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Reliability of locked plating in tibial plateau fractures with a medial component - 27/03/12

Doi : 10.1016/j.otsr.2011.10.009 
M. Ehlinger a, , M. Rahme a, B.-K. Moor b, A. Di Marco a, D. Brinkert a, P. Adam a, F. Bonnomet a
a Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospitals group, 1, avenue Molière, 67098 Strasbourg cedex, France 
b Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland 

Corresponding author.

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Summary

Background

Tibial plateau fractures are notoriously difficult to manage, particularly when there is a medial or posteromedial component. We report a retrospective analysis of our experience with consecutive tibial plateau fractures including a medial component that were managed using a single lateral locking plate.

Hypothesis

Tibial plateau fractures with a medial component can be effectively managed using a single lateral locking plate.

Materials and methods

From January 2005 to December 2008, 20 patients (ten women and ten men, mean age 47 years) were managed for tibial plateau fractures having a medial component, including five Schatzker IV, five Schatzker V, and ten Schatzker VI. One patient had an open fracture. A single lateral anatomically contoured locking compression plate (LCP™) was used with or without additional isolated screws. Mobilization was started immediately after the procedure, and non-weight-bearing was maintained for at least 6 weeks.

Results

All patients were followed until healing. A final evaluation was available for 13 patients after a mean of 39.1 months (12–72); five patients were lost to follow-up and two died. Early revision was needed in one patient for 20° malreduction within the fracture site. We recorded one case each of deep vein thrombosis, superficial infection, knee stiffness, and spontaneously regressive common fibular nerve dysfunction. At final evaluation (n=13), mean range of motion was 0°/2°/130° with a mean Lysholm score of 94.1 (73–100) and a mean HSS score of 93.6 (74–99). All previously employed patients returned to work at the same level after a mean of 4.5 months. Mean healing time (n=20) was 10 weeks (6–12). Initially, articular step-offs greater than 2mm were noted in five patients. At healing, no further displacements or aggravation of articular step-offs were recorded. The reductions remained stable over time. At final evaluation (n=13), mean tibiofemoral mechanical angle was 179.7° (176–184) and no patients had evidence of osteoarthritis.

Discussion

The radiological and clinical outcomes in our patients were satisfactory. A single lateral locked plate ensured stable reduction of tibial plateau fractures with a medial component. Biomechanical studies of these fractures have provided conflicting data on the stability of reduction using single plate systems. However, previously reported clinical outcomes are similar to those found in our study and support the effectiveness of favouring the use of single locking plate fixation.

Level of evidence

Level IV, noncomparative retrospective study.

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Keywords : Proximal tibial fracture, Articular fracture, Locking plate, Tibial plateau fractures, Schatzker classification


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© 2012  Elsevier Masson SAS. Tous droits réservés.
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Vol 98 - N° 2

P. 173-179 - avril 2012 Retour au numéro
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