Bicondylar tibial plateau fracture osteosynthesis with double-plate fixation: Similar complication rates and clinical results but improved radiographic outcomes with dual compared to single approach - 23/03/24
, Maxime Fabre-Aubrespy a, Bastien Mandon a, Xavier Flecher a, b, Matthieu Ollivier a, Jean-Noël Argenson a, Christophe Jacquet a
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Abstract |
Introduction |
Associating posteromedial and anterolateral approaches should improve fracture line visualization and optimize bicondylar tibial plateau fracture reduction compared to a single midline approach. The present study aimed to compare postoperative complications rates and functional and radiographic results after double-plate fixation via either a single or a dual approach. The study hypothesis was that double-plate fixation using a dual approach provides equivalent complications rates with improved radiographic results compared to a single approach.
Material and methods |
A retrospective 2-center study compared bicondylar tibial plateau fractures treated by double-plate fixation on a single versus a dual approach between January 2016 and December 2020. Comparison focused on major complications requiring surgical revision, radiographic measurements of medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA); change from their respective baseline values of 87° and 83° (deltaMPTA and deltaPPTA), and functional results on KOOS, SF12 and EQ5D-3L self-reported questionnaires.
Results |
Major complications occurred in 2 of the 20 single approach group patients (10%) [1 surgical site infection (SSI) (5%), and 1 skin complication (5%)], and in 3 of the 39 dual approach group patients (7.69%) (p=0.763), at an average 29 months’ follow-up. In the sagittal plane, deltaPPTA was significantly lower with dual than single approach (respectively, 4.67° versus 7.43°; p=0.0104). There were no significant intergroup differences in deltaMPTA or functional results at last follow-up.
Conclusion |
The present study suggests an absence of significant difference in major complications, between single and dual approach for double-plate osteosynthesis of bicondylar tibial plateau fractures. Using a dual approach enabled improved anatomic restoration in the sagittal plane, without significant differences observed in the frontal plane or functional scores at an average 29months’ follow-up.
Level of evidence |
III; case-control study.
Le texte complet de cet article est disponible en PDF.Keywords : Bicondylar tibial plateau fracture, Schatzker type V fracture, Locking plate osteosynthesis, Proximal tibia, Single midline approach, Dual incision technique
Plan
| ☆ | Study performed in the Institut du Mouvement et de l’Appareil Locomoteur, Département d’Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France. |
Vol 110 - N° 2
Article 103655- avril 2024 Retour au numéro
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