IS ARTHROSCOPICALLY ASSISTED TREATMENT OF TIBIAL PLATEAU FRACTURES BETTER THAN OPEN TREATMENT? AN OUTCOME COMPARISON OF 50 CASES OF EACH OPTION

Abstract

Objectives: tibial plateau fractures are a therapeutic challenge for the trauma surgeon. Arthroscopically assisted surgical treatment (AT) is an option in these fractures that is used more and more frequently even in more complex lesions. The objective of this study is to determine if, at a minimum 1 year follow up, arthroscopic treatment is comparable to open treatment (OT) in respect to radiologic and functional outcomes.

Materials and Methods: We have prospectively reviewed our first 50 arthroscopic cases and compared them with 50 open surgery cases examined retrospectively. The cases in the second group were selected from a database of 87 patients and were matched for Schätzker type, degree of displacement, age and sex with cases of the first group. In each group there were 50 patients (33 male/17 female; mean age: 45,4 years in the AT group and 43,6 years in the OT group). Of the 50 cases in each group, ten were Schätzker I tibial plateau fractures, sixteen were type II, seven type III, eleven type IV, three type V and three type VI. In the AT group all fractures were reduced and fixated with cannulated screws under direct arthroscopic control and in 6 cases a percutaneous plate was added. In the OT group all fractures were reduced and fixated with cannulated screws under direct vision (n=41) or radiologic control (n=9) and in 37 cases a plate was added. Associated lesions were identified and treated accordingly in both groups. Results were evaluated with the following scales: Rasmussen, Honkonen, ICDK, Lysholm, SF-36 and Knee Society scores.

Results: All cases were available for follow up a minimum of 12 months after surgery (2.6 +/−1.4 years in AT and 3.7+/−1.5 years in OC). The patients in the AT group had lower hospital stances (p< 0.05) and lesser postoperative wound complications (zero versus 3). Radiological reduction and alignment was considered excellent or good in 92% of AT cases and 88% of OT cases. Knee society scores were 191+/−18 in AT and 176+/−21 in OT. Lysholm scale scores were 85+/−20 in AT and 72+/−21 in OT. Rasmussen scale scores were 29+/−2.2 in AT and 26+/−3.9 in OT. Most of the differences between both groups was related to range of motion but pain scores were similar.

Conclusions: Arthroscopically assisted treatment of tibial plateau fractures seems to offer better results than open surgery with less hospital stay, lesser postoperative complications and clearly improved range of motion. It can be considered an adequate alternative to traditional open reduction and fixation even in complex fractures.