Are Locked Plates Needed for Split Depression Tibial Plateau Fractures?

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• Displaced tibial plateau fractures frequently necessitate surgical intervention.
• Plate and screw constructs are the standard fixation method.
• Increased use of locking plate technology lacks evidence of superior outcomes for simple fractures.

Purpose of the Study:

• To compare clinical outcomes of locked versus nonlocked plating for Schatzker type-II (OTA Type 41B) tibial plateau fractures.
• To evaluate the cost-effectiveness of locked versus nonlocked plating in this patient cohort.

Main Methods:

• Prospective, nonrandomized study of 77 patients with Schatzker type-II fractures.
• Comparison of locked plate (n=35) and nonlocked plate (n=42) constructs.
• Assessment of clinical outcomes (SMFA, VAS, ROM) and radiographic results.
• Calculation of implant costs.

Main Results:

• No significant differences in demographic factors, physical examination, radiographic outcomes, or SMFA scores between locked and nonlocked groups.
• Locked constructs were $905 more expensive per implant than nonlocked constructs.
• No evidence of improved clinical outcomes with locked plating.

Conclusions:

• Routine use of locked plating is not supported for simple split depression fractures of the lateral tibial plateau.
• Standard nonlocked, precontoured implants offer adequate fixation for Schatzker type-II fractures.
• Nonlocked plating is a more cost-effective option for these specific fracture patterns.