TREATMENT OF TIBIAL PLATEAU FRACTURES BY LIMITED INTERNAL-FIXATION

Seventy-five adults who sustained 76 tibial plateau fractures were tre ated according to a prospective protocol using instability in extensio n as the principal indication for operative fixation, Patients showing instability underwent closed manipulative reduction under fluoroscopi c guidance, If significant joint depression persisted after reduction, elevation of the fracture was performed either from below using bone punches through a cortical window or via limited arthrotomy, Iliac cre st bone graft was used to buttress depressed fractures, Fixation was t hen secured using 7-mm cannulated screws with mashers or buttress plat es and screws. Postoperatively, 58 of 76 knees were managed in a hinge d knee brace, allowing the patient early range of motion and protected weightbearing for 8 weeks, Patients who were found to have a stable k nee were treated with Bledsoe braces according to the postoperative pr otocol, In the 75 patients, 18 of the 76 knees were unsuitable for per cutaneous screw fixation because of fracture complexity requiring plat es, severe open injuries, or inadequate reductions with limited fixati on had been done, A minimum followