Strategies in Management of Tibial Plateau Fractures

Abstract:
Background: Advancement in technology and acceleration in automobile development have been accompanied by increase in number and severity of fractures and those of tibial plateau are no exception. Being one of the major weight bearing joints of the body, fractu res around it are of paramount importance. The study was aimed to identify the strategies in surgical treatment of tibial plateau fractures, its functional outcome and
complications. Methods: Thirty-two cases of tibial plateau fractures treated and studied from Jan 2015 to Dec 2017 and
followed up for a minimum period of 6 months and maximum of 2 yrs.
Results: The selected patients evaluated thoroughly: clinically and radiologically, were taken for surgery, after
the relevant lab investigations. The indicated fractures were treated as per the Schatzker’s types accordingly
with ORIF with buttress plate with or without bone grafting with respect to the condition of the skin which
decided our timing of surgery and the method of internal fixation. Early range of motion started soon after the
surgery. No weight bearing upto 6-8 weeks. The full weight bearing deferred until 12 weeks or complete
fracture union. Immobilization in insecurily fixed fractures continued for 3-6 weeks by POP cast. The knee
range of motion was excellent to very good, gait and weight bearing after complete union was satisfactory. We
found loss of tibial plateau contour by redepression in 1 case, knee stiffness in 3, wound dehiscence in 2 cases and non-union in none of our cases. Conclusion: Surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion and reducing post-traumatic osteoarthritis and
hence to achieve optimal knee function. However soft tissue condition dictates the method and timing of the
surgical management.