Fragment-specific fixation of simple and complex tibial plateau fractures using mini fragment plates

In some multi-fragment tibial plateau fracture patterns, it may be more technically demanding to provide the appropriate support when using anatomic pre-contoured proximal tibial plates or other small fragment plates, especially when buttressing smaller apex-directed fracture fragments. The purpose of this study is to describe our surgical technique and highlight the potential role of low profile, mini fragment (2.0_2.7 mm) plates in the surgical management of different types of tibial plateau fractures.

This is a retrospective study of 45 cases (45 patients, 31 males, mean age of 43.5 years) who had unicondylar or multicondylar tibial plateau fractures and were surgically managed using mini fragment plates, either as supplementary or standalone implants. The clinical notes and radiographs were reviewed to determine performance and complications, with particular focus on bony union, loss of reduction, implant failure, and soft tissue complications.

No intraoperative complications were recorded, and after a mean of 50.7 months, all the fractures have united. Two cases had knee stiffness and required manipulation under anesthesia, while only one case of secondary mild joint space depression was noted in the follow-up radiographs. No cases of nonunion, implant failure, or other cases of loss of reduction were recorded at the last radiolographic follow-up. Two patients required plate removal, at 4 months (a skeletally immature patient) and 18 months (another patient presented with secondary wound infection) postoperatively after fracture union. At the last radiographic follow-up, the average postoperative knee flexion was 121 degrees (range, 100-140), and the average postoperative Kellgren-Lawrence OA grade was 1 (range, 0-4).

The low-profile mini fragment plates are effective implants that may be safely used, either in association with other proximal tibial anatomic plates or as standalone implants, depending on the fracture configuration, with overall good outcomes.