TIBIAL PLATEAU FRACTURE FIXED BY LOCKING COMPRESSION PLATES
Journal of Evolution of Medical and Dental Sciences
BACKGROUND: High energy complex tibial plateau fractures are usually associated with severe soft tissue injury overlying the fracture. Locked compression plating has clear biomechanical advantages and loss iatrogenic tissue damage when compared with conventional plating. MATERIAL AND METHOD: Between January, 2012 to June, 2013, 20 patients with Tibial plateau fractures were included in this prospective study. All fractures were treated with locked compression plating using open/MIPO approach.
... en/MIPO approach. Clinical and radiological data, including fracture pattern, changes in alignment, local and systemic complications, and hardware failure and fracture union were analyzed. RESULTS: Twenty patients have been evaluated, with mean follow up of 13 months fractures were treated percutaneously in 30% of cases. All but 1 fracture progressed to union at a mean of 15.5 (14-18) weeks, 95% cases had acceptable anatomical and functional outcome (Rasmussen's criteria). CONCLUSION: Biomechanically, this plate works as an "Internal fixator" rather than a plate. It preserves periote blood supply and provides fixed angle stability. Other methods like Intra-medullary nailing, external fixators and conventional plating are also used for fixation. Angular mal alignment and malunion have been reported with intramedullary nailing. 9,10 Studies involving external fixation techniques shows complications such as loosening of pins, malunion, imperfect articular reductions and pin tract infections. 11 However, in high energy, complex tibial plateau fractures, conventional plating has been associated with a high rate of wound complications and deep sepsis, hardware failure, delayed union and nonunion. 12,13 In these cases, conventional plate osteosynthesis requires excessive dissection through injured soft tissue envelop and compression of plate to the bone and relies on friction at the bone plate interface and thereby causes compression of periosteal blood supply and de vitalization of bone fragments. Additionally it also does not provide fixed angle stability between plate and screws. In our study, all fractures progressed to union in 14-18 weeks except one in which fracture united 24 weeks. We used primary bone grafting in 25% cases. There were acceptable anatomical and functional results in 19 Cases (95%) (Rasmussen's criteria). More over complications occurred in 3 cases (15%) and these were superficial (15%) and deep infection (10%). Other studies cole et al 14 & Sanguen SS et al 15 have also shown such results. CONCLUSION: The locking compression plate system provided stable fixation in this series of patients with tibial plateau fractures. The overall complication rate was low and anatomical and functional outcome was acceptable in 95% cases in mean follow up of 13 months. We found 95% of simple and complex fractures progressed to union and deep infection rate was 10%. However, the fixation techniques are demanding and the surgeon needs considerable experience with locking plate technique especially in percutaneous approach. Further prospective, randomized studies are desirable to confirm our findings and to eventually draw safer conclusions.