Introduction and purpose: Fractures of the tibial plateau account for 1% of the total. Among them, 55–70% involve the lateral plateau with differences in separation and subsidence. Minimally invasive osteosynthesis under arthroscopic control increases the indications in these cases. Our purpose is to assess the long-term clinical and radiological outcomes. Materials and methods: We carried out a retrospective analysis of the medium-term results of closed fractures of the tibial plateau treated with arthroscopic reduction and percutaneous fixation with cannulated screws. A series of 32 patients with displaced fractures of the tibial plateau underwent surgery between 1993 and 2004. We used the AO classification. We analysed the clinical, functional and radiological results. Results: The mean follow-up was 6 years. We treated 12 type 41B1, 7 type 41B21, 5 type 41B22, 7 type 41B31 and 1 type 41B12. All the fractures were consolidated and 79.1% had anatomical reduction. External meniscal injuries that could be sutured were present In 11 cases (34.3%). Joint balance was complete in 24 knees. According to the Lysholm scale 23 had an excellent outcome and 9 good. One case presented infection of the surgical wound, which was resolved by surgical debridement and antibiotic therapy. Conclusions: The results suggest that this is a good method for treating selected fractures of the tibial plateau

Background

There exists no consensus opinion as to the most suitable post-operative rehabilitation and weight bearing status for proximal tibia articular fractures treated with internal fixation using plates and screws.

Introduction

The optimal management of intra-articular tibial plateau fractures with metaphyseal-diaphyseal dissociation remains challenging and controversial. We report results using the technique of limited open reduction with external fixation using a fine wire circular frame.

Aims

Our objective was to conduct a systematic review and meta-analysis, to establish whether differences arise in clinical outcomes between autologous and synthetic bone grafts in the operative management of tibial plateau fractures.

Aim: Complex tibial plateau fractures, Shatzker type VI, rare in the past, became more common nowadays because of high energy injuries. These complex fractures usually accompanied by compromised skin and soft tissue envelope requires deliberate planning as treatment in the past invite a high rate of complications.

Materials and method: During a period of 24 months, 16 fractures of tibial plateau, Shatzker VI, were treated in 16 patients, all regarding vehicle accidents.11 patients were men and 5 women with a mean age of 42 years old (27–67).There were 2 open and 14 closed fractures (3 type I, 8 type II and 3 type III according to Tscherne’s classification).All cases were treated with circular external fixators (hybrid), whereas 9 of them needed additional mini internal fixation (one or two screws).

Results: 14 patients were evaluated with a mean period of follow up 1.9 years. Healing was achieved in all 14 cases with a mean period of 16 weeks (12–24).Fixator removal was performed when bone healing was completed. There was no deep infection. 12 patients at the end of treatment had a range of motion between 0° – 120°. 3 fractures developed a malunion (1 valgus deformity, 2 anterior angular deformity). Radiographic evidence of arthritis appeared in 2 patients during follow up. Pin tract infection occurred in one case, treated with antibiotics.

Conclusion: The use of circular external fixators (three olive wires to tibial plateau) obtains good stabilization while allows early joint motion, protects soft tissue envelope and in combination with minimal internal fixation achieves satisfactory reduction of comminuted fractures making the technique promising for the management of these complex fractures.

Purpose of the study: We compared in vitro the efficacy of screw-plate fixation versus double screw fixation on a model of type 2 Schatzker fracture of the lateral tibial plateau.

Materials and methods: Ten screw-plate fixations using a lateral prebent plate and 10 double-screw fixations (6.5 mm screws) were made on 10 pairs of non-embalmed cadaver knees after simulation of type 2 Schatzker fractures. The strength of each fixation was tested with a compression device. Criteria indicating failure were displacements greater than 2 mm of one or more fracture lines. The force applied at rupture and the stiffness of each type of fixation were compared. Wilcoxon’s test was used for statistical analysis.

Results: Force at rupture and stiffness of the fixation were similar for the two types of fixation. There was no statistical difference (p > 0.05) between the screw-plate and the double-screw fixations.

Discussion: Our findings on a model of type 2 Schatzker fractures are in agreement with previous data obtained by other authors working on models of type 1 Schatsker fractures. The biomechanical stability of the double-screw fixation is as good as that obtained with screw-plate fixation for the treatment of fractures of the lateral tibial plateau.