Fri., 10/19/07 Tibia, Paper #24, 10:54 am OTA-2007
Lateral Locking Plates for the Treatment of Bicondylar Tibial Plateau Fractures: A Treatment Protocol, Indications, and Results
J. Tracy Watson, MD (n); Matthew Phillips, MD (n);
Dave Karges, MD (e-Zimmer); James Jackman, MD (n);
Division of Orthopaedic Traumatology, Department of Orthopedic Surgery,
St. Louis University School of Medicine, St. Louis, Missouri, USA
Purpose: We hypothesize that a medial or posterior medial condyle fracture initially reduced with direct cortical apposition can be successfully stabilized with a laterally based locking plate for bicondylar fracture fixation. The purpose of this study was to evaluate a prospective staged protocol utilizing lateral locking plates for the treatment of select bicondylar plateau fractures.
Material and Methods: Over 3 years, patients admitted with complex tibial plateau (OTA 41-C1, C2, C3) fractures were treated according to a prospective protocol. Immediate application of knee-spanning external fixation to achieve ligamentotaxis reduction and put the soft tissues at rest was performed. Distraction radiographs and CT scans were evaluated for medial condylar reduction. Apex reductions demonstrating direct cortical apposition and minimal comminution underwent definitive fixation with only laterally based locking plates following soft-tissue recovery. Reductions demonstrating medial condylar comminution, inadequate fragment size, and inability to be reduced indirectly were treated with lateral and adjunctive medial plating.
Routine clinical follow-up included physical examination and standardized radiographss including mechanical axis determination with medial proximal tibial and lateral distal femoral angles calculated. Patients were followed through complete fracture healing and full weight bearing status.
Results: 63 patients with bicondylar plateau fractures were treated. 26 patients met radiographic criteria for solitary lateral locking plate fixation. 85% of patients sustained multiple injuries including compartment syndrome 20% and open fracture 16%. 25 patients were available for long-term follow-up (average 1 year; range, 6.5-28 months).
All fractures healed. Immediate postoperative medial proximal tibial angles ranged from 83° to 92°. 21 patients demonstrated no varus collapse. Four patients (16%) demonstrated minimal change (average 1° of varus) (not significant). Complications included superficial wound infection (2 patients) treated with antibiotics. Two patients (8%) required hardware removal. Functional outcomes were satisfactory, but demonstrated effects of associated injuries.
Conclusion: Our staged protocol demonstrates the importance of assessing medial condylar reduction. If the medial component is reduced with cortical apposition without apex comminution and adequate fragment capture size, no significant varus collapse will occur and a laterally based locking plate can be utilized with confidence for these bicondylar injuries.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.