Clinical and radiological evaluation of proximal tibia fracture fixed with variable angle proximal tibial interlocking plate: A prospective observational study

Abstract

Background: Tibial plateau fractures are complex injuries produced by high- or low-energy trauma and principally affect young adults. In view of the ever-increasing high-velocity road traffic accidents, there is an increase in complex, multifragmentary periarticular fractures of the tibia. The goal of proximal tibial fracture treatment is to obtain the early union of fracture in the most acceptable anatomical position with the early and maximum functional return of activity. The use of more modern implants with locking screws and precontoured locking plates provides better stability and may further improve outcome. In this regard, this study was undertaken to study the functional outcome and radiological outcome of closed proximal tibial fracture Schatzker's type I, II, and III treated with variable angle-locking compression plate (VA-LCP). Methods: A hospital-based prospective study was undertaken among the 54 adult patients with closed proximal tibial fracture Schatzker's type I, II, and III requiring surgical intervention and treated by VA-LCP. A predesigned, self-administered pro forma was designed to keep the objectives of the study at the center point. The patients were categorized based on their relevant age, gender, fracture type, and complications. Qualitative data were represented in the form of frequency and percentage. The final outcome was obtained using modified Rasmussen clinical and radiological score as well as the total healing period of the subjects followed up for a period of 24 weeks. All care and caution were exercised while utilizing the patient data for the current research as outlined in the hospital guidelines pertaining to the usage of patient data for this study, and confidentiality was maintained throughout. Results: The maximum study population belonged to the age group of 50–59 years, which comprised about 44.5%. 26 (48.2%) of the tibial fractures were diagnosed to have Schatzker's type II fractures followed by 15 (27.7%) type III and 13 (24.1%) type I. Group I (30–39 years) showed faster healing with a mean healing period of 18.6 ± 1.9 weeks, followed by Group II (40–49 years) with a mean healing period of 19.6 ± 4.1. Mechanical failure (7, 12.9%) and some secondary complications (12, 22.2%) were also observed during follow-up in the outpatient department. At the end of follow-up, 35 patients (64.8%) had excellent clinical result, 19 (35.2%) had good clinical result, and no patient had a poor functional outcome. For the radiological assessment, there were 29 patients (53.8%) with excellent, 18 (33.3%) with good, 7 (12.9%) with fair, while none with poor results. Conclusion: Treatment of proximal tibial fractures is challenging because of limited soft tissue cover and less vascularity. There are various treatment options for these fractures starting from closed reduction with casting to open reduction and internal fixation with a plate. The excellent functional results and lack of soft tissue complications suggest that a VA-LCP should be considered as an option in tibial plateau fractures. A balance between anatomical reduction and soft tissue stripping is required to avoid any complications.