Buttress Plate Research Articles

Evaluation and Management of Posterior Wall Acetabulum Fractures.

Posterior wall acetabulum fractures typically result from high-energy mechanisms and can be associated with various orthopaedic and nonorthopaedic injuries. They range from isolated simple patterns to multifragmentary with or without marginal impaction. Determination of hip stability, which can depend on fragment location, size, and displacement, directs management. Although important in the assessment of posterior wall fractures, CT is unreliable when used to determine stability. The dynamic fluoroscopic examination under anesthesia (EUA) is the benchmark in assessment of hip stability, and fractures deemed stable by EUA have good radiographic and functional outcomes. In fractures that meet surgical criteria, accurate joint reduction guides outcomes. Joint débridement, identification and elevation of impaction, and adjunctive fixation of posterosuperior and peripheral rim fragments along with standard buttress plate fixation are critical. Complications of the fracture and surgical fixation include sciatic nerve injury, posttraumatic osteoarthritis, osteonecrosis of the femoral head, and heterotopic ossification. Although accuracy of joint reduction is paramount for successful results, other factors out of the surgeon's control such as comminution, femoral head lesions, and dislocation contribute to poor outcomes. Even with anatomic restoration of the joint surface, good clinical outcomes are not guaranteed and residual functional deficits can be expected.

Effectiveness of triangular stabilization system for patients with postoperative nonunion of femoral neck fracture

To explore the effectiveness of triangular stabilization system in the treatment of postoperative nonunion of femoral neck fracture. The clinical data of 30 patients with postoperative nonunion of femoral neck fracture who met the selection criteria between December 2014 and December 2019 were retrospectively analyzed. There were 21 males and 9 females with an average age of 40.7 years (range, 15-65 years). The Pauwels angle at the time of injury was 51°-79°, with an average of 63.6°. According to the Pauwels classification, they were all type Ⅲ. The time from the first operation to this revision operation was 5-24 months, with an average of 9.7 months. The preoperative visual analogue scale (VAS) score was 4.2±1.3, the Harris score was 31.2±5.3, the neck-shaft angle was (116.3±7.9)°, and the lower limb shortening length was (1.73±0.53) cm. Triangular stabilization system, which was made of dynamic condylar screw and medial anatomical buttress plate, combined with the window bone grafting at the fracture site was used for bone nonunion revision. The postoperative lower limb shortening length, neck-shaft angle, fracture healing time, and complications were recorded; the Harris score was used to evaluate the hip joint function, and the VAS score was used to evaluate the pain improvement before and after operation. All patients were followed up 12-60 months, with an average of 27.7 months. There was no clear sign of femoral head necrosis and collapse after operation; 1 patient developed infection at 4 months after operation, and the incision healed after debridement and removal of internal fixator. All patients achieved bone healing, and the healing time was 2.8-6.0 months, with an average of 3.9 months. At last follow-up, the lower limb shortening length was (0.30±0.53) cm, which was significantly corrected when compared with preoperative one ( t=16.721, P=0.000); the neck-shaft angle was (133.9±5.7)°, which was significantly recovered when compared with preoperative one ( t=-11.239, P=0.000). The VAS score was 0.7±0.9, the Harris score was 88.3±5.9, both of which were significantly improved when compared with preoperative scores ( t=16.705, P=0.000; t=-40.138, P=0.000). Triangular stabilization system combined with window bone grafting can provide a stable and balanced mechanical environment, promote fracture healing, and achieve satisfactory effectiveness in the treatment of postoperative nonunion of femoral neck fracture.

Open Reduction and Internal Fixation of Intra-articular Distal Radius Fracture by Buttress Plate: An Outcome Assessment

This study aims to evaluate the surgery outcomes of distal radius fractures using open reduction and internal fixation (ORIF) with buttress plate in our hospital. 200 patients were included with age above 18 years, having distal radius fractures and who were treated by ORIF buttress plate. The patients who had intraarticular distal radius fractures were included in this study. Data was collected from hospital records. Mean age of our patients was 38.5 ± 8.3 years. Patients were assessed functionally using Gartland and Werley point system and anatomically (radiologically) using Sarmiento’s modification of Lindstrom criteria. Among study participants, 140 patients had excellent restoration (70%), 20 patients had good restoration (10%) and the rest had fair restoration. There were some complications among patients like superficial infection and injury to superficial branch of radial nerve. In the follow up, we notice stiffness in one case with reduced range of movement of wrist and fingers. In our study, we had good to excellent results in 80% cases, anatomically and functionally. We conclude from our study ORIF using buttress plate is the best method for managing displaced intra-articular distal radius fractures.

