A study on clinical and radiological outcome of proximal tibial plateau fractures treated with locking plate

Author(s): Santosh S Nandi, Gireesh Khodnapur, Shreepad Kulkarni and Pranav Paritekar

Abstract: Introduction: Tibial plateau fractures are one of the most challenging fractures for an orthopaedic surgeon to understand and successfully treat. These are best treated at specialized Centres by trained surgeons who routinely treat such injuries. Anatomic reduction and internal fixation with the locking plate are the treatment of displaced intra-articular tibial plateau fractures. The goal of surgical treatment is to obtain an anatomic reduction of the articular surface while avoiding complications.
Aim: 1) To study the clinical and radiological outcome of closed intra-articular proximal tibial plateau fractures treated with a locking plate at a six-month follow-up.
2) To study the secondary displacement in closed intra-articular proximal tibial plateau fractures treated with locking plates at a six-month follow-up.
Method: 26 patients with a closed intra-articular fracture of the tibial plateau treated with locking plate admitted to Shri BM Patil Medical College, BLDE (Deemed to be university), Vijayapura, Karnataka from Sept 2014 to Sept 2015 were studied prospectively. The Radiological & functional outcomes of these patients were assessed & compared using Rasmussen's clinical and radiological scores.
Result: The study comprised 22 male and 4 female patients aged from 21 to 72 years with a mean age of 45.04 years. The right-sided injury was more (57.69%), most fractures were due to road traffic accidents. We noted excellent functional outcome in 19 (73%), good in 4 (15 %) & fair in 3 (12%) patients at 6 months. We found most patients (69.23%) had an excellent range of motion (>1200) at six months. The mean duration for fracture healing was 17.31 weeks (range 14-24 weeks) with a standard deviation of 2.4 weeks. There was no statistically significant difference in the functional outcome of patients above and below 40 years (P=0.215) at six months. There was a statistically significant better functional outcome in patients with pure lateral condyle fractures than in other higher grade fractures of the tibial plateau. (p-value = 0.009) at six months.
Interpretation: Patients with closed intra-articular tibial plateau fractures treated with locking plate have satisfactory (88%) functional outcomes at six months follow up. There is a strong correlation between radiological outcome & functional outcome at six months follow-up. An increase in severity and grade of tibial plateau fractures have a statistically significant adverse effect on the final clinical product. Younger patients have a slightly better functional outcome compared to older patients, not statistically significant, though.

DOI: https://doi.org/10.22271/ortho.2022.v8.i1f.3049