Will the Articular Surface Collapse After the Fixation of a Tibial Plateau Fracture?

Tibial plateau fractures present significant challenges, especially when joint depression is accompanied by metaphyseal comminution. The primary objective in these fractures is to attain, if feasible, an anatomic reduction of the articular surface, thereby restoring joint congruity and mechanical alignment to enhance functional outcomes and decrease the incidence of post-traumatic arthritis. Fractures with significant depression of the articular surface necessitate the elevation of the depressed fragments and stable internal fixation.

This study aimed to assess prospectively postoperative articular congruity and determine the articular surface collapse following open reduction and restoration of depressed tibial plateau fractures. The analysis of results was made in terms of age of patients, sex distribution, type of fracture, and special habits. The second objective of the study was to evaluate the surgical and patient-related factors associated with this drawback. The data were analyzed to detect any statistically significant correlation between these parameters and clinical and radiographic outcomes using Rasmussen's clinical and radiological grading systems in a six-month follow-up.

Patients with tibial plateau fractures were selected based on inclusion and exclusion criteria, and these fractures were categorized according to the Schatzker classification based on post-traumatic anteroposterior and lateral X-ray films. In addition to that, all patients had preoperative CT scans of the injured knee. The sample size consisted of 40 cases with a history of proximal leg or knee trauma. All cases underwent open reduction and restoration of the articular surface. Depression of the joint surface was elevated under visual control; a buttress plate and screws were used for internal fixation. For inclusion in the present analysis, two conditions had to be satisfied: adequate reduction with plate fixation and a follow-up period of at least six months. Radiological follow-up included an early postoperative X-ray and CT scan, serial follow-up X-rays, and an X-ray and CT scan at six months.

Fourteen (35%) patients assessed experienced postoperative articular surface collapse during the follow-up evaluation. A statistically significant association was found between postoperative articular surface collapse and the following variables: age, preoperative articular surface fragmentation, use of bone graft, smoking, and early weight-bearing. Collapse correlated strongly with clinical outcomes, including significant knee pain (p<0.001) and reduced walking capacity. The presence of collapse also adversely affected the radiographic scores at follow-up (p < 0.001).