Comparative study of posterior malleolus fixation in trimalleolar ankle fractures treated with anterior to posterior screw versus posterolateral plate

Objectives: To compare radiographic and clinical midterm outcomes of posterior malleolar fractures treated with anterior to posterior lag screw versus posterior buttress plating fixation. Patients: Between June 2017 and June 2021, patients with posterior malleolar fractures were identified by the Current Procedural Terminology code and their charts were reviewed for eligibility. Intervention: Posterior malleolar fixation using either anterior to posterior (AP) lag screws or posterior buttress plating. Main Outcome Measurements: Demographic data, length of follow-up, range of motion, and postoperative Short Musculoskeletal Function Assessment (SMFA) scores were the main outcome measurements. Immediate postoperative radiographs for residual gap/step-off and final follow-up radiographs for the degree of arthritis that developed were evaluated.Results: 37 patients were eligible for the study, and 27 choose to participate. 16 patients underwent posterior buttress plating, and 11 underwent AP screw fixation with mean follow-up times of 26 and 20 months, respectively. Demographic data were similar between groups. The posterolateral plating group demonstrated superior postoperative SMFA scores compared with the AP screw group with statistically significant differences in the SMFA bother index (26.7 vs. 9.2, P = 0.03) and trends toward improvement in the mobility (28.3 vs. 12.9, P = 0.08) and functional indices (20.2 vs. 9.4, P = 0.08). There were no significant differences in the range of motion or the development of ankle arthritis over time. Conclusions: Patients with trimalleolar ankle fractures in whom the posterior malleolus was treated with posterolateral buttress plating had superior clinical outcomes at follow-up compared with those treated with AP screws.

Pathoanatomy and clinical outcomes following operative treatment of supination adduction type II medial malleolus fractures-a cohort study.

The purpose of the current study was to retrospectively clarify the anatomic character and evaluate the mid-term operative outcomes for vertical medial malleolar fractures (MMFs). A total of 53 patients with supination adduction (SAD) type II MMFs treated with open reduction and internal fixation (ORIF) between March 2009 and June 2013 were included. We reviewed the patients' preoperative X-ray and computed tomography (CT) to determine the pathoanatomic characteristics of medial malleolus fractures. Buttress plate lag screws fixation had been applied. Complications and treatment failures were recorded; the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. For the 53 patients, only 39.6% cases with simple vertical MMFs. The mean distal tibial articular surface (DTAS) involvement in the MMF was 16.5%±11.6% (range, 0-47%). The mean follow up time was 62.4±14.1 [44-91] months. There were 7 cases of traumatic osteoarthritis (TOA), and 3 cases of failure were reported in the screw fixation group. The mean AOFAS score was 80.6±15.8 points, and the mean VAS score was 2.1±1.7 points, with a good to excellent rate (GTE) of 81.1%. No significant difference was found in comparing the AOFAS, VAS, GTE, incision relative complication rate, infection rate, loss of reduction (LoR) rate, and TOA rate between groups (P>0.05). The participants in the buttress plate group reached a shorter mean full weight-bearing (FWB) time (P=0.04). More than 60% vertical MMFs are with one or more characteristics of medial cortex comminuted fractures, or die-punch fragments, or medial joint compression. And patients with die-punch fragment, medial joint compression, LoR, large DTAS involvement and small fracture line angle (FLA) were positively correlated with the fair to poor results. Lag screw fixation should be cautiously used in vertical MMF patients with comminuted medial cortex.

Biomechanical comparison of four different posterior malleolus fixation techniques: A finite element analysis

PurposeThe objective of this study was to compare the biomechanical behavior of four fixation methods for posterior malleolar fracture (PMF) by finite element analysis (FEM). MethodsFour internal fixation techniques used for fixation of PMF were assessed by FEM - a computational study: posterior one-third tubular 3.5 mm buttress plate (PP) with one screw (PP 1 screw), PP with two screws (PP 2 screws), two cannulated 3.5 mm lag screws in the antero-posterior (AP) direction (AP lag screws), and two postero-anterior (PA) cannulated 3.5 mm lag screws (PA lag screws). PMF with 30% and 50% fragment sizes were simulated through computational processing reconstructed from computed tomography (CT). The simulated loads of 700 N and 1500 N were applied to the proximal tibial end. The FEM evaluated the total and localized displacements of the PMF. For the analysis of stresses, the variables maximum principal (traction) and minimum principal (compression) were used. For the metallic implants, the equivalent von Mises stress (VMS) was used. ResultsPA lag screw showed the lowest values for total and localized displacement, minimum and maximum total stress, and VMS in both physiological conditions and sizes of posterior malleolus involvement. The localized displacement was statistically lower for lag screws compared to PP techniques at 700 N (p < 0.05) and 1200 N (p < 0.05). The maximum total stress was statistically lower for PA lag screws compared to PP 1 fixation with 700 N (p = 0.03) and 1200 N (p = 0.039). ConclusionPA lag screws yield better results in terms of total and localized displacement, minimum and maximum total stress, and VMS in both physiological conditions and sizes of posterior malleolus involvement. These results demonstrate that PA lag screws are biomechanically the most efficient technique for the fixation of PMF.

