Sat., 10/10/09 Knee/Tibia, Paper #86, 4:32 pm OTA-2009
Fracture Pattern and Fixation Type Related to Loss of Reduction in Bicondylar Tibial Plateau Fractures
Michael J. Weaver, MD1,3 (7-Synthes); Adam C. Strom, BS2 (n);
R. Malcolm Smith, MD3 (7-Synthes); Mitchel B. Harris, MD1 (7-Synthes);
David Lhowe, MD3 (7-Synthes); Mark S. Vrahas, MD1,3 (7-Synthes);
1Brigham and Women’s Hospital, Boston, Massachusetts, USA
2Dartmouth University, Hanover, New Hampshire, USA
3Massachusetts General Hospital, Boston, Massachusetts, USA
Purpose: The purpose of this study was to evaluate the relationship between fracture pattern and method of fixation and loss of reduction in bicondylar tibial plateau fractures.
Methods: We reviewed a consecutive series of bicondylar tibial plateau fractures, with preoperative CT scans and minimum 4-month follow-up. Fracture patterns were classified by CT. Articular alignment was measured postoperatively and again at union to assess loss of reduction.
Results: 140 patients were studied. Preoperative CT scans revealed 47% had a single large medial fragment with the articular surface intact, 14% had a medial articular fracture line without a coronal component, and 39% had a coronal fracture through the medial articular surface. All patients were treated with unilateral locked plating except for 11 with a medial coronal fracture, who had dual plating.
Patients with a medial coronal fracture treated with unilateral locking plates had a median change of 2° (range, –4.5° to 13°) into varus at healing compared to 0.5° (range, –2.5° to 8°) for patients without a medial fracture line (P = 0.002, Mann-Whitney U test). Median loss of reduction for patients with medial coronal fractures treated with dual plating was 0.5° (range, –2° to 3.5°). Patients with coronal fracture lines treated with dual plating had significantly less loss of reduction that those treated with unilateral locked plating (P = 0.019).
Conclusion: We demonstrate increased loss of reduction of bicondylar tibial plateau fractures treated with unilateral locked plates when a medial coronal fragment is present. Our data suggest improved maintenance of alignment when dual plating is used for these fractures compared to unilateral locked plating.
Disclosure: (n=Respondent answered 'No' to all items indicating no conflicts; 1=Board member/owner/officer/committee appointments; 2=Medical/Orthopaedic Publications; 3=Royalties; 4=Speakers bureau/paid presentations; 5A=Paid consultant or employee; 5B=Unpaid consultant; 6=Research or institutional support from a publisher; 7=Research or institutional support from a company or supplier; 8=Stock or Stock Options; 9=Other financial/material support from a publisher; 10=Other financial/material support from a company or supplier).
• 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. Δ OTA Grant