Comparison Between Conventional and Variable-Angle Locking Compression Plates in Complex Proximal Tibia Fractures

Proximal tibial fractures, particularly those involving the tibial plateau, are complex injuries that require careful management to restore knee function and prevent long-term disability. Recent advancements have introduced variable-angle locking compression plates (VALCP) as a potential alternative to the widely used fixed-angle locking plating techniques. These plates allow for more precise screw placement, potentially improving fixation and clinical outcomes. The goal of this study was to find out how well conventional locking plates and VALCP treat Schatzker's type I, II, and III tibial plateau fractures in terms of clinical, functional, and radiological outcomes. We evaluated the outcomes using the Rasmussen functional and radiological grading systems, as well as the Oxford Knee Score (OKS).

This prospective study was undertaken by a tertiary care medical institute from January 2020 to August 2021. The study included a total of 60 patients with Schatzker's type I, II, and III tibial plateau fractures. These patients were randomly assigned to two groups, with each group consisting of 30 patients. Conventional locking compression plates (CLCP) treated one group, while VALCP treated the other. Clinical, functional, and radiological outcomes of patients were evaluated using the OKS, Rasmussen's functional grading system, and Rasmussen's radiological grading system. Additionally, the study documented and examined the duration of the surgical procedure, the stability of the fixation, and any complications that occurred in the postoperative phase over a span of six months.

The study included 52 males and eight females, aged 19 to 65 years. The mean age was 42.66 years for the conventional LCP group and 35.6 years for the VALCP group. Road traffic accidents were the most common cause of injury, with 86.67% in the VALCP group and 70% in the conventional group. In both groups, the majority of fractures were Schatzker type II. At the six-month follow-up, 60% of VALCP patients had excellent functional outcomes compared to 50% in the conventional group. Radiologically, 80% of VALCP patients had excellent results versus 73.33% in the conventional group. The OKS showed that 86.67% of VALCP patients had excellent results, compared to 73.33% in the conventional group. While VALCP showed slightly better outcomes, the differences were not statistically significant. Complications were minimal, with 90% of VALCP and 86.67% of conventional LCP patients experiencing no complications.

The small number of patients, short-term study, and heterogeneity of fractures constitute a limitation of this study. VALCP plating in tibial plateau fractures is a good treatment modality because it seems to improve fixation, provides early mobilization, and has excellent to good functional and radiological outcomes. However, no significant difference in functional and radiological outcomes was found between the conventional and VALCP groups.