Treatment of acetabular fractures with quadrilateral plate injury – a comparison of two commonly used methods

BackgroundAcetabular fractures with quadrilateral plate (QLP) involvement have traditionally been treated by buttress plates applied through an Ilio-inguinal approach. Recently, many surgeons prefer the application of infra-pectineal plates through the modified Stoppa approach for this purpose. Whether one method can be preferred over the other is a matter of investigation. HypothesisThe research question was whether an infra pectineal plate applied through the modified Stoppa approach for acetabular fractures with QLP involvement would result in an equivalent or better outcome than a buttress plate applied through an ilioinguinal approach. Patients and MethodsThis was a retrospective study of patients with QLP fractures operated by either of the two methods and who had completed at least one year follow up. Demographic and surgical details and the radiological and clinical outcomes at the last follow-up visit were obtained from patient records. ResultsA total of 41 patients were treated with a buttress plate applied through an ilioinguinal approach (group A), and 49 patients were treated with an infra-pectineal plate by the modified Stoppa approach (group B). Duration of surgery and intra-operative blood loss was significantly less in group B patients. Radiological and clinical outcomes were better in group B patients than group A patients. Implant loosening was more frequent in group A patients. Injury to the obturator vessels were more common in group B patients. ConclusionWith a comparatively lesser surgical duration and blood loss, better clinical and radiological outcomes at least one year after the surgery, an infra-pectineal plate applied through the modified Stoppa approach can be considered the preferred treatment for most acetabular fractures with QLP involvement. Level of evidenceIII.

Outcome of locking compression plate fixation in the management of distal end femur fractures: one year hospital based study

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Distal femur fractures make up 6 to 7% of all femur fractures. Various plating options for distal femur fracture are conventional buttress plates, fixed-angle devices, and locking plates. This study was planned to evaluate and explore locking compression plate fixation in distal end femur fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study was conducted as prospective clinical study in 20 skeletally mature patients with x-ray evidence of distal femur fracture fulfilling inclusion and exclusion criteria, operated with distal femur LCP plating. Patients were assessed radiologically and classified according to distal femur fracture classification and outcome graded as excellent, good, fair and poor based on Lysholm Knee Score.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 15 excellent outcome cases, 3 cases were type A1 fracture, 1 case had type A3, 2 cases had type B1 and B2 each, 5 cases had type C2 and 2 cases had type C3 fracture. 1 case with good outcome was type C3. 1 case with fair outcome was type B2. While 3 cases with poor outcome were type A1, A2 and C3.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The DF-LCP is an ideal implant to use for fractures of the distal femur. However, accurate positioning and fixation are required to produce satisfactory results. We recommend use of this implant in Type A and C, osteoporotic and periprosthetic fractures.&lt;/p&gt;

The Role of Medial Buttress Plate Augmentation of Cannulated Screws in Unstable Femoral Neck Fractures: A Pilot Study

Background: About 20% of femoral neck fracture surgeries require re-operation. The use of medial buttress plate may reduce the reoperation rate. The purpose of this study is to examine the results of using the method of augmentation of the cannulated screws with medial buttress plate for treatment of unstable femoral neck fractures. Methods: This study included patients with femoral neck fractures of Pauwels type 2 and 3 in which closed reduction was not successful. The patients underwent open anatomical reduction and implantation of three screws, and then the medial placement of the buttress plate was performed. Patients were followed up after 2 weeks, 6 weeks, 3 months, and 6 months. Union and fracture healing and operative complications were assessed using plain radiography. Results: This study included 8 patients with Pauwels type 2 and 3 femoral neck fractures. All patients were men with the mean age of 38.0 ± 11.3 years. Re-hospitalization 30 days after surgery, surgical site infection, deep vein thrombosis (DVT), and deep infection were not observed in any of the patients. The angle between the neck and the femur shaft dramatically increased during the 6-month follow-up (P = 0.049). Union occurred in 6 (75%) patients after 6 months, while 2 patients were lost to follow up. Participants’ Harris Hip Score (HHS) had a significant improvement from 3 months to 6 months after surgery (P = 0.02). Conclusion: Augmentation of cannulated screws with medial buttress plate for unstable femoral neck fractures in patients has advantages in short-term clinical follow-up.

