We carried out percutaneous, arthroscopicallyand fluoroscopically-assisted osteosynthesis of fractures of the tibial plateau in 52 patients, of whom 38 were assessed using the HSS knee score and standing radiographs. We reviewed 31 AO type-B fractures and seven type-C fractures after a mean follow-up of five years (1 to 14). Fixation was achieved using percutaneous screws and/or an external frame; 33 associated intra-articular injuries, diagnosed in 21 out of the 38 patients, were treated arthroscopically.Subjectively, 94.7% of the patients reviewed were satisfied. According to the HSS knee score 78.9% of the results were excellent, 13.2% good, 7.9% fair and none was poor. Narrowing of the joint space was found in 28.9% of the injured and 5.3% of the unaffected knees and axial deviation of 5° to 10° in 15.8% of the injured and 10.5% of the unaffected knees.Of the 52 fractures, reduction was incomplete in one, and in two secondary displacement occurred, of which one required corrective osteotomy. Deep-venous thrombosis occurred in four cases.The technique has proved to be safe but demanding. It facilitates diagnosis and appropriate treatment of associated intra-articular lesions.J Bone Joint Surg [Br] 1998;80-B:959-64. Received 30 December 1997; Accepted after revision 30 April 1998 In fractures of the tibial plateau precise reduction of the articular surface with stable fixation restores the mechanical axis allowing early mobilisation. Ligamentous stability and preservation of the menisci are important for a longlasting result.1-9 Open reduction and internal fixation has a significant complication rate 8,10,11 which has encouraged interest in percutaneous techniques. [12][13][14][15] Arthroscopy is particularly helpful since it provides a good view of the fractured articular surface and any other intra-articular lesion, while limiting soft-tissue damage. Good early results of arthroscopically-assisted osteosynthesis of fractures of the tibial plateau have been reported previously. [16][17][18][19][20][21][22][23] There are few long-term studies. Our aim was to determine whether the good immediate results withstood the test of time.
Patients and MethodsWe performed arthroscopically-assisted treatment in 64 patients with fracture of the proximal tibia involving the knee. In seven the intercondylar eminence had been avulsed in a single injury; they were excluded because they represented an isolated injury to the cruciate ligament. Another five patients were treated conservatively after arthroscopic evaluation and were also excluded. In the 52 remaining patients the fractures were reduced percutaneously and fixed under arthroscopic and fluoroscopic control by one of the senior authors (FH or PPC). There were 38 patients, 22 women and 16 men with a mean age at injury of 47 years (14 to 81), available for independent review (TS or CSN). One patient had died from an unrelated cause and 13 others could not be traced or refused to participate in the study. These lost patients were assessed from their hospital records...