaluated for union and alignment by modified Rasmussen radiological assessment score. Results: A total of 22 patients with mean age 34 years (range 22 to 49 years) were included in the study. 16 were male and 6 were female. The mean delay in surgery was 5.3 days (range 3 to 9 days). All Fractures were united at mean duration of 14.4 weeks, and the mean time to full weightbearing was 12 weeks. The mean range of knee motion was 121°. The mean knee severity score was 85. 18 patients had excellent results, 2 had good results, 1 had fair result and 1 had poor result as per Knee severity score. As per Rasmussen radiological assessment score 20 had excellent and one each had good and fair results and none of the patient had poor results. Two with superficial infection and one had hardware prominence but none of the patients had non-union, arthritis or secondary loss of reduction. Conclusion: Schatzker type V and VI fractures require double plate fixation for optimal stability, which prevents secondary loss of reduction and varus/valgus collapse of the fracture and provides excellent radiological and function outcome.

Arthroscopy-assisted tibial plateau fracture surgery - Minimum 2 years follow up results

Complications and unplanned outcomes following operative treatment of tibial plateau fractures

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tibial plateau fractures involve the articular surface of the proximal tibia. They account for approximately 1% of adult fractures. A number of articles have been published regarding tibial plateau fracture management. Interestingly excellent results have been published concluding not all fractures of the tibial plateau require surgery and not all displaced intra-articular fractures need to be reduced surgically. In this method we used conservative method to restore normal joint anatomy, joint stability, and functional motion and avoid complications.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study design is prospective study including forty randomly selected cases of diagnosed tibial plateau fracture presented in Orthopaedic department of tertiary referral centre over 18 months period and treated with conservative method. The patients then were followed up and evaluation of outcome was analyzed as per modified Rasmussen clinical criteria and radiological criteria at six months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this study, tibial plateau fracture was seen more in patients of age group 31-40 (35%). Mean age being 41.25 years. There were 28 (70%) male and 12 (30%) female. Road traffic accident comprises the majority of cases (75%). Regarding radiological outcome, 41.5% had excellent result, 34.3% had good result, 8.5% had fair result and 15.7% had poor result. 84% had acceptable outcome. The Rasmussen’s functional outcome at final follow up was 46% patients had excellent result, 30% had good result, 12% had fair result and 12% had poor result. 88% had acceptable clinical outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Conservative management of tibial plateau is still a reliable, inexpensive and alternative treatment option with favourable functional outcome.&lt;/p&gt;

&#x0D; INTRODUCTION&#x0D; Tibial plateau fracture is a common fracture that accounts for 1-2% of all fracture. Various treatment options including proximal tibial plating with locking compression plates are available for the treatment of tibial plateau fracture. This study was done to determine the clinical profile and functional outcome of tibial plateau fracture following locking compression plating.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; This prospective and observational study was carried out in Orthopedics Department of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH) from December 2018 to July 2020. After Ethical clearance (UCMS/IRC/224/18) from Institutional Review Board (IRB) of UCMS-TH and informed written consent, all patients with tibial plateau fracture (Schatzker II-VI) who fulfilled the inclusion criteria were enrolled in the study and treated with locking compression plate. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months for clinical, radiological and functional assessment. Descriptive statistics like frequency, percentage, mean and standard deviation were used to analyze the data.&#x0D; &#x0D; RESULTS&#x0D; In our study of 30 cases, the mean age was 37.77 ±15.65 years. Most of the cases were Schatzker type VI (13 patients) and type II (9 patients). The average duration for fractures union was 23.4 ±2.1 weeks. Superficial wound infection was the common complication seen in five cases. At six months, the mean knee society score (KSS) was 78 ±7.22 and majority of patients (19 patients) had good results.&#x0D; &#x0D; CONCLUSION&#x0D; Locking compression plate has an excellent functional and radiological outcome. It is an effective implant that can be adopted for the treatment of tibial plateau fractures in adults.&#x0D;