Arthroscopy-Assisted Management of Schatzker Type III Lateral Tibial Plateau Fracture With Interference Screw Fixation

Tibial plateau fractures occur in both old and young patients and may be caused by low-energy trauma, as well as high-energy trauma. Owing to the variety of injury mechanisms and fracture patterns, tibial plateau fractures are very challenging to treat. One of the most demanding fractures is the type III fracture according to the Schatzker classification, which is a pure depression of the lateral tibial plateau. Treatment with open surgical procedures is associated with vast soft-tissue trauma and prolonged recovery after surgery. Although soft-tissue trauma is minimized and visual control is improved throughout arthroscopy-assisted surgical procedures, internal fixation using buttress plates or lag screws is still required to reduce and fix the depressed plateau. We present an arthroscopy-assisted technique of reduction and fixation of the lateral tibial plateau fracture with 3 BioComposite interference screws (Arthrex, Munich, Germany) that provides a high amount of stability and reduces patient immobilization, allowing for faster rehabilitation.

To study the functional outcome in proximal tibia fracture having a posteromedial fragment fixed with buttress plating

Objective: The main objective of the study is to emphasizes the importance of the postero-medial fragment in the management of the tibial plateau fractures and study the functional outcome in Proximal tibia fracture treated with buttress plating. So accurate reduction and buttressing the fragment is essential for excellent functional outcome. Materials and Methods: It was a single center Retrospective and prospective study. 60 patients, with mean age 50.53 + 13.47, presenting with traumatic fractures of proximal tibial having posteromedial fragment treated with buttress plating via posteromedial approach were included in the study and were followed up for the period of 1-year post-surgery. Anatomical and functional evaluation was done using the modified Rasmussen’s clinical and radiological criteria. Results: Mean Rasmussen’s Clinical Outcome score was 26.63 ± 2.63 with 53.33% (32 patients) showed excellent clinical outcome and 30% (18 patients) showed good outcome. Mean Rasmussen’s Radiological Outcome score was 8.3 ± 0.95 with 60% (36 patients) showed excellent radiological outcome and 33.33% (20 patients) showed good outcome. The correlation between Rasmussen’s Clinical and Radiological Score was found to be strongly positive (R=0.76) which was a statistically significant finding (p

Study of various modalities of treatment of internal fixation of tibial condylar fracture-schatzkers type v and type VI

Fractures of the tibial plateau usually result from high energy trauma. Fractures of the tibial plateau change the knee kinematics, alter joint stability, and cause joint incongruity. Fractures range from simple lateral condyle fractures to severe comminuted metaphyseal fractures. Various surgical modalities like open reduction internal fixation with cannulated Screw fixation, Condylar plate with or without bone graft, AO/ASIF Buttress plate (T/L) with or without bone graft, Proximal tibial locking plate have been practiced. To study the functional outcomes of various modalities of treatment of internal fixation of tibial condylar fractures schatzkers type V and type V1. To find out the basis of selecting the mode of treatment of tibial condylar fractures to bring out the best functional results. 35 patients of age group 18-70 yrs who presented with X-ray based Schatzker Type V and VI proximal tibia fractures were selected for the study. All the patients underwent Open Reduction and Internal Fixation with locking compression plating. The functional outcomes were assessed using knee society score. Complications were observed and treated accordingly with an average follow-up of 12 months. It was observed that the mean duration of the union was 14-16 weeks. Most of the patients (19) showed excellent results with a good range of motion of 122⁰. The combination of dual approaches with dual fixation and with fixed angle locking plates is a safe and effective way to have direct reduction and satisfactory fixation for complex tibial plateau fractures.

Buttress plateを併用した上腕骨遠位coronal share fractureの治療小経験

Buttress plateを併用した上腕骨遠位coronal share fractureの治療小経験

Outcomes of Direct Infrapectineal Buttress Plate for Quadrilateral Surface Fractures of Acetabulum Using an Anterior Intrapelvic Approach.

