J Korean Fract Soc.  2012 Apr;25(2):110-116. 10.12671/jkfs.2012.25.2.110.

Treatment of Tibial Plateau Fractures Using a Locking Plate and Minimally Invasive Percutaneous Osteosynthesis Technique

• Park HG
• Lee DH
• Lee KJ

• KMID: 2015453
• DOI: http://doi.org/10.12671/jkfs.2012.25.2.110

Abstract

PURPOSE
To acknowledge the importance of precise reduction of articular surface of tibial plateau fractures and to make a guideline of treatment by evaluating outcomes and effectiveness of using locking plate and minimally invasive percutaneous osteosynthesis technique.
MATERIALS AND METHODS
Twenty-nine patients who underwent surgery for tibial plateau fracture from November 2005 to March 2010 were enrolled with 12 months follow-up in a retrograde manner. The Shatzker classification was used to classify fractures, and we used lateral submeniscal approach to make a precise reduction of articular surface. Radiologic evaluation was determined by presence of bone union, malalignment, and reduction loss or joint depression of articular surface. Post-operative infection, time of active movement of the knee joint, time of partial weight loading, and range of motion (ROM) of knee joint were evaluated. Lysholm Knee Score was used for functional evaluation.
RESULTS
Bone union took place in all but one case that developed osteomyelitis. Angulation deformity of more than 10degrees and reduction loss or joint depression of more than 5 mm were not observed. There was one case of osteomyelitis and one case of superficial surgical site infection. There were satisfactory clinical results, with an average time of active knee joint movement and weight loading of 6 weeks. The average ROM of knee joint was 125degrees in the last follow up. As for functional evaluation using Lysholm Knee Score, cases showed an average Lysholm Knee Score of 94 which was a satisfactory result.
CONCLUSION
In cases of tibial plateau fractures, if a surgeon accurately reduces the articular surface of joint and use minimally invasive locking plate it will help in bone union biologically, reducing the incidence of soft tissue injuries, and biomechanically maintaining the articular surface of the joint, proving itself to be a useful method of treatment.

Keyword

Tibial plateau fracture; Anatomical reduction; Locking plate with MIPO technique

MeSH Terms

Congenital Abnormalities
Depression
Follow-Up Studies
Humans
Hypogonadism
Incidence
Joints
Knee
Knee Joint
Mitochondrial Diseases
Ophthalmoplegia
Osteomyelitis
Range of Motion, Articular
Soft Tissue Injuries
Hypogonadism
Mitochondrial Diseases
Ophthalmoplegia

Figure

• 

  Fig. 1 (A) As a surgical method, we used a lateral submeniscal approach to make a precise reduction of the articular surface. (B) Following elevation, subarticular defects were filled with allograft. (C) Intraoperative fracture reduction was assessed with direct visualization and biplanar fluroscopic images. (D) The metaphyseal-diaphyseal component was stabilized with a locking plate placed in a submuscular tunnel (minimally invasive percutaneous osteosynthesis technique).

• 

  Fig. 2 A 46-year-old man with Shatzker type VI (road traffic accident). (A) Preoperative x-ray and computed tomography. (B) 1 year postoperatively showing application of a medial plate (dual incision).

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  Fig. 3 A 27-year-old man with Shatzker type VI (motorcycle traffic accident). (A) Preoperative x-ray and computed tomography. (B) At the last follow-up, radiograph shows satisfactory results.

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