Functional outcome of surgical management of tibial plateau fractures in adults

Abstract

INTRODUCTION Tibial 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.