PurposeReduction and stable fixation of the quadrilateral plate are challenging primarily due to its location in the true pelvis, limited bone stock, juxta-articular nature, and its comminution. The current study aimed to investigate the quality of reduction and functional outcomes after open reduction and internal fixation (ORIF) with infrapectineal buttress plating of the quadrilateral surface via an anterior intrapelvic approach.Materials and MethodsWe conducted a retrospective review of twenty-one patients with acetabular fractures involving quadrilateral plate operated at Ghurki Trust Teaching Hospital between January 2017 and December 2018. Radiological assessment of the quality of reduction was conducted using criteria described by Matta. Functional outcomes were evaluated using a modified Postel Merle d'Aubigné score.ResultsThe current study included 15 males and 6 females with a mean age of 40.67±12.17 years (range, 22–62 years). The most common fracture pattern was anterior column and posterior hemi-transverse in eight patients followed by true bicolumn and T-type fractures in seven and four patients respectively. Both transverse fractures were transtectal. The quality of reduction according to Matta criteria was anatomical in 14 patients, imperfect in five and poor in two. Functional outcomes were excellent in 47.6% cases, good in 42.9%, and fair in 9.5% cases. Both patients with fair outcomes had non-anatomical reduction, and one required total hip arthroplasty at a later time.ConclusionQuadrilateral plate reconstruction with an infrapectineal buttress plate applied though an anterior intrapelvic approach provides high rates of anatomical reduction and yields good functional outcomes.

Fractures of the anterolateral tibial rim : The fourth malleolus

The anterolateral tibial rim with the anterior tibial tubercle (Tubercule de Tillaux-Chaput) serves as an insertion site of the anterior inferior tibiofibular ligament (AITFL). It can also be termed the anterior malleolus or fourth malleolus. Fractures of the anterolateral tibial rim typically result from an external rotation or abduction mechanism of the talus within the ankle mortise. They are frequently overlooked in plain radiographs. Computed tomography (CT) is needed for an exact visualization of the fracture anatomy and treatment planning. A total of three main types can be differentiated: (1)extra-articular avulsion fracture of the AITFL, (2)fracture of the anterolateral distal tibia with involvement of the joint and tibial incisura and (3)impaction fracture of the anterolateral tibial plafond. Surgical fixation of displaced anterolateral distal tibial fractures aims at bone-to-bone stabilization of the anterior syndesmosis, restoration of the tibial incisura for the distal fibula and joint surface. Displaced extra-articular avulsion fractures (type1) are fixed with asuture anchor or transosseal suture. Larger fragments involving the tibial incisura and plafond (type2) are mostly fixed with screws. Impression fractures of the anterolateral tibial plafond (type3) necessitate elevation with restoration of the joint surface, bone grafting of the impaction zone as needed and anterior buttress plating. Only afew studies have reported the treatment results of anterolateral tibial rim fractures in adults. Conservative treatment of dislocated fragments reportedly leads to non-union and malposition of the distal fibula with incongruence of the ankle mortise requiring revision. Impaction fractures (type3) can lead to secondary avascular necrosis of the anterolateral tibial plafond.

Greater sigmoid notch dysplasia causing elbow instability: Lateral ligament reconstruction and Stamp osteotomy.

The coronoid is one of the elbow's primary static stabilisers, and the importance of reconstruction following fracture with instability has been established. In the developing elbow, instability can lead to greater sigmoid notch dysplasia that can make reconstruction challenging. A novel technique to improve osseous stability with an opening wedge 'stamp osteotomy' reconstruction of the coronoid is described combined with a lateral ligament reconstruction, in two patients with recurrent posteromedial rotatory instability. The technique improves congruity and coverage of the greater sigmoid notch with the trochlea whilst maintaining articular cartilage. Extra-articular iliac crest bone graft is used to maintain the position with buttress plate support. The surgical technique is described and the clinical and radiographic outcome reported in two patients. Level of evidence: IV.

Concerns Regarding the Sufficiency of Isolated Buttress Plating in the Management of Posterior Wall Acetabular Fractures: Letter to the Editor.

We read the recently published article [1] in your journal with great interest. This study has compared the efficacy of isolated buttress plate fixation with the combination of intra-wall/ lag screw and buttress plate in the surgical management of posterior wall acetabular fractures. The authors have highlighted the advantage of avoiding inadvertent intraarticular screw penetration and have also shown comparable outcomes with the use of isolated buttress plate. As the reader, we would like to put forward some concerns based on the study analysis.

