Comparison of outcome of unilateral locking plate and dual plating in the treatment of bicondylar tibial plateau fractures

Abstract

BackgroundTibial plateau fracture (TPF) includes different fracture patterns with varied degrees of articular depression and displacement. Many kinds of fixators, including newly designed plate with locking screws, were applied to treat these complicated fractures. We intended to follow up the surgical outcomes of (1) unilateral locking plate, (2) classic dual plates, or (3) hybrid dual plates for TPF.Materials and methodsWe retrospectively reviewed 76 patients with TPF, Schatzker types V and VI, who we operated from June 2006 to May 2009 in our institute. Excluding patients who expired due to other medical conditions and without complete follow-up, 45 patients were sorted out in this series. The scheme of surgical intervention was designed by visiting staff, and 15 patients, as group I, were treated with unilateral locking plate. The other 19 patients, as group II, were treated with classic dual plates. The residual 11 patients, as group III, were treated with hybrid dual plates (one lateral approach locking compression plate (LCP) + medial anti-gliding plate). All patients were under periodic F/U at about 6 weeks interval for at least 18 months postoperatively.ResultsIn group I, 13 cases achieved solid bony union without obvious traumatic OA change, limitation of ROM, or malalignment. In groups II and III, 15 and 10 patients reached the same goal, respectively. By analysis of the recorded parameters with statistical software (SPSS 12.0), there were five parameters with significant difference, including Schatzker classification, operation time, staged treatment or not, hospitalization period, and hardware impingement.ConclusionsThere was no significant statistical difference of union rate between these three groups in our series. Based on our clinical follow-up, several key points were emphasized: (1) Soft tissue problems should be kept in mind, and usage of locking plate can reduce the discomfort of hardware impingement effectively. (2) The single lateral approach technique for TPF with locking plate results in less operation time and shorter hospitalization period. (3) If the medial buttress cannot be established by reduction of the lateral fracture, then open reduction of the medial side is necessary and buttresses the medial fragment by dual plates.

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

“…The rate of nonunion reported by Barei et al was 1.2% (95% CI 0.2-6.5%) in a series of 41-C3 tibial plateau fractures treated with a dual plate construct through two incisions [5]. In the present study, no loss of limb alignment was found, but six patients (8.7%; 95% CI 5.3-15.0%) showed reduction loss, which was lower than that reported by Lee et al in a study of two-incision technique to treat bicondylar tibial fracture (13.3%; 95% CI 5.3-29.7%) [21]. In our experience, rigid fixation, bone grafting and discouraging early weight-bearing may be effective in preventing loss of reduce.…”

Function and Knee Range of Motion Plateau Six Months following Lateral Tibial Plateau Fractures

“…functional, radiographic, and clinical outcomes. 6,7 To make an informed decision, both surgeon and patient should understand expected functional outcomes, range of motion (ROM), pain levels, and complication rates associated with this injury pattern. It is also important to have an understanding of the expected timeline for recovery for each patient following injury.…”

Costs and Complications of Single-Stage Fixation Versus 2-Stage Treatment of Select Bicondylar Tibial Plateau Fractures

“…1, 5, 12, 26-29 30 This led to technique modifications and alternative strategies for soft tissue management. 18,21,22,28,31,32 After good initial results were reported with a two-stage approach in tibial pilon fractures 33 , this technique spread to tibial plateau fractures. 13,14 Initial placement of a spanning external fixator was found to restore gross fracture alignment, maintain length, accelerate resolution of soft tissue swelling, and facilitate delayed fixation.…”

“…Dual (medial and lateral) incisions, locking fixation, and minimally invasive techniques have all reportedly contributed to fewer soft tissue and infectious complications. 17,21,31,[34][35][36][37][38] While two-stage treatment became a popular widespread practice, it is unclear to what extent this practice was responsible for improved results in the treatment of tibial plateau fractures compared to refined techniques of soft tissue dissection and implant evolution.…”