Fixation of Posterior Tibial Plateau Fracture with Additional Posterior Plating Improves Early Rehabilitation and Patient Satisfaction

Shivam Sinha; Mahipat Singh; Shyam K Saraf; Amit Rastogi; Alok K Rai; Tej Bali Singh

doi:10.4103/ortho.IJOrtho_295_18

Fixation of Posterior Tibial Plateau Fracture with Additional Posterior Plating Improves Early Rehabilitation and Patient Satisfaction

Indian J Orthop. 2019 May-Jun;53(3):472-478. doi: 10.4103/ortho.IJOrtho_295_18.

Authors

Shivam Sinha^{1

2

3}, Mahipat Singh¹, Shyam K Saraf¹, Amit Rastogi¹, Alok K Rai¹, Tej Bali Singh⁴

Affiliations

¹ Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
² Fellow Paediatric Orthopaedics and Limb Lengthening, KUMC, Seoul, South Korea.
³ Fellow Arthroscopy and Arthroplasty, SIOR, Pune, Maharashtra, India.
⁴ Department of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Abstract

Introduction: Posterior tibial plateau fractures (PTPF) are difficult to manage because of options of multiple approaches, paucity of implants, and lack of ideal construct for fixation. We investigated the benefits of using posterior approach and buttress plate for fixation of the posterior tibial condylar fractures in terms of the fracture healing rate, clinico-radiological, perioperative morbidity, and patient-related outcomes and compared them in those who achieved acceptable reduction without posterior stabilization.

Patients and methods: Seventy two patients with posterior tibial plateau fractures were prospectively followed after random allocation into two Groups A and B. Thirty eight patients of Group A (dual plating) were managed with stabilization of posterior fragment with Lobenhoffer approach in addition to anterolateral plating. Thirty four patients of Group B (single plate) were managed with isolated anterolateral plating after reducing the PTPF. Twelve patients lost to follow-up and sixty patients were available (thirty in either group) for final assessment. Followup was done by clinical examination, radiographs and computed tomography scan, fracture union, articular continuity, and deformities around the knee. Subjective outcome assessment was done with the International Knee Documentation Committee (IKDC) 2000 and Knee Society Score (KSS).

Results: At 1-year followup, the two groups did not differ in time of fracture union. IKDC and KSS were significantly better in dual-plating group (P < 0.001). Mean operative time and blood loss were more in dual-plating group (A). The mean hospital stay and complications did not show significant differences.

Conclusion: Addition of posterior approach for stabilization of the posterior fragment in posterior tibial plateau fractures achieves early and improved knee functions, good range of movements, minimal deformities, and pain scores by the time fracture unites. However, peri-operative morbidity, Extra implant costs and increased operative time are its disadvantages.

Keywords: Operative treatment; patient outcomes; posterior approach to knee; posterior tibial plateau fracture.