Session II - Tibia
Fri., 10/8/04 Tibia, Paper #11, 11:17 am
Functional Outcomes of AO/OTA C3 Bicondylar Tibial Plateau Fractures Treated with Dual Incisions and Medial and Lateral Plating
Purpose: We report on the functional outcomes of high-energy AO/OTA C3 bicondylar tibial plateau fractures stabilized with medial and lateral plating using anterolateral and posteromedial surgical approaches. We correlated the adequacy of operative reduction with functional outcome.
Methods: Between 1994 and 2001, all patients sustaining an intraarticular fracture of the proximal tibia were identified from a prospectively designed orthopaedic database. Eighty-three patients sustained 83 complex tibial plateau fractures classified as AO/OTA type 41-C3. All were treated with medial and lateral plate fixations with use of two incisions. The use of a midline anterior surgical approach was abandoned prior to the study period, and, similarly, fixed-angle screw/plate devices were not yet available. Forty-one patients completed the Musculoskeletal Function Assessment (MFA). Two orthopaedic trauma-trained surgeons blinded to the MFA scores independently assessed the quality of reduction on intraoperative and immediate postoperative plain radiographs with use of four radiographic parameters: articular reduction, sagittal alignment, coronal alignment, and condylar width. Statistical analysis was performed by use of a regression model.
Results: There were 23 male and 18 female patients with an average age of 46 years (range, 21 to 72). The mean time of follow-up was 55 months (4.6 years) (range, 30 to 104). Twenty-four patients (58%) were treated with temporary spanning external fixation prior to definitive open reduction internal fixation. The average delay to definitive fixation was 8.75 days (range, 0 to 30). Five patients sustained open injuries (12%). Four patients had an associated compartment syndrome (9.7%). Complete radiographic information was available for 31 patients. All patients sustained fractures involving the articular surface of the lateral tibial plateau. Ninety percent of these demonstrated comminution and depression of the lateral articular surface. In addition, 68% of patients had fractures involving the articular surface of the medial tibial plateau. Of these, 66% were simple fractures, 19% were comminuted, and 14% demonstrated comminution with articular depression. Seventeen patients (55%) had a satisfactory articular reduction (#2 mm step or gap), 28 patients (90%) had satisfactory coronal plane alignment, 21 patients (68%) demonstrated satisfactory sagittal plane alignment, and all 31 patients demonstrated satisfactory plateau width. The mean MFA score was 24 (range, 1 to 63). Age and the presence of polytrauma were statistically associated with a higher (worse) MFA score (P = 0.037 and P = 0.014, respectively). When age and the presence of associated polytrauma were accounted for, regression analysis demonstrated that a satisfactory articular reduction was significantly associated with a lower (better) MFA score (P = 0.033). When compared with normative data, patients sustaining C3 bicondylar tibial plateau fractures treated with open reduction internal fixation with use of medial and lateral approaches and plating demonstrated significant residual dysfunction.
Conclusions: This study was performed to evaluate the functional outcomes of a homogenous group of fractures treated with a consistent surgical method. An accurate reduction of the articular surface was correlated with an improved outcome and should be the primary surgical goal in the treatment of these injuries.