Comparison of the results of the synthesis of Schatzker II and III tibial plateau fractures by screwing versus plate

PURPOSE

Lateral tibial plateau fractures with depression are the most common. Their treatment is currently surgical. Many therapeutic procedures have been described. Our aim is to evaluate the results of open surgery and to compare the two internal fixation methods used: lag screw versus plates.

MATERIALS AND METHODS

This is a retrospective comparative study of two series of tibial plateau fractures Schatzker types II and III treated surgically over a period of ten years with two different methods: Group A: Internal fixation using screws for 86 patients. Group B: Internal fixation using plates for 71 patients. Functional and anatomical results were assessed according to Rasmussen's clinical and radiological scores.

RESULTS

The patients' average age was 44 years (range from 18 to 76). The male gender was predominant (104 males and 53 females). Road traffic accidents were the most common aetiology with over two thirds of the cases. The fractures were type Schatzker II in 61% of the cases. The mean follow-up was five years. Although the clinical and radiological Rasmussen scores were better in group A (internal fixation with lag screws), those differences were statistically insignificant (p = 0.6 and p = 0.8). Group A clinical and radiological scores were 26.06 and 16.57, respectively and those of group B were 25.72 and 16.45. We noticed more sepsis and skin complications and a longer operating time (95 min versus 70 min) in group B patients with a statistically significant difference. None of the patients of our series had bone grafting.

CONCLUSION

For Schatzker II and III fractures, an internal fixation with lag screws would be preferable when possible especially in the case of a pure depression fracture. It yields satisfactory results with a shorter operating time and less complication rate.

Low profile fragment specific plate fixation of lateral tibial plateau fractures - A technical note

PURPOSE

Precontoured plates used to stabilize lateral tibial plateau (LTP) fractures are limited in their ability to raft particular areas of the reconstructed articular surface. These implants also do not fit every individual's bony anatomy and can lead to soft tissue irritation. The purpose of this study was to evaluate fragment specific plate fixation of LTP fractures using generic small and mini fragment constructs.

METHODS

This was a retrospective case series of LTP fractures treated with small fragment tubular and/or mini fragment plate constructs at a single Level I trauma center. Postoperative complications were recorded. Final radiographs were analyzed to determine union and interval subsidence of the articular surface and/or loss of reduction.

RESULTS

All 19 LTP fractures healed without loss of reduction or implant failure. There was minimal interval subsidence of the LTP in all patients. There were no complications or reoperations for symptomatic implant removal within the given follow-up period.

CONCLUSION

Fragment specific fixation of LTP fractures using small and mini fragment plates creates a lower profile construct that reliably maintains fracture reduction to union.

Delayed but favourable outcome of lateral tibial plateau fracture after screw fixation: A 3-year prospective cohort study of 56 patients

BACKGROUND

Although a large number of studies aimed to investigate the outcome following lateral tibial plateau fractures, the literature includes limited information on mid- to long-term follow up. The primary objective of the present study was to investigate the 3-year development in Knee Injury and Osteoarthritis Outcome Score (KOOS₅) of patients with surgically managed lateral tibial plateau fractures.

METHODS

Prospective cohort study. The study includes all patients treated surgically following a lateral tibial plateau fracture (AO-41B) in the period December 2013 to November 2016. The primary outcome measurement was the patient-reported KOOS₅ score. Secondary outcome measurements were quality of life, knee osteoarthritis, muscle strength, pain reactions, and gait function.

RESULTS

Fifty-six patients were included. Thirty-nine patients were eligible for the 3-year follow up (70%). The mean age at the time of the 3-year follow up was 58.3 years with a range of 25-89. The 3-year postoperative mean KOOS₅ scores were 75.5 (95% confidence interval: 68.6-82.3). Compared with the KOOS₅ score at 12-month follow up (61.3), a significant increase was observed (P > 0.001). In comparison with the established KOOS reference population, the study population showed statistically worse KOOS outcomes only for the subscale sport.

CONCLUSIONS

Patient-reported outcome (KOOS₅) among patients with a fracture of the lateral tibial plateau increased significantly between the 1-year and 3-year follow ups. In contrast to the 1-year follow up, patients at the 3-year follow up reported results comparable to those of a healthy reference population, excluding the Sport subscale. Guiding the patients in anticipation of a prolonged recovery period is highly important in everyday clinical practice.

Presence of magnetic resonance imaging verified soft tissue injuries did not significantly affect the patient-reported outcome 12 months following a lateral tibial plateau fracture: A 12-month prospective cohort study of 56 patients

BACKGROUND

Soft tissue injuries following lateral tibial plateau fracture affect more than half of patients. Regardless of the type of soft tissue injured, it is still unclear how different treatment strategies influence postoperative outcome. The aim of this study was to report the 12-month Knee Injury and Osteoarthritis Outcome Score (KOOS₅) of patients with surgically managed lateral tibial plateau fractures divided into groups with and without conservatively managed magnetic resonance imaging (MRI)-verified soft tissue injuries.

METHODS

Prospective cohort study. Patients treated surgically following a lateral tibial plateau fracture (AO-41B) between December 2013 and November 2016 were included. Soft tissue injuries were evaluated with preoperative MRI scans. The primary outcome score was the 12-month KOOS₅ score divided into groups with and without soft tissue injuries.

RESULTS

A total of 56 patients were included. Average patient age was 56 years (range 22-86). Thirty-three patients (59%) were female. Fifty percent of patients presented with MRI-verified soft tissue injuries. At 12 months postoperatively, the mean KOOS₅ score for patients with soft tissue injuries was 53.5 (95% confidence interval (CI): 44.8-62.1) and the KOOS₅ score for patients without soft tissue injuries was 59.6 (95% CI: 50.7-68.6). No significant difference in the KOOS₅ score between patients with and without soft tissue injuries was observed (P = .31).

CONCLUSIONS

At 12-month follow-up the presence of MRI-verified soft tissue injuries did not significantly affect the patient-reported KOOS₅ score. More research is needed to investigate the effects of surgical vs. non-surgical treatment strategies of associated soft tissue injuries following lateral tibial plateau fractures.