DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20160541

Functional outcome of surgical management of tibial plateau fractures in adults

Arunim Swarup, Avinash Rastogi, Siddharth Singh, Kamal Swarn

Abstract


Background: Tibial plateau fractures are one of the commonest intra articular fractures. These injuries encompass many varied fracture configuration that involve medial, lateral or both tibial plateau with varied degree of compression and articular displacements. Being one of the major weight bearing joints of the body, these fractures are of paramount importance. Since there are various modalities for fixation of these fractures with satisfactory results, but there is no general consensus as to which modality is the best in terms of functional outcome and proving the superiority of one over the other. Keeping this aim in mind, we have conducted the present study to determine the efficacy of different practised methods of fixation, and if one are superior to the other.

Methods: Sixty cases of tibial plateau fractures were treated with various surgical modalities and were followed up for a period of 2 years (2013 to 2015) at N.S.C.B Subharti hospital and their functional outcome was evaluated using Rasmussen’s functional score.

Results: On selection these patients were classified according to Schatzker classification and were fixed accordingly using percutaneous cannulated cancellous screw, plating using LCP/ buttressing by open or MIPPO technique and screws depending upon the fracture configuration. Early range of motion was started as soon as pain subsided and weight bearing was deferred until radiological signs of union were evident. The knee range of motion was excellent to very good and weight bearing after complete union was satisfactory. Infection and stiffness in 2 cases was seen and there was one case of non-union in this series.

Conclusions: Surgical management of tibial condylar fracture will give excellent anatomical reduction and rigid fixation to restore anatomical congruity, facilitate early motion, hence to achieve optimal knee function and reducing post traumatic osteo-arthritis.   

 


Keywords


Tibial plateau fractures, Ligamentotaxis, Schatzker, Rasmussen

Full Text:

PDF

References


De Coster TA, Nepola JV, el-Khoury GY. Cast brace treatment of proximal tibia fractures. A 10 year follows up study. Clin Orthop Relat Res. 1988;231:196-204.

Apley AG. Fractures of tibial plateau. Clin Orthop North Am. 1979;10:61-74.

Ali AM, El-Shafie M, Willet KM. Failure of fixation of tibial plateau fractures. J Orthop Trauma. 2002;16(5):323-9.

Stevens DG, Beharry R, McKee MD, Waddell JP, Schemitsch EH. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma. 2001;15(5):312-20.

Schatzer J, McBroom R, Bruce D. The tibial plateau fracture: the Toronto experience 1968-1975. Clin Orthop. 1979;138:94-104.

Yong MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994;23(2):149-54.

Keogh P, Kelly C, Cashman WF, McGuinness AJ, O’Rourke SK. Percutaneous screw fixation of tibial plateau fractures. Injury. 1992;23(6):387-9.

Duwelius PJ, Rangitsch MR, Colville MR, Wall TS. Treatment of tibial plateau fractures by limited internal fixation. Clin Orthop Relat Res. 1997;339:47-57.

Marsh JL, Smith ST, Do TT. External fixation and limited internal fixation for complex fractures of tibial plateau. J Bone Joint Surg Am. 1995;77(5):661-73.

Mikulak SA, Gold SM, Zinar DM. Small wire external fixation of high energy tibial plateau fractures. Clin Orthop Relat Res. 1988;356:230-8.

Rasmussen PS. Tibial condyle fractures. Impairment of knee joint stability and indication for surgical intervention. J Bone Joint Surg Am. 1973;55(7):1331-50.

De Mourgues G, Chiax D. Treatment of tibial plateau fractures. Rev Chir orthop Reparatrice Mot. 1969;55(6):575-6.

Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res. 1994;302:199-205.

Burri C, Bartzke G, Coldewey J, Mugglar E. Fractures of tibial plateau. Clin Orthop Relat Res. 1979;138:84-93.

Bowes DN, Hohl M. Tibial condyle fractures. Evaluation of treatment and outcome. Clin Orthop Relat Res. 1982;171:104-8.

Segal D, Malik AR, Merrick J, Wetzler MJ, Franchi AV, Whitelaw GP. Early weight bearing of lateral tibial plateau fractures. Clin Orthop Relat Res. 1993;294:232-7.

Ebraheim NA, Sabry FF, Haman SP. Open reduction and internal fixation of 117 tibial plateau fractures. Ortho Blue Journal. 2004;27(12):1281-7.

Watson JJ, Wiss AD. Fractures of proximal tibia and fibula. Bucholz RW, Heckman JD (eds). Rockwood and Green’s fracture in adults, 5 ed. Philadelphia: Lippincott Williams and Wilkins. 2001:1799-1839.

Buchko GM, Johnson DH. Arthroscopy assisted operative management of tibial plateau fractures. Clin Orthop Relat Res. 1996;332:29-36.

Oh JK, Oh CW, Jeon IH, Kim SJ, Kyung HS, Park IH, et al. Percutaneous plate stabilization of proximal tibial fractures. J Trauma. 2005;59(2):431-7.