Fractures of the tibial plateau

Abstract

The majority of tibial plateau fractures are treated surgically by the members of a West German Fracture Study Group. Non-displaced fractures are treated either nonoperatively or with compression screw osteosynthesis. Fractures with depression/displacement or impaction, combination fractures and comminuted fractures are treated by osteosynthesis with a buttress plate. In cases of impacted fractures and combination fractures, the joint plateau is elevated, the subchondral defect is packed with cancellous bone, and stabilization for motion is achieved with osteosynthesis. Two hundred and seventy-eight cases treated by these guidelines available for follow-up evaluation were analyzed in 2 groups according to the experience of the treating surgeon. The results were unequivocally superior in Group B with the more experienced surgeons as compared to Group A. This applied not only to the subjective but also to the radiological, and functional results at the time of follow-up evaluation. In addition, there were significant differences in the rate of complications. In Group A there were 5.5% superficial and 9.5% deep infections, but in the group with the skilled surgeons, there were 0% and 0.7% infections, respectively. Every fracture with persistent displacement/depression, every fracture with impaction or fragmentation, and every combination of plateau fractures should be treated operatively by an experienced surgeon.