Surgical fixation methods for tibial plateau fractures

Area of Science:

• Orthopaedic Surgery
• Trauma Management
• Biomaterials Science

Background:

• Tibial plateau fractures are intra-articular knee injuries with high complication rates, including early osteoarthritis.
• Surgical fixation is common for complex fractures, often involving bone defect fillers.
• Current treatment lacks consensus on optimal fixation methods and the necessity of bone defect fillers.

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 defect fillers used in treating these fractures.

Main Methods:

• Systematic search of CENTRAL, MEDLINE, Embase, and trial registries up to March 2023.
• Inclusion of randomized controlled trials (RCTs) and quasi-RCTs comparing surgical techniques and bone fillers.
• Independent data extraction and risk of bias assessment, with GRADE certainty assessment.

Main Results:

• Fifteen trials (948 participants) were included, all with high risk of bias and very low certainty of evidence.
• Limited evidence suggests hybrid fixation may have little effect on function or reoperation compared to ORIF, but is very uncertain.
• No significant differences were found between single-plating and double-plating ORIF for function, with very uncertain evidence.

Conclusions:

• Insufficient evidence exists to recommend specific surgical fixation methods for tibial plateau fractures.
• The optimal approach for managing bone defects in these fractures remains unclear.
• Further well-designed RCTs with larger sample sizes are required to establish best practices.