A study on functional and radiological outcome of complex tibial plateau fractures by posteromedial plating

Authors

  • N. Manikandan Department of Orthopaedics, Tirunelveli Medical College, Tamil Nadu, India
  • K. P. Saravanakumar Department of Orthopaedics, Tirunelveli Medical College, Tamil Nadu, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20190055

Keywords:

Posteromedial plating, Three column, Proximal tibia, Locking compression plate

Abstract

Background: In orthopaedic practice, three column concept and fixation for proximal tibia are becoming popular as it was proved that fixation of posterior column is a must for proper weight transmission and stability. This study demonstrates the use of the posteromedial surgical approach to the knee in treating patients with complex tibial plateau injuries with a posteromedial column fracture. The aim of the study was to study the functional and radiological outcome of complex tibial plateau fracture by posteromedial plating.

Methods: This is a prospective study involving 20 patients with complex tibial condyle fractures with posterior column fractures. Preoperative computed tomography is taken with radiography for complete evaluation of fracture fragments even in the coronal plane. Fractures were classified as Schatzker type 4 or above with a posteromedial split depression. Plating is done with posteromedial locking compression for buttressing posteromedial fragment. The outcome of surgery was evaluated using the Oxford knee scoring system. Longest follow up of study is 2 years.

Results: All fractures healed within 6 months without any secondary displacements or secondary osteoarthritis. Out of 20 patients 16 patients have the postoperative anatomic reduction (0 mm step off) 2 had an acceptable reduction of <2 mm step off. At 4-12 months median range of flexion 135*(125-145*). The mean Oxford knee score was 25-33.

Conclusions: Fixation of posteromedial fragment in a complex tibial condyle fracture is a must as it involves posterior column. Using a locking compression plate provides perfect fracture fixation and thereby more stability to knee joint & better functional outcome.

References

Madhor A Karunakar, Micheal J bose. Rockwood and Greens “Fracture in adults”. 5th edition. 2001.

Barei D, OʼMara T, Taitsman L, Dunbar R, Nork S. Frequency and Fracture Morphology of the Posteromedial Fragment in Bicondylar Tibial Plateau Fracture Patterns. J Orthop Trauma. 2008;22(3):176-82.

Higgins T, Kemper D, Klatt J. Incidence and Morphology of the Posteromedial Fragment in Bicondylar Tibial Plateau Fractures. J Orthop Trauma. 2009;23(1):45-51.

Raza H, Hashmi P, Abbas K, Hafeez K. Minimally invasive plate osteosynthesis for tibial plateau fractures. J Orthop Surg. 2012;20(1):42-7.

Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res. 1979;(138):94-104.

Kettel Kemp, DB; Hill Berry BM; Murrish DE et al: Degenerative arthritis of the knee secondary to fracture malunion: Clin Orthop. 1988;234:159-69.

Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Anterior knee pain following the lateral parapatellar approach for tibial nailing. Arch Orthop Trauma Surg. 2009;129(6):773-7.

Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscherne H. Treatment of posterior tibial plateau fractures via posteromedial and posterolateral exposures. Der Unfallchirurg. 1997;100(12):957-67.

Berber R, Lewis CP, Copas D, Forward DP. Postero-medial approach for complex tibial plateau injuries with a posteromedial or posterolateral shear fragment. Injury. 2014;45(4):757-65.

Weil Y, Gardner M, Boraiah S, Helfet D, Lorich D. Posteromedial Supine Approach for Reduction and Fixation of Medial and Bicondylar Tibial Plateau Fractures. J Orthop Trauma. 2008;22(5):357-62.

Downloads

Published

2019-02-23

Issue

Section

Original Research Articles