Publication:

A study on functional and radiological outcome of complex tibial plateau fractures by posteromedial plating

Background In orthopaedic practice, three column concept and fixation for proximal tibia are becoming popular as it was proved that fixation of posterior column is a must for proper weight transmission and stability. This study demonstrates the use of the posteromedial surgical approach to the knee in treating patients with complex tibial plateau injuries with a posteromedial column fracture. The aim of the study was to study the functional and radiological outcome of complex tibial plateau fracture by posteromedial plating.

Methods This is a prospective study involving 20 patients with complex tibial condyle fractures with posterior column fractures. Preoperative computed tomography is taken with radiography for complete evaluation of fracture fragments even in the coronal plane. Fractures were classified as Schatzker type 4 or above with a posteromedial split depression. Plating is done with posteromedial locking compression for buttressing posteromedial fragment. The outcome of surgery was evaluated using the Oxford knee scoring system. Longest follow up of study is 2 years.

Results All fractures healed within 6 months without any secondary displacements or secondary osteoarthritis. Out of 20 patients 16 patients have the postoperative anatomic reduction (0 mm step off) 2 had an acceptable reduction of <2 mm step off. At 4-12 months median range of flexion 135*(125-145*). The mean Oxford knee score was 25-33.

Conclusions Fixation of posteromedial fragment in a complex tibial condyle fracture is a must as it involves posterior column. Using a locking compression plate provides perfect fracture fixation and thereby more stability to knee joint & better functional outcome.