PERCUTANEOUS SCREW FIXATION OF UNICONDYLAR TIBIAL PLATEAU FRACTURES.

Abstract

Background: Tibial plateau fractures are common injuries which often produce major disability. Open reduction and internal fixation of these fractures has a significant complication rate and numerous recent reports have a tendency to avoid open plating in favour of a variety of limited surgical approaches and percutaneous techniques usually in association with external fixation.

Patients and Methods: The technique of closed manipulation, indirect reduction and percutaneous screw fixation was attempted in 29 displaced tibial plateau fractures (Schatzker types I – IV) in 29 patients. Closed, indirect reduction was successful in only 25 fractures (86.2%); and the remaining four cases were excluded from the study. Patients` age ranged from 19 – 62 years (average 41 y.). Of the 25 fractures, 4 (16%) were open; type I or II Gustilo Anderson classification. Additional mini incision to raise a depressed articular fragment and to apply a bone graft was needed in 12 fractures (48%). Post operative cast or brace was applied for 3–5 weeks. Full weight bearing was started 8–12 weeks postoperatively.

Results: Anatomical reduction was achieved in 20 fractures (80%), and the remaining 5 (20%) were showing grade I residual step or gap formation. Bone healing was achieved in all cases (100 %); and occurred in 8 – 12 weeks (average 9.4 w.) Patients were followed for 24 – 37 months with an average of 30 months. According to the HSS knee score; there were 9 excellent (36%), 13 good (52%), and 3 fair (12%) final end results. According to the Iowa Knee Score there were 14 excellent (56%), 9 good (36%), and 2 fair (8%) final end results. Of these 25 patients, 76% (19 patients) were satisfied; and 24% (6 patients) were not satisfied by the final end result. There were no cases of loss of reduction, wound infection, or cases with poor final clinical outcome.

Conclusion: Indirect technique of reduction combined with percutaneous screw fixation could effectively reduce most displaced unicondylar tibial plateau fractures (Schatzker types I – IV) and is associated with good final outcome, with few reported complications.