Publication: Tibial plateau fractures: four years review at B&B Hospital
Date
2004
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Background: Tibial plateau fractures involve the articular surface of the tibia resulting from a combination of axial
loading with varus or valgus stress. Inadequate and inappropriate treatment may result in significant functional loss.
Objective: The purpose of this study was to determine the outcome of our treatment modalities and to compare with
the results of comparable studies. Methods: The results of treatment of 81 knees were reviewed over the period of
five years (1997 to 2002). There were 62 men and 18 women, with an average age of 37 years (15 years to 75 years)
at the time of initial evaluation. One patient had bilateral involvement. Fractures were classified according to
Schatzker. Seven patients were treated conservatively. Sixteen patients (17 knees, one had bilateral involvement)
were operated with closed reduction and percutaneous cannulated screws fixation. Thirty one patients' required open
reduction and internal fixation with cannulated screws. Fifteen fractures were plated, and in eleven cases, external
fixators were used. Follow up period ranged from six months to three years. Results: Results were graded as
excellent, good, fair and poor on the basis of functional outcome. Forty- three (54%) patients (44 knees) had
excellent, twenty-two (26%) had good, five (6%) had fair and ten (14%) had poor results. Poor results were
associated with high energy fractures, late presentation, and inadequate physiotherapy follow up. Eight patients
(10%) had complications. One had common peroneal nerve palsy, six had wound infection and one patient
demonstrated early arthritic changes. Conclusion: Tibial plateau fracture is a challenging fracture to manage.
Restoration of articular congruity and early range of motion should be the primary goal. Proper and adequate
preoperative planning is mandatory. Well maintained articular congruity with stable fixation helps early
mobilization and better functional outcome.
Key Words: Plateau, Axial load, Varus, Valgus, Articular congruity, Functional outcome