Surgical fixation methods for tibial plateau fractures

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomaterials

Background:

• Tibial plateau fractures are complex intra-articular knee injuries associated with high complication rates, including early osteoarthritis.
• Surgical fixation and bone void fillers are commonly employed for complex fractures, yet consensus on optimal methods is lacking.

Purpose of the Study:

• To evaluate the benefits and harms of various surgical interventions for tibial plateau fractures.
• To assess the efficacy of different bone void fillers in managing bone defects associated with these fractures.

Main Methods:

• Systematic review of randomized and quasi-randomized controlled trials.
• Searched multiple databases including Cochrane, MEDLINE, and EMBASE up to September 2014.
• Primary outcomes included quality of life, lower limb function, and serious adverse events.

Main Results:

• Six trials (429 participants) were included, all small and at high risk of bias, yielding very low-quality evidence.
• Hybrid fixation showed potential benefits in reoperation rates and return to activity compared to ORIF, but results were uncertain.
• Bone substitutes showed comparable functional outcomes to autografts, with a notable reduction in donor site pain.

Conclusions:

• Insufficient evidence exists to recommend a definitive surgical fixation or bone void filler method.
• Approaches minimizing soft-tissue damage and avoiding autograft donor site morbidity are not contradicted by current data.
• Well-designed, larger randomized trials are necessary to establish best practices for tibial plateau fracture management.