A review of rare palatal fractures and their management

Objective: The objective of this study was to diagnose rare palatal fractures and to subcategories them to formulate a definitive treatment plan depending upon the fracture lines. Materials and Methods: All patients presenting in triage with palatal fractures were classified after computed tomography scan. Thirteen patients diagnosed with complex and transverse palatal fractures were included in the study. Complex fracture was further subdivided into five groups: (a) comminuted, (b) oblique, (c) S shaped, (d) C shaped, and (e) T shaped. The patients were divided into two groups. In Group A, six patients were managed without palatal vault plating, and in Group B, seven patients were managed with palatal vault plating along with anterior alveolar and anterior maxillary buttress plating. Results: Twelve patients presented with complex fracture and one patient presented with transverse fracture. The male-to-female ratio and age range of the study were 5.5:1 and 15–55 years, respectively.Le Fort I and II fracture was present in five patients, isolated Le Fort II fracture in four patients, Le Fort I was present in two, and Le Fort I, II and III fractures was present in two patients. Conclusion: Complex palatal fractures can be subcategorized which simplifies the management and documentation of the fracture. Palatal vault plating should be attempted in cases where there are two large fracture segments to achieve the better stability of fracture and reduce the duration of maxillomandibular fixation in postoperative period.

A study on surgical management of Bicondylar fracture tibia

Background: The knee joint is complex joint and being superficial joint is more exposed to external forces. It is the commonly injured joint now a day because of increased vehicular trauma and sports related injuries. Bicondylar tibial plateau fractures usually occur in a bimodal age distribution. The most important factor in deciding the timing and modality of definitive management is the status of local soft tissue. Adequate fixation and early achievement of post-operative range of motion are important for a good prognosis and adequate postoperative functioning. Surgical fixation of Bicondylar tibial plateau fractures is challenging because of geographic complexity and compromise of the soft tissue envelope. In this small study, our aim is to outline the various principles of surgical management of Bicondylar fracture tibia as practiced in our institution and to evaluate the results while having an insight into contemporary literature related to the topic.Materials and Methods: A prospective, observational study conducted on 34 patients satisfying the inclusion criteria from June 2016 to June 2018 to study different methods of surgical management of bicondylar fracture tibia.Result: According to Modified Rasmussen Scoring System, clinically we had 06(17.65%) excellent, 23(67.65%) good, 4(11.76%) fair and 01(2.94%) poor results and radiologically 10(29.41%) excellent, 16(47.06%) good, 08(23.53%) fair and none poor results. We also used Oxford Knee Score in our study where we had 8(23.52%) excellent results, 19(55.88%) good results, 7(20.58%) fair results and 00(00%) poor results.Conclusion: Pre-op planning is must. CT scan gives exact anatomy of fracture pattern and helps in deciding type of implant and also guides about the surgical approach to be used. To reduce skin related problems and to achieve reasonable alignment, spanning external fixator should be applied at early stage and kept till acute phase is over. Bicondylar tibial plateau fractures having bone defects must be filled with iliac crest autograft / bone substitutes after reduction of articular fragments. Medial side buttress plating is always desirable in bicondylar fracture pattern with unstable medial condyle to prevent delayed medial collapse and undesirable varus deformity. Early mobilization not only gives good knee ROM but also restores patient’s confidence resulting in better compliance.

A prospective evaluation of posteromedial buttress plate as a tool for management of bicondylar fracture of tibia

Background: Tibial plateau is important component of knee joint and bicondylar fracture of tibial plateau is a complex fracture and challenges to orthopaedic surgeon. The lateral locking plate alone may not be sufficient to hold this fragment, because of the morphology and position of postero-medial fragment, leading to late varus collapse. To counter this problem, a separate posteromedial buttress plateis now been used by surgeons.Method: This is a prospective study that included 36 patients with closed posteromedial tibial plateau fractures who had undergone open reduction and internal fixation through a posteromedial approach by plate and screws between August 2017 and December 2020. Open reduction was done for all patients with anterolateral and open posteromedial approach internal fixation was done with lateral and posteromedial buttress plate.Result: As per Rasmussen’s functional scoring 26(72.23%) patients have excellent outcome, in 8 (22.23%) patients and in two patients (5.56%) outcome was fair.Discussion and Conclusion: Bicondylar fracture is more common in younger population with female predominance. Road traffic accident is more common than then fall and schatzker type 5 fracture was common than schatzker type 6 fracture. Rasmussen’s functional scoring patients have excellent in more than 70 % patients. Posteromedial buttress plate is a good tool for management of bicondylar fracture of tibia.