A study on outcomes of posteromedial buttress plating in tibial plateau fractures

Abstract

Introduction: Bicondylar tibial plateau fractures with posteromedial fragment have always posed a challenge to the surgeons. Time to time, with better imaging modalities, the understanding of these fractures have improved and fixation modalities have changed. The morphology and position of the posteromedial fragment is such that lateral locking plate alone may not be sufficient to hold this fragment, leading to late varus collapse. To counter this problem, a separate posteromedial buttress plate is now been used by surgeons and our study aims at analysing the functional outcomes in patients treated with these posteromedial buttress plate. Materials and method: This was a prospective study carried out between June 2016 to June 2019 at Civil hospital Ahmedabad. 30 patients with Schatzker type IV, type V and type VI injuries with posteromedial fragment were included. They were operated with posteromedial buttress plate and lateral locking plate or screws. These patients were followed up at 15 days, 1.5 months, 3 months and 6 months and outcome was assessed according to Rasmussen's radiological and functional scoring. Results: The most common age group in these patients was 20-39 years with male predominance. Road traffic accident was the commonest mode of trauma. Excellent outcome was found in 67%, good in 26%, fair in 7% and no case of poor outcome. There were no cases of loss of reduction, malalignment or late varus collapse. The rate of complication was low. Conclusion: Posteromedial fragment in tibial plateau fractures is best managed with a separate posteromedial buttress plate rather than relying on lateral based fixation device. Properly planned fixation with accurate anatomical articular reduction and rigid fixation results in overall excellent outcome with low rate of complication.