Intra-articular bicondylar tibial plateau fractures managed surgically by dual plate osteosynthesis: A clinico-radiological and functional outcome evaluation

Abstract

Background: The management of bicondylar fracture of proximal tibia is a challenging task and the objective of treatment is to achieve stable, painless and mobile joint and also to prevent the secondary degeneration of the joint. Dual plating in such fractures is beneficial to address fracture fragments in different planes and also to achieve anatomical reduction under direct vision. The aim of the study was to evaluate the functional results in patients with tibial plateau bicondylar fracture treated by open reduction and internal fixation using dual plate osteosynthesis. Materials and Methods: Patients who underwent dual plate fixation for post-traumatic bicondylar tibial plateau fracture were included in the study. This was a prospective study conducted at a Tertiary care Private Hospital in Kolkata, between August 2017 to May 2020. All patients were followed up at an interval of 2 weeks, 6 weeks, 12 weeks, 6 months, 9 months, 1 year and 1.5 year. Radiological and functional results were classified in four categories as per Rasmussen’s criteria. Results: Outcome at final follow-up was assessed with Rasmussen’s functional grading system. In a total of 40 patients, 24 (60%) patients showed Excellent and 11 (27.5%) patients had Good results whereas 4 (10%) patients had Fair outcome and 1 (2.5%) patient demonstrated Poor surgical result at the final follow-up. Rasmussen’s radiological assessment showed 7 (17.5%) Excellent, 25 (62.5%) Good, 5 (12.5%) Fair and 3 (7.5%) patients with Poor result. At the end of 1.5 year, the average Rasmussen’s functional knee score for 40 patients was 25.85 ± 4.83. Conclusion: Dual plate fixation of intra-articular bicondylar tibial plateau fractures is a safe and effective treatment option as it provides good surgical exposure, less soft tissue injury, rigid fixation, acceptable alignment of articular congruity, reasonable time to union and allows early weight bearing and range of motion of knee with good functional outcome.