Surgical treatment of tibial plateau fractures

Abstract

Introduction. Tibial plateau fractures represent approximately 1% of the total fractures in the general population and 8% among the senile age population. The peak incidence among men is between 30 and 40 years, while in women between 60 and 70 years. It is considered that most of such fractures are caused by road accidents and catatraumatisms. Isolated fractures of the lateral plateau occur in 55-70% cases, 10-25% medial plateau and 10-30% are bicondylar. Approximately 90% of fractures are associated with different degrees of soft tissue injury and 1-3% are open. Tibial plateau fractures in 7 - 43% of cases are accompanied by collateral ligament injury and in 23% anterior cruciate ligament injury in high energy cases. Meniscus lesions have been reported in over 50% of cases. Fractures caused by high energy trauma can be associated with neuro-vascular lesions, compartment syndrome, deep vein thrombosis, soft tissue crushes or wounds. The frequency of failures and complications of surgical treatment of these lesions remains considerable. Although the development of modern surgical techniques and fixation implants has generally improved the functional results obtained after such fractures, however, the optimal way of managing these extremely complex lesions remains controversial. Aim of the study. Analyzing the results and methods of surgical treatment of patients with tibial plateau fractures treated in Orthopedics and Traumatology Clinic "V. Bețișor " durind 2014-2018 years. Materials and methods. They were analyzed 100 clinical cases: men – 40 and women – 60, mean age 54 years. Trauma circumstances: habitual trauma – 75 cases, traffic accident – 15, precipitation – 6, sport – 3, aggression – 1. Schatzker classification was used: type I was meet in 10 cases, II – 25, III – 15, IV – 5, V – 28, VI – 17; 95 close, 5 open. For imaging examination were used X-ray and CT. Surgical treatment consisted of: close reduction , internal fixation - 15 cases (10- percutaneus canulated screws arthroscopic assisted, 5- external fixator), open reduction, internal fixation – 85 cases. Bone graft was done in 20 cases. Results. Postoperative follow up was performed at 6, 12, 18, 24 weeks. Patients were evaluated according to the Lysholm Knee Scoring Scale, obtaining an average score of 86 points. Bone healing was noticed in a period of between 12 to 18 weeks. Postoperative complication developed in 15 cases. Results were depending on the stability of fixation, precocity, rightness of functional recovery and patient compliance. Conclusions. Favorable functional results and less complication were meet in cases of individual approach of surgical treatment, the suitable choice of implants and less invasive surgical techniques.