BackgroundThis study evaluated the clinical and radiological outcomes of lateral tibial plateau fractures involving the central and postero-lateral regions, comparing an extended lateral approach with lateral epicondyle osteotomy (ECO) to a conventional approach without an extention (No-ECO).MethodsA retrospective cohort study was conducted at two centers, examining complex lateral tibial plateau fractures treated with either an extended lateral approach with ECO or without it. Only AO/OTA type B3/C3 fractures involving the antero-latero-central (ALC) and postero-latero-central (PLC) segments were included. Fracture reduction quality was assessed via post-operative CT scans, and clinical outcomes and complications were evaluated over a minimum of 24-month follow-up.ResultsA total of 110 patients (mean age: 51.3 ± 11.1 years) were included, with an average follow-up of 52.7 ± 16.9 months. The ECO group (n = 56) consisted of more severe injuries, indicated by higher external fixator use (48.2% vs. 22.2%, p = 0.0044) and additional affected segments. Postoperative CT scans revealed that the ECO group had significantly less fracture step-off (0.8 mm vs. 3.0 mm, p = 0.0002) and angulation at the ALC/PLC (8.1° vs. 20.1°, p = 0.0002) segment and PLC/PLL (postero-latero-lateral) (2.2° vs. 7.5°, p = 0.02) segments. Clinically, the ECO group achieved superior IKDC scores (71.7 vs. 63.7, p = 0.0097). A negative correlation was found between postoperative ALC/PLC depression and IKDC scores (r=-0.36, p = 0.0002).ConclusionPatients treated with ECO had a significantly better clinical and radiologic postoperative outcomes, with the quality of fracture reduction positively correlating with the clinical IKDC score. This was achieved despite more severe injuries, as indicated by higher external fixator use and number of affected segments.Level of evidenceIII Retrospective Cohort Study.Trial registrationThe study was retrospectively registered and conducted according to the guidelines of the Declaration of Helsinki and approved by the local Ethics Committee (PV7319).

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures of the proximal tibia involve a major weight bearing joint and are intra-articular injuries which frequently result in functional impairment. They require an accurate reduction of the articular surface with stable internal fixation. If these fractures are not managed appropriately, they often result in high rates of morbidity in the form of knee stiffness and arthritis. This study was done to assess the functional and radiological outcomes following various surgical modalities and to compare them with other studies as available in literature.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 30 patients with tibial plateau fractures treated by various surgical modalities at Saveetha Medical College and Hospital were studied from January 2013 to February 2015 and were followed up for a minimum period of 6 months. Functional and radiological outcomes were assessed by the Rasmussens scoring system.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All 30 patients fulfilling the inclusion criteria were thoroughly evaluated and were taken up for surgery with various modalities of fixation which included cannulated cancellous screws, T and L buttress plates and locking compression plates. Articular surface elevation with bone grafting was done in depressed fractures. Early knee mobilization was started and strict non-weight bearing walking was advocated. We had a 90% acceptable functional result which was comparable with other studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In our study, we conclude that accurate reduction of the articular surface with stable internal fixation and early mobilization with bone grafting in depressed fractures with protracted weight bearing till fracture union gives good functional results. Also radiological values often do not often correlate well with functional outcomes. &lt;/p&gt;

Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity

Posttraumatic arthrofibrosis is a common problem encountered in the orthopaedic setting for which there is no agreement on the optimal management strategy. The literature does not optimally describe the efficacy of arthroscopic lysis of adhesions for arthrofibrosis following tibial plateau fracture. The purpose of this study is to quantify the efficacy of arthroscopic lysis of adhesions with manipulation for the treatment of arthrofibrosis of the knee in patients who previously underwent surgical management of tibial plateau fracture. All patients who underwent arthroscopic lysis of adhesions from a single surgeon since 1999 were retrospectively reviewed. Clinical outcomes were evaluated by flexion, extension, and range of motion (ROM) preoperatively, intraoperatively, and postoperatively at intervals of 1, 4, 8, and 12 weeks, and any additional long-term follow-up. A total of 28 patients who had developed arthrofibrosis following surgical management of a tibial plateau fracture and failed nonsurgical management of knee stiffness were included in this study. There were significant improvements in total ROM following intervention at all time points compared with preoperative values (p < 0.001), with mean improvements of 59.3 degrees intraoperatively, 32.9 degrees (1 week), 37.1 degrees (4 weeks), 41.5 degrees (8 weeks), and 47.6 degrees (12 weeks). There were significant improvements in degrees of knee flexion following intervention at all time points compared with preoperative values (p < 0.001), with mean improvements of 50.8 degrees intraoperatively, 27.3 degrees (1 week), 36.0 degrees (4 weeks), 38.3 degrees (8 weeks), and 43.9 degrees (12 weeks). There were significant increases in degrees of knee extension intraoperatively (8.5 degrees) and at 1 week postoperatively (5.9 degrees) compared with preoperative values (p <0.01). At 12 weeks postoperatively, those who had previously undergone external fixation had significantly greater increases in ROM (p = 0.048). Arthroscopic lysis of adhesions for knee arthrofibrosis following surgical management of tibial plateau fracture significantly improves knee ROM.