PERCUTANEOUS PLATING OF PROXIMAL METAPHYSEAL TIBIAL FRACTURES

Abstract

In a prospective study, we reviewed 52 metaphyseal fractures of the proximal tibia treated by percutaneous plating between January 1996 and October 2000. Owing to the proximity of the fractures to the joint, intramedullary nailing was not suitable.

The mean age of the patients, most of whom were men, was 41 years (16 to 82). Five fractures were open. There were 10 comminuted fractures extending into the diaphysis and five segmental fractures. The fractures were reduced and under the image intensifier percutaneously plated through a short approach proximal to the fracture. Fracture reduction was achieved either by manipulation and traction or by use of femoral distractor and reduction clamp. Synthes tibial head buttress plates and screws were used for stabilisation. On average, three proximal and distal screws were percutaneously inserted. Satisfactory fracture reduction was achieved in the anteroposterior plane in all fractures, but in the sagittal plane tilting of the proximal fragment was observed in five cases. There were no intra-operative neuro-vascular complications. Postoperatively the leg was immobilised in a brace for 6 to 12 weeks. At a mean of six to eight weeks, when radiological signs of healing were noted, weight-bearing was permitted. The mean time to union was 12 weeks (8 to 18). There were two cases of delayed union. No patient had functional restrictions, secondary displacement or failure of fixation. In four patients the proximal screws backed out, but this did not affect functional outcome. Late sepsis, which developed at the site of the distal screws in six patients, subsided after drainage of abscesses in two patients and removal of plate and screws in four.

Percutaneous plating may be used to manage proximal tibial fractures unsuited to intramedullary nailing.