Clinical, Functional and Radiological Results of Bicondylar Tibial Plateau Fractures (AO41.C) Treated by Osteosynthesis with Plates and Screws.

Abstract

Objectives: Bicondylar tibial plateau fractures are technically demanding fractures that have a high rate of complications. The aim of this study was to analyse the outcomes of patients diagnosed with bicondylar tibial plateau fractures (AO41.C of the AO/ASIF classification) who were treated by osteosynthesis with plates and screws.

Methods: A retrospective observational study of 27 patients was conducted. The mean follow-up was 49.52 months. The minimum follow-up was 2 years. The mean age of the patients was 51.44 years. Fifty-two percent of the patients required external fixation due to poor soft tissue condition, with a mean time to definitive surgery of 9.42 days. The 27 patients were definitively treated by open reduction and internal fixation with plates and screws. In 21 patients, the osteosynthesis was carried out with two plates using a dual approach (anterolateral and posteromedial). In addition to the medial and lateral plate, in 2 patients, a posterior plate was used. In 4 patients, the chosen option was a synthesis with a single plate through the anterolateral approach.

Results: The average score on the KOOS (Knee Injury and Osteoarthritis Outcome Score) scale at the end of the follow-up was 53.26 points. The use of external fixation did not correlate with a worse clinical result at the end of the follow-up. According to the Kellgren-Lawrence scale, all patients presented different degrees of arthritic changes. The main complication was discomfort related to the hardware, and 15 patients (55,56%) underwent hardware removal. One of the patients also required a high tibial corrective osteotomy due to the malunion of the fracture in valgus.

Conclusion: Although a notable reduction and union of the fracture are achieved, bicondylar tibial plateau fractures result in a major loss of articular function and posttraumatic radiological changes.