Functional outcome of Schatzker type V and VI tibial plateau fractures managed with open reduction internal fixation using dual plates
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20173215Keywords:
Tibial plateau fractures, Oxford knee score, Schatzker type V, Schatzker type VI, Soft tissue injuryAbstract
Background: Complex tibial plateau fractures remain a challenge to even the most experienced surgeons. These injuries usually affect the young population in their productive years thereby causing socioeconomic impact. We performed a retrospective study to evaluate the functional outcome of of Schatzker type V and VI managed through open reduction and internal fixation.
Methods: 26 patients with Schatzker type V and type VI tibial plateau fractures treated with open reduction and internal fixation using plates were included in the study. Three patients were lost to follow up, 23 patients were evaluated in the final analysis. The preoperative, intraoperative data was noted from the indoor files.The final evaluation was done using Oxford knee score and VAS score.
Results: There were nine Schatzker type V fractures and 14 patients with Schatzker type VI fractures. The mean duration of follow-up was 68.32 months ranging from 41 months to 126 months. The mean Oxford knee score was 39.78. Patients with Schatzker type VI had mean OKS of 37.7.The mean MPTA and mean PPTA were 88.75 degrees and 7.35 degrees respectively. Average VAS Score was 2.8 ranging from 1 to 3.9. All patients returned to their pre-injury level of activity and employment. There were no patients of deep infection.
Conclusions: We conclude that open reduction and internal fixation of high-energy tibial plateau fractures gives excellent to good functional outcome with minimal soft tissue complications. The complications can be minimized with proper patient selection and soft tissue dissection.
References
Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994;23:149–54.
Mallik AR, Covall DJ, Whitelaw GP. Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev. 1992;21:1433–6.
Mckee MD, Pirani SP, Stephen DJ. The Canadian Orthopedic Trauma Society, Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am. 2006;88:2613–23
Ebraheim NA, Sabry FF, Haman SP. Open reduction and internal fixation of 117 tibial plateau fractures. Orthopedics. 2004;27(12):1281-7.
Schatzker J. Anterior approach to the knee with osteotomy of the tibial tubercle for bicondylar tibial fractures. J Bone Joint Surg Am. 1988;70:1575–6.
Blokker CP, Rorabeck CH, Bourne RB. Tibial plateau fractures: an analysis of the results of treatment in 60 patients. Clin Orthop Relat Res. 1984;182:193-9.
Ali AM, Burton M, Hashmi M, Saleh M. Outcome of Complex Fractures of the Tibial Plateau Treated with a Beam-Loading Ring Fixation System. J Bone Joint Surg. 2003;85(5):691-9.
Berkson EM, Virkus WW. High-energy tibial plateau fractures. J Am Acad Orthop Surg. 2006;14:20–31.
Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–4.
Jiang R, Luo CF, Wang MC, Yang TY, Zeng BF. A comparative study of Less Invasive Stabilization System (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee. 2008;15:139–43.
Murray D, Fitzpatrick R, Rogers K, Pandit H, Beard D, Carr A, et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br. 2007;89:1010–4.
Lachiewicz PF, Funcik T. Factors influencing the results of open reduction and internal fixation of tibial plateau fractures. Clin Orthop Relat Res. 1990;259:210–5.
Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: Definition, demographics, treatment rationale, and long term results of closed traction management or operative reduction. J Orthop Trauma. 1987;1:97–119.
Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg. 2006;88(8):1713–21.
Stannard JP, Wilson TC, Volgas DA. The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma. 2004;18:552–8.
Kumar A, Whittle AP. Treatment of complex (Schatzker Type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review. J Orthop Trauma. 2000;14:339–44.
Hutson JJ, Jr, Zych GA. Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators. J Orthop Trauma. 1998;12:214–8.
Williams DP, Blakey CM, Hadfield SG, Murray DW, Price AJ, Field RE. Long-term trends in the Oxford knee score following total knee replacement. J Bone Joint Surg. 2013;95(1):45–51.
Hawker GA, Melfi CA, Paul JE, Green R, Bombardier C. Comparison of a generic (SF-36) and a disease specific (WOMAC)(Western Ontario and McMaster Universities Osteoarthritis Index) instrument in the measurement of outcomes after knee replacement surgery. J Rheumatol. 1995;22(6):1193–6.
Yao Y, Lv H, Zan J, Li J, Zhu N, Jing J. Functional outcomes of bicondylar tibial plateau fractures treated with dual buttress plates and risk factors: a case series. Injury. 2014;45(12):1980-4.
Pun TB, Krishnamoorthy VP, Poonnoose PM, Oommen AT, Korula RJ. Outcome of Schatzker type V and VI tibial plateau fractures. Indian J Orthop. 2014;48(1):35-41.
Zhang Y, Fan D, Ma B, Sun S. Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique. Orthopedics. 2012;35(3):359–64.
Prasad GT, Kumar TS, Kumar RK, Murthy GK, Sundaram N. Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates. Indian J Orthop. 2013;47(2):188–94.
Khatri K, Lakhotia D, Sharma V, Kumar KGN, Sharma G, Farooque K. Functional Evaluation in High Energy (Schatzker Type V and Type VI) Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation. Int Scholarly Res Notices. 2014(2014):589538.
Cole PA, Zlowodzki M, Kregor PJ. Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma. 2004;18(8):528–35.