Split-Depressed Lateral Tibial Plateau Fractures: A Comparison of Augmented Percutaneous Screws Versus Augmented Plate and Screw Construct in a Cadaveric Model

Abstract

Objectives: To compare the strength of fixation of percutaneous screw versus plate/screw fixation in a paired cadaver model of OTA 41-B3 (Schatzker type II) split-depression fractures of the lateral tibial plateau. Methods: Six matched pairs of cadaveric knees were acquired. An OTA 41-B3 (Schatzker type II) split-depression fracture was created in all specimens using a standardized method. One specimen from each matched pair of knees was fixed with percutaneous screws, and the other was fixed with a plate/screw construct. All specimens underwent augmentation of the central metaphyseal defect with calcium phosphate. Mean residual displacement (depression) was measured on thin-slice high-resolution computed tomography using a standardized methodology following 3 experimental conditions: (1) after they were fixed, before loading; (2) unloaded cycling (simulating postoperative range of motion exercises); and (3) loaded cycling (simulating postoperative weight-bearing). Load to failure was also compared. Results: After adjustment for baseline measurements, there was no significant difference in mean residual depression of the lateral tibial plateau between treatments groups after unloaded or loaded cyclic testing. Mean residual depression was less than 1 mm in both the treatment groups. Load to failure was statistically equivalent between treatment groups. Conclusions: In our cadaveric study, in combination with calcium phosphate augmentation for both methods, percutaneous screw fixation conferred comparable strength of fixation compared with plate/screw constructs for treatment of OTA 41-B3 (Schatzker type II) tibial plateau fractures.

Management of unicondylar tibial plateau fractures: a review

“…A recent cadaver study demonstrated that the use of independent screws for fixation provides comparable strength relative to plate and screw constructs, and this technique may be particularly beneficial in that it allows for less invasive treatment of TPF. 77 Schatzker III pure depression type fractures of the lateral plateau most often occur in the setting of poor bone quality. Treatment of these fractures involves elevation of the depression and restoration of normal plateau architecture.…”

Augmented Fixation for Fractures of the Appendicular Skeleton

“…As CaPO4 augmentation has become commonplace, some surgeons have explored its use in constructs that may be inadequate without augmentation. Bowles et al 52 performed a cadaver evaluation of two augmented constructs for OTA 41-B3 split depression (Schatzker type II) fractures. The authors compared two 6.5-mm cannulated lag screws to a 4.5-mm proximal tibial plate and cancellous lag screws.…”

Subchondral raft plate fixation for lateral tibial plateau fractures - A prospective study

“…A thorough knowledge of anatomy is required for adequate reconstruction, early mobilization and to prevent long term complications [6]. Fixation of these fractures can be done through conventional or minimally invasive arthroscopic aided methods [7][8][9]. Anterolateral approach along with lateral buttress plating is used generally [10,11].…”