Uniaxial versus polyaxial plating in tibial plateau fractures: a pilot prospective randomized controlled trial

Polyaxial plates allow screw placement at variable angles, offering potential advantages over monoaxial locking plates. However, no comparative studies have assessed their efficacy in tibial plateau fractures. This study evaluates the clinical, radiological, and functional outcomes of uniaxial versus polyaxial locking plates in tibial plateau fracture management.

This prospective randomized controlled trial included 40 patients with AO/OTA 41 B-C tibial plateau fractures. Patients were stratified into low-grade (Schatzker 1-3) and high-grade (Schatzker 4-6) fractures and randomized to receive either uniaxial or polyaxial locking plates. Clinical (Visual Analogue Scale and Rasmussen clinical scores), radiological (Rasmussen radiological score), and functional (Knee Society functional score and Knee Injury and Osteoarthritis Outcome score) assessments were conducted at 3, 6, 12, and 24 months postoperatively.

The study included 32 high-grade and eight low-grade fractures, predominantly in young males (M:F = 37:3). Both groups had comparable demographics and fracture patterns. The polyaxial plating group (n = 20) had reduced intra-operative radiation exposure. However, no significant differences were observed in overall clinical, radiological, and functional outcomes (p > 0.05). Subgroup analysis of high-grade fractures showed significantly better clinical scores in the polyaxial group beyond six months up to the last follow up (p < 0.05).

Polyaxial plates facilitate fixation and reduce intra-operative variables. While radiological and functional outcomes were similar, clinical outcomes were slightly better in high-grade fractures. These findings suggest polyaxial plates could be preferable for managing complex tibial plateau fractures.

Therapeutic Level 1.

CTRI/2020/02/023280, https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MzgyMzk=&Enc=&userName=. Registered on: 13/02/2020.