Arthroscopically-assisted internal fixation of tibial plateau fractures: adding an anti-settling screw

ABSTRACT

Intra-articular fractures of the proximal tibia can often be troublesome because of the early and late arthritic complications of damage of the articular surface, and intra-articular lesions. There are some potential benefits of arthroscopy in solving some of the pitfalls of these fractures. The purpose of this work is to study these benefits, and the benefits of adding an antiglide screw. Fifty patients with tibial plateau fractures were treated in Assiut University hospital. Of these patients only [16 patients] were included in this study. Fourteen were men, and two were women. The age ranged between 27-60 years [mean 43 years]. Inclusion in this study was limited to cases of split split depression, or local depression unicondylar fractures using Schatzker classification. Mean follow up was 15 months [6-24 months]. The post operative clinical evaluation depended on Rasmussen scoring system. The radiological evaluation was according to Honkonen and Jarvinen. Complete anatomical reduction of the fracture fragments was achieved in 14 knees [87.5%]. Up to 2 mm displacement or step off was accepted in two knees [12.5%]. Clinical assessment according to Rasmussen classification was 10 knees [62.5%] excellent, 4 knees [25%] good, 2 knees [12.5%] fair, and none was poor. Radilogical results were 13 knees [81.25%] grade one, 2 knees [12.5%] grade two, and one knee [6.25%] grade three. None of the cases was grade four at the final follow up radiograph. The use of arthroscopy allowed precise anatomic reduction of the articular surface in the knee. It is particularly helpful in type two and three injuries with central articular depression which often are difficult to assess on preoperative imaging studies. It is also helpful in assessing other intra-articular injuries as meniscal tears and/or ligamentous injuries and their management if possible. The antiglide screw may help in prevention of loss of reduction