Posteromedial plate application using medial midline incision for complex tibia plateau fractures: a retrospective study

Abstract

Background Application of a posterior plate for tibia plateau fractures associated with posterior column involvement is becoming a widespread standard practice as previous studies have shown that additional fixation of the posterior column with a posteromedial buttress plate creates strongest fixation in terms of fracture stabilization This study evaluated the clinical and radiological results of patients undergoing surgery for complex tibial plateau fractures involving the posterior column with a posteromedial plate applied via a medial midline incision. Methods Medical records of patients undergoing surgery for Schatzker type IV, V, and VI tibia plateau fractures involving the posterior column in our institution were reviewed retrospectively. Patients with a follow-up of less than 1 year, pathological fractures, posterolateral column fractures requiring separate fixation, and open fractures were excluded from the study. Three-dimensional computed tomography (3D CT) was performed in all patients before surgery. The study population consisted of 25 patients (21 males and 4 females) with a mean age of 41.5 (19–66) years. The etiologies of the fractures were traffic accidents in seven cases, pedestrian falls in five cases, falls from a height in seven cases, and motor vehicle accidents in six cases. Results The mean follow-up period was 15.9 months (12–25), mean time to union was 14.32 (9–20) weeks, mean Knee Society score (KSS) was 88 (81–95), and range of movement (ROM) was 123° (95°–140°). Loss of reduction was detected in only one patient (4%). A superficial incisional infection occurred in an anterolateral incision in only one patient (4%), and it recovered after oral antibiotic therapy. None of the patients required early implant removal and none had vascular or nerve complications in the postoperative period. Postoperatively, 23 (92%) patients had anatomical reduction and 2 (8%) had acceptable reduction in the sagittal plane CT sections. Acceptable reduction was achieved in 6(24%) patients and anatomical reduction was achieved in 19 (76%) in the coronal plane CT sections (Table 2). Conclusions Clinical results of posteromedial plate application using a single medial midline incision is promising as complication rates were very low and knee scores were high.

Supplementary Posteromedial Plating for the Fixation of Complex Tibial Plateau Fractures: A Prospective Study

“…Neogi DS et al prospectively followed 32 patients managed with dual plating and reported superficial infection in four (12.5%) and deep infection in one (4%) patient [ 21 ]. Söylemez MS et al observed a case of superficial infection in the anterolateral incision (4%), which healed with oral antibiotic treatment [ 4 ]. These findings do not vary significantly from our study, in which no cases of deep infection were seen.…”

“…Tibial plateau fractures (which account for 30% of all tibial fractures) are classified using the Schatzker or Association for Osteosynthesis/Orthopaedics Trauma Association (AO/OTA) classifications [ 6 , 7 ]. Bicondylar tibial plateau fractures, which fall under the Schatzker types V/VI or AO/OTA type 41-C, account for 18%-39% of all tibial plateau fractures and are unstable and serious injuries, with considerable articular depression, multiple displaced condylar fracture lines, meta-diaphyseal fracture extensions or comminutions, and significant deterioration of the soft-tissue envelope which may result in superficial or deep infection and skin necrosis and make them prone to compartment syndrome and vascular injuries [ 3 , 4 ]. These primary injuries frequently involve the menisci and the ligaments of the knee joint and, if left untreated, lead to the development of knee instability [ 5 ].…”

“…These primary injuries frequently involve the menisci and the ligaments of the knee joint and, if left untreated, lead to the development of knee instability [ 5 ]. Because of their high frequency, a large area of the joint involved, and significant displacement pattern suggesting instability of posteromedial tibial plateau fractures, surgeons should be aware of its fracture morphology and the potential need to fix this fragment using a posteromedial-based technique [ 4 , 5 ]. Posterolateral tibial plateau fractures (incidence 15%) involve a mean of 14.3% of the tibial plateau [ 7 ].…”

“…Conservative management by traction and cast was very common before the advent of internal and external fixation devices. However, the prognostic outcome was poor due to complications of stiffness and malunion [ 3 , 4 ]. For optimum treatment of these fractures, a general outline must be obtained by evaluating the mechanism and energy of the sustained injury, as well as a complete medical history, and thereafter, the fixation of the underlying fracture pattern should be planned by various operative options including definitive external fixation, less invasive stabilization system (LISS), dual plating with a single incision, and dual plating with a two-incision technique [ 8 , 9 ].…”

“…Tibial plateau fractures encompass a wide range of injuries, ranging from simple to complex fracture patterns, all of which are induced by high-energy trauma [1,2]. The number of PTPFs has risen in tandem in recent years with the rise in traffic accidents due to high-energy injuries [3][4][5]. Tibial plateau fractures (which account for 30% of all tibial fractures) are classified using the Schatzker or Association for Osteosynthesis/Orthopaedics Trauma Association (AO/OTA) classifications [6,7].…”