Summary

Excellent clinical and radiological outcomes following arthroscopic reduction and internal fixation of tibial plateau fractures independently of the Schatzker classification

Abstract

Introduction

Tibial plateau fractures account for approximately 1% of all fractures. Surgical goals are anatomic reduction, joint stability, to treat associated injuries and manage the soft tissue envelope, especially in high energy trauma. Arthroscopic reduction and internal fixation avoids the need of performing an arthrotomy to control the reduction and treat intra-articular injuries and requires less invasive approaches which is an advantage for soft tissue preservation. There are specific risks about performing arthroscopy in these fractures, especially in Schatzker V and VI.
Objectives:
To evaluate clinical and functional outcomes of patients treated in our institution between 2012 and 2015 with Tibial plateau fractures submitted to arthroscopic reduction and internal fixation

Materials And Methods

Retrospective revision of 39 patients with tibial plateau fractures submitted to surgery in our institution in a three years time frame. Inclusion criteria were all the patients who presented with tibial plateau fractures. 17 patients with a follow up period inferior to 6 months were excluded. All the patients were submitted to arthroscopic reduction and internal fixation. Data regarding type of fracture, pre operative articular depression, type of osteossynthesis, associated injuries, clinical and functional Rasmussen scores and complications was collected. Statistical analysis was performed using with SPSS v22.

Results

The population of our study is 22 patients, 13 males and 9 females, mean age of 49 years old. According to Schatzker classification there is 1 type I, 6 type II, 3 type III, 2 type IV, 6 type V and 4 type VI. In 10(45%) patients synthetic bone blocks were used. There were 6 (27,3%)patients with associated injuries diagnosed intra-operatively with arthroscopy which motivated therapeutic attitudes. The range of motion was assessed and the mean flexion was 113 ± 13.38 degrees and all the patients achieved 0º of extension. The functional scores were measured. The Rasmussen radiological score was measured in 14 patients and mean value was 15.14±2,03 and all of them had good or excellent outcomes. The Rasmussen clinical score was measured in all patients and the mean value was 27,5±1.36 and all of them achieved good or excellent outcomes. Just 4 patients had a clinical score different than excellent (27).
The type of fracture has no significant statistical relation with clinical Rasmussen score (p=0,217).
The use of bone blocks showed a negative relation (rpb = -.377, p = .166) with Rasmussen radiological score but not with Rasmussen clinical score (rpb = .215, p = .348).
There were no complications related to the arthroscopy itself and we had 4 surgical complications, 1 algoneurodystrophy, 1 early loss of reduction with the need for re-intervention, 1 infection and 1 post operative valgus instability. Mean follow-up time was 24,3 months.

Conclusions

The use of synthetic bone blocks has no effect in clinical outcomes and can even worsen radiological outcomes. With arthroscopic reduction and internal fixation we were able to achieve excellent clinical and radiological outcomes as demonstrated by the measured Rasmussen scores. Even in worse fracture patterns there were no complications related to the arthroscopic procedure.