Session V - Knee / Tibia

Fri., 10/11/13 Knee/Tibia, PAPER #58, 2:30 pm OTA 2013

Are Locked Plates Needed for Fixation of Split Depression Tibial Plateau Fractures (Schatzker Type II)?

Michelle Abghari, BS; Alejandro I. Marcano, MD; Roy Davidovitch, MD; Sanjit Konda, MD;
Kenneth A. Egol, MD;
NYU Hospital for Joint Diseases, New York, New York, USA

Background/Purpose: Displaced tibial plateau fractures most often need surgical treatment. Usually a plate and screw construct is used in treatment of these fractures. Locking plate technology has seen an increase in usage for both complex and simple fracture patterns without evidence demonstrating their efficacy. The purpose of this study is to compare the clinical use of locked versus unlocked plating for repair of displaced Schatzker type II tibial plateau fractures.

Methods: 91 consecutive patients treated surgically for Schatzker type II tibial plateau fractures were prospectively seen over a 5-year period. 42 patients (46.2%) were treated using a locked plate and screw construct and 49 (53.8%) were treated with an unlocked plate and screw construct. Pre- and postoperative care, plate morphology and length, and patient demographic factors were similar in both groups. Clinical outcomes of the two groups were assessed using Short Musculoskeletal Function Assessment (SMFA) scores, pain levels, and range of knee motion. Radiographic outcome was assessed with plain films at all follow-up points. Implant costs for the 2 types of constructs were calculated from hospital purchasing records.

Results: Patients were assessed at a mean 13.9 months (range, 6-72) of follow-up. Comparing patients treated with locked versus unlocked constructs, no significant differences were seen in physical exam parameters or radiographic outcomes. Total SMFA scores did not differ; however, the SMFA Functional Domain was significantly better in the unlocked group (Table 1). The locked construct cost an average $400 more than the unlocked construct.

Conclusion: Based on the clinical outcomes and cost per implant, we can find no evidence to support the routine use of locked plating for simple split depression fractures of the lateral tibial plateau. The use of standard nonlocked, precontoured implants provide adequate fixation for these fracture patterns.

Alphabetical Disclosure Listing

• 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.