A study on functional outcome of osteosynthesis for fracture proximal tibia

Abstract

Background: The ultimate objective in the management of tibial plateau fracture is to ensure anatomic reduction, restore the axial alignment and maintain a stable fixation such a way to prevent the secondary displacement of fracture fragment. The various type of managing the tibial plateau fractures apart from conservative management are open reduction and internal fixation, closed reduction and percutaneous fixation and hybrid type of external fixation. Aim: To evaluate the functional outcome of osteosynthesis of tibial plateau fractures using different surgical techniques after a minimum period of 6 months by using Rasmussen scoring system. Methodology: All patients with proximal tibial fracture in the age group between 20 and 60 years were included as our study subjects. A total of 38 patients were taken as our study subjects. The tibial fractures were classified based on schatzker type of fracture classification. Fracture reduction was done under Carm guidance by closed methods using ligamentotaxis. After confirming the reduction under C-arm guidance fixation of the fracture was done with locking plate. Functional outcome assessment of knee joint was done after six months post-operatively by using Rasmuseen score, which includes pain perception, walking capacity, extension at knee joint, range of movements and stability. Results: Majority of the patients who had undergone closed reduction with cancellous screw procedure or open reduction and internal fixation with buttress plate and bone graft had the functional outcome between excellent and good whereas patients who had underwent dual plating had a fair to poor outcome and this difference was found to be statistically significant. Pain and knee stiffness were reported in very few patients at the end of 6 months. Conclusion:In the management of tibial plateau fractures, open reduction with internal fixation using plate screws with lesser soft tissue dissection would lead to excellent functional outcome.