Two-level fixation with headless compression screws for tibial plateau fractures

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• Tibial plateau fractures with small, "floating" intra-articular fragments present significant reduction and fixation challenges.
• Standard fixation methods using k-wires or lag screws may be insufficient for these complex fracture patterns.

Purpose of the Study:

• To describe a two-level fixation technique utilizing fully threaded headless compression screws for interfragmentary fixation of small fragments in comminuted tibial plateau fractures.
• To evaluate the clinical experience and outcomes of this surgical approach.

Main Methods:

• A retrospective case series of 29 patients with comminuted tibial plateau fractures treated between 2006 and 2021.
• Involved a two-level fixation strategy: initial interfragmentary fixation of small fragments with headless compression screws, followed by plate fixation.
• Clinical outcomes were assessed at a median follow-up of 16.5 months, with functional outcomes measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at a median of 5.2 years.

Main Results:

• Anatomic or good reduction was achieved in 82% of cases.
• Postoperative arthrosis was observed, with 25% of cases showing grade 0.
• Functional outcomes, measured by KOOS, showed variable results across different subscales, with median scores for symptoms/stiffness at 69 and sports at 30.

Conclusions:

• The described two-level fixation technique, incorporating fully threaded headless compression screws, is a simple and effective addition to managing comminuted tibial plateau fractures.
• This method aids in achieving satisfactory reduction and fixation of challenging intra-articular fragments.