Operative results of closed tibial plateau fractures

ABSTRACT

Management of tibial plateau fractures remains challenging because of their number, variety and associated soft tissue injuries that further augment their complexity. Comparison of operative results in recent reports has been difficult due to a lack of standard fracture classification scheme and uniform standardized objective criteria for evaluating results. Between August 2003 to December 2004, 27 closed tibial plateau fractures were treated operatively using methods and principles advocated by AO/ASIF and followed up for an average of 35.74 months [range 24-68 months]. Fractures were classified according to Schatzker's staging system and results evaluated using Rasmussen's 30-point clinical grading system and Rasmussen's radiological evaluation of the knee at a minimum follow-up of 2 years. Type II was the most common fracture type [12 cases] followed by type 1[8 cases]. There were 37% excellent and 51.85% good functional results with only 3 patients having unacceptable results. The mean Rasmussen's functional score was 25.062 [range 15-30]. Minimal fixation in comminuted or depressed fractures as compared to rigid fixation was the cause of unacceptable results. Loss of knee range of motion in a few cases was attributed to delayed knee mobilization in these cases. Using Rasmussen's radiological grading, 2 patients had excellent results and 8 1.48% patients had good results. Only 3 patients had poor radiological results. The mean rasmussen's radiological score was 15.33 [range 10-18]. Moreover, clinical evaluation did not correlate with the follow-up radiograph. Anatomic reduction and rigid internal fixation followed by early knee motion and partial weight bearing during bone healing are the cornerstones in the treatment of tibial plateau fractures. Standard fracture classification, uniform reporting and evaluating criteria, along with detailed analysis of uniform treatment methods, has helped us to enhance our understanding of these fractures