Fractures of the proximal tibia, particularly those that extend into the knee joint are termed as tibial plateau or tibial condylar fractures. It results from indirect coronal or direct axial compressive forces. Overall worldwide, it comprises of 1% of all fractures & 8% of the fractures in elderly. In the past two decades, with improvements in surgical techniques and implants, there has been a growing trend towards surgical management of these injuries. Thus we have advanced from the conservative approach to internal fixation in fractures as an acceptable mode of treatment. No proven uniform successful method of treatment. Nevertheless, tibial plateau fractures remain challenging because of their number, variety and complexity.
Aim: To study the surgical management in terms of unilateral and dual plating for bicondylar intraarticular fractures of proximal tibia to obtain a stable, pain free, mobile joint, to prevent the development of osteoarthritis and to correlate the radiological findings with the type of fracture and the functional end result.
Materials and Methods: This was a prospective study of 44 cases. All patients included in this study sustained tibial plateau fracture grade V and VI according to Schatzker Classification. We used Rasmussen’s functional and radiological scoring system for the comparison of outcome of plating. In the surgical group 20 patients were treated by unilateral plating and 24 patients were with dual plating. These patients were followed up for an average period of 13 months.
Results and discussion: In our study according to Rasmussens functional scoring4, we have achieved excellent outcome in 43%, good in 50%, fair in 7%, which is comparable to the standard studies. These studies suggest that while isolated lateral locked plating may offer a more biological approach to bicondylar fractures, and may provide a viable alternative for open fractures with a medial wound or fractures with tenous soft tissues, classical dual plating remains the most rigid construct.
Conclusion: The surgical management of tibial bicoondylar fracture is challenging and dual plating gives excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early knee motion by reducing post-traumatic osteoarthritis and thus achieving optimal knee function.