Closed reduction/percutaneous fixation of tibial plateau fractures: Arthroscopic versus fluoroscopic control of reduction

Objective: To evaluate arthroscopic versus fluoroscopic reduction and percu taneous fixation of lateral tibial plateau fractures of AO/OTA Types 41.B1 to 41.B3. Design: Prospective study. Setting: University hospital. Patients and Intervention: One hundred sixty-eight patients underwent opera tive treatment for a tibial plateau fracture from 1988 to 1995. Thirty-thre e of these patients had monocondylar fractures of the lateral plateau that were treated by percutaneous reduction and fixation techniques. In the firs t ten cases, arthroscopic control of reduction was used. The following twen ty-three consecutive cases were treated by reduction and fixation solely un der fluoroscopic control. The arthroscopy group was followed for a mean of fifty-two months and the fluoroscopy group for thirty-eight months. Results: Nine of ten cases of the arthroscopy group had an excellent or goo d result in Rasmussen's knee score at follow-up. One patient with an unredu ced anterolateral depression zone despite arthroscopic surgery required a t otal knee prosthesis after eighteen months. Sixteen cases in the fluoroscop y group met the follow-up criteria: Fifteen were graded good or excellent i n Rasmussen's clinical score; sixteen were excellent or good in the radiolo gical score. One patient claimed chronic medial joint line pain after a lat eral: split fracture and had arthroscopy revealing chondral degeneration on the medial side but had no pathological findings in the lateral compartmen t. No secondary meniscus or ligament surgery was performed in the follow-up period. Conclusions: Percutaneous treatment of fractures of the tibial plateau can be performed using arthroscopy as well as image intensification to control reduction of the joint surface. We were not able to demonstrate any signifi cant benefit from arthroscopy compared with fluoroscopic reduction. Reducti on under image intensification is technically easier in our practice, espec ially in serial fractures and multiply injured patients; We reserve arthros copy for cases with significant ligament injuries and for children with fra ctures of the median eminence.