Multi-plate reconstruction for severe bicondylar tibial plateau fractures of young adults

Abstract

Purpose This study was to evaluate clinical outcomes and complications following multi-plate reconstruction for treating severe bicondylar tibial plateau fractures of young adults. Methods Between September 2007 and February 2012, 26 patients with severe bicondylar tibial plateau fractures met inclusion criteria; they were treated using multi-plate technique through combined approaches. Patients received an average follow-up of 40.8 (range, 18-64) months, which included anteroposterior and lateral imaging, postoperative complications, range of motion and stability of the knee. The Rasmussen score was applied for functional and radiological evaluation. Results Three to five plates were used for reconstruction. No intra-operative complications occurred. Postoperative complications included bulge of hardware in four patients and superficial dehiscence in three cases in the anterolateral incision of which one developed to deep infection. There was no neurovascular damage, and no implant breakage or loosening. Hardware was removed partly or totally in 16 cases. The average Rasmussen score at final follow-up was 27.2 (range, 21-30) points for functional evaluation and 16.4 (range, 14-18) for radiology. Conclusions Multi-plate reconstruction is a valid and safe method for treating severe bicondylar tibial plateau fractures of young adults.

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

“…With the combination of a heavy lateral locking plate and multi medial-posterior small antiglide plates, good results were achieved in 12 patients in the preliminary report [7]. Zhai et al [26] reported their experience with applying multi-plates (3-, 4-, and 5-plates) for severe and complicated bicondylar tibial plateau fractures in 26 young patients. They used 3.5-mm T-plates for the medial and posterolateral fragments, and a heavy locking plate for the splitdepressed anterolateral fragment.…”

“…For those complex bicondylar fractures, anatomic reduction of the PM fragment is of paramount importance [4,7,26,27]. By exact reposition of the distal V-shaped fracture spike, the fragment height and tilt angle can be anatomically restored.…”

“…Additionally, the attachment of the ACL/ PCL may be isolated from the intercondylar spine and form a solitary fragment. Clinically, because the posterolateral quadrant fragments are very difficult to approach and fix, involving the posterolateral quadrant is a marked feature of the term "severe and complex bicondylar tibial plateau fractures" [26].…”

Comparison of the pre-shaped anatomical locking plate of 3.5 mm versus 4.5 mm for the treatment of tibial plateau fractures

“…However, the use of two plates can expose difficulties when implanting a total knee arthroplasty, with the obligation to remove the plates through two incisions and a longer surgery time. Some authors proposed a multiplate reconstruction for severe bicondylar tibial plateau fracture, especially for young adults, with three to five plates [23]. In order to reduce cutaneous and septic complications a double mini-invasive surgical access was proposed.…”

The application of a three-column internal fixation system with anatomical locking plates on comminuted fractures of the tibial plateau

“…The operations were all performed by the same chief surgeon (ChenShou Lin). All cases were treated with reduction and internal fixation through combined approaches [4] (Fig. 2a), i.e.…”