Complex tibial plateau fractures: Clinical and radiological outcome following plate osteosynthesis

To assess the clinical and radiological outcome of complex tibial plateau fractures treated with single or dual plate osteosynthesis and augmentation of metaphyseal defects with bone graft substitute.

A retrospective review was conducted on patients presenting with tibial plateau fractures (TPF) between January 2018 and June 2019. Of the 62 patients who presented in this period, 33 met the inclusion criteria of complex type TPF. Simple split fracture types and open fractures were excluded. All patients were operated in the supine position and anatomical locking plate or low profile buttress plates for additional fragments were used. Synthetic bone graft substitute was used in filling of the metaphyseal defects. Patients were evaluated clinically using the Knee Society Score and with radiographic examination using the Heiney-Redfern Scale.

All the patients were followed for an average of 13.39±4.63 months (range 6 - 24 months). All the included patients were males with the mean age of 41.3±12.84 years (range18-70 years). Objective knee society score graded excellent in 24 (72.8%) patients, good in 8 (24.2%) and fair in 1 (3%). Functional score, on the other hand, was excellent in 21 (63.6%), good in 9 (27.3%) and fair in 3 (9.1%) patients. Radiological outcome evaluated on x-rays and according to the H-R scale was good in 23 (69.8%) and fair in 10 (30.2%). Fracture union was achieved in all patients with no secondary loss of reduction.

The treatment of complex tibial plateau fractures with plate osteosynthesis and graft augmentation of metaphyseal defects has shown optimal results both clinically and radiologically. Excellent joint motion and knee society score is achieved by early rehabilitation following stable fixation. However, long-term risk of post-traumatic arthritis and its severity following complex TPF needs to be determined in different methods of fixation.