Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures
Weaver MJ et al. – Most patients with bicondylar tibial plateau fractures do well when treated with lateral locked plating. However, those with a medial coronal fracture line tend to have a higher rate of subsidence and loss of reduction when lateral locked plating is employed alone. These fractures may be better treated with dual plating if the soft tissues allow.Methods
- Preoperative CT scans and postoperative plain films were evaluated on a consecutive series of bicondylar tibial plateau fractures.
- Fracture patterns were classified by CT.
- Angular alignment was measured immediately postoperatively and again at clinical and radiographic union to assess loss of reduction.
- A total of 140 patients were studied.
- Sixty-six (47%) had a single large medial fragment with the articular surface intact, 19 (14%) had a medial articular fracture line with a mainly sagittal component and 55 (39%) had a coronal fracture through the medial articular surface.
- A total of 129 patients had been treated with lateral locked plating alone whilst 11 patients (all with a coronal fracture of the medial condyle) underwent dual plating.
- There was little loss of reduction (median subsidence 0.5°) when lateral locked plating was employed alone in patients with a single medial fracture fragment or with a sagittal medial fracture line.
- When lateral locked plating was used in the presence of a medial coronal fracture line, there was a significantly higher rate of subsidence (median 2.0°) compared to those with no medial fracture line (p=0.002).
- Patients with coronal fracture lines treated with dual plating had significantly less loss of reduction that those treated with lateral locked plating (p=0.01).