Bicondylar tibial plateau fracture treated by open reduction and fixation with unilateral locked plating

Abstract

The management of bicondylar tibial plateau fractures is challenging. A lateral locking plate offers an alternative method to traditional dual plating to avoid further stripping of soft tissue. Nevertheless, the rate of malreduction and fixation loss remains high. From 2007 to 2009, we performed open reduction and fixation with unilateral locked plating to directly reduce the fracture in 15 patients with bicondylar plateau fracture. The average follow-up duration was 16.2 months (range: 12-30 months), and the average age of the patients was 43 years (range: 19-64 years). All fractures were Orthopaedic Trauma Association type 41-C. Postoperative radiographic alignment was evaluated immediately and at 2-4 weeks, 8-12 weeks, 5-7 months, and 11-13 months. Both Oxford knee score and Hospital for Special Surgery knee score were used to evaluate functional outcomes. The average duration within which union was achieved was 4.8 months (range: 2-10 months). One patient incurred wound dehiscence; however, there was no case of deep infection. Malreduction occurred in one patient (6.7%) while fixation loss occurred in three patients (20%) with subsidence of the posteromedial fragment and varus malalignment. Despite the malreduction rate being lower in our study than in previous studies involving unilateral locked plating, a high rate of fixation loss was recorded. Per our limited experience, we believe that unilateral locked plating may have limitations in patients with selective patterns of bicondylar tibial plateau fractures.

Functional outcomes of bicondylar tibial plateau fractures treated with dual buttress plates and risk factors: A case series

“…However, this treatment modality requires exposure of the fracture zone, which may endanger soft tissue and destroy the biological environment for fracture healing. A single locking plate provides the requirements of minimally invasive treatment, as its own design characters, which cannot meet the requirements of medial condyle fixation in some cases [3,4]. The Ilizarov circular ring fixation can achieve clinical results similar to those of open reduction and internal fixation (ORIF) through indirect fixation, decreasing complications and the length of hospital stay, but loss of range motion is common and must be carefully monitored postoperatively [5].…”

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“…Our study suggests that single lateral locked plate can be an effective implant in providing fracture stabilization of Bicondylar tibial plateau fractures. (Table 5) illustrates comparison between our study and other studies published since 2004 with the start of era of single lateral locked plating for Bicondylar tibial plateau fractures [14][15][16][17].…”

The effect of coronal splits on the structural stability of bi-condylar tibial plateau fractures: a biomechanical investigation

“…Bi-condylar tibial plateau fractures are challenging traumas due to their complex fracture geometry and accompanying soft tissue injury [1,2]. These fractures mainly occur in young patients as a result of high-energy trauma and generally require open reduction and internal fixation [3,4].…”

“…Healing complications for these fractures have been reported from 14% up to a staggering 42% [5][6][7][8][9][10]. The main goal of operative treatment is the patient's return to daily activity and functionality, which can be achieved through accurate reconstruction of the knee joint and the anatomical axes [2]. For planning and achieving suitable treatment, it has been recognized that providing a three-dimensional representation of the fracture by CT imaging plays a critical role [1,[11][12][13][14].…”