A modified subchondral raft technique using free 5.5-mm cannulated compression screws for depressed tibial plateau...

In tibial plateau fractures, achieving anatomical restoration of the articular surface and preventing postoperative collapse are critical for successful outcomes. Bone grafting is still commonly used to fill subchondral voids after reduction; however, it carries risks such as donor-site morbidity and technical difficulties. To address these issues and enhance subchondral stability, sub-chondral raft techniques have been developed. Although various screw and plate configurations have been investigated in the litera-ture, there is still no clear consensus regarding the most effective method. We aimed to evaluate the effectiveness of our modified technique using free 5.5-mm cannulated compression screws in preventing postoperative collapse and improving functional recovery in tibial plateau fractures.

A total of 21 patients were included based on the following criteria: age ≥18 years, presence of >10 mm depression in the lateral tibial plateau, and no history of previous surgery on the affected knee. A subchondral raft construct was established without grafting using free 5.5-mm cannulated compression screws. Postoperative evaluation at 12 months included radiological and functional assessments using the Rasmussen Clinical Score (RCS) and Rasmussen Radiological Score (RRS).

The mean preoperative articular depression was 14.7 mm, improving to 1.1 mm at the one-year follow-up. Mean condylar widening decreased from 5.3 mm preoperatively to 0.7 mm postoperatively. The average postoperative hospital stay was 3.7 days, and the mean time to return to work was 3.5 months. At one year, radiological and functional outcomes were favorable, with a mean RCS of 26.6 and a mean RRS of 16.6.

The modified raft technique using 5.5-mm cannulated compression screws is a simple and effective option for managing depressed tibial plateau fractures, preventing articular collapse and facilitating faster recovery.