Functional outcome of surgical management of tibial plateau fractures in adults

Abstract

INTRODUCTIONTibial plateau fractures occur when proximal tibia experiences an excessive axial load. The mechanism of injury and the energy required to cause these fractures are age dependent. Younger patients tend to sustain these fractures secondary to high energy trauma such as fall from height and motor vehicle accidents, while older patients sustain tibial plateau fractures secondary to low energy trauma such as low level fall or stumble.The management of these types of injuries has for long been subject of controversies. The spectrum of treatment ranges from simple casting and bracing to skeletal traction and early motion to open reduction and internal fixation.1,2 Moreover, the appropriate treatment for injuries of different severities is unclear.A brief review of literature reveals that different avenues are being explored for these fractures. Ali, et al reported a 31% fixation failure for tibial plateau fracture in their elderly population.3 Stevens et al noted that only 57% of 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.

A prospective study of management of tibial plateau fractures by locking compression plate in adults

“…In these 3 weeks, the patient was made to stand up supported and walk with the help of walker. 23,24 Patients who did not adhere to these essential post-operative rehabilitation protocols had a decreased range of knee flexion and 2 patients also developed knee stiffness. This is a short term study to assess the functional outcome of tibial plateau fracture plating done in a small number of patients within the same demographic area.…”

Functional and Radiological evaluation of management of tibial plateau fractures: A prospective study

“…A study conducted by the Kehribar and Karapinar (2019) observed that 29(87.9%) were males and three (12.1%) were females. A study conducted by the Swarup et al (2016) observed that out of 60 study participant, 78% were males & 22% were females. A study conducted by the Jakinapally et al (2018) observed that out of 20 study participants, 15 (75%) were males and ive (25%) were females.…”

“…A study conducted by the Swarup et al (2016) observed that out of 60 study participants inal end result as per Rasmussen's criteria was excellent in 37, good in 11, fair in six and poor in six patients. A study conducted by the Jakinapally et al (2018) observed that nine (45%), cases had excellent outcome, seven (35%) cases had a good outcome, three (15%) cases had fair outcome and one (5%) case had a poor outcome.…”

“…A study conducted by the Swarup et al (2016) observed that Seven patients were managed with cancellous screws; sixteen patients underwent open reduction and ixation with plating while plating supplemented with bone grafting was done in ten patients. Plating with MIPO technique was performed in twelve patients and an external ixator was applied in four patients.…”

“…It was observed that 11 (22%) participants undergone bone grafting while 39 (78%) participants were without bone grafting. A study conducted by the Swarup et al (2016) observed that 10 (16.67%) patients undergone bone grafting. Conducted by the Jakinapally et al (2018) observed that seven (35%) patients undergone bone grafting along with ORIF with a buttress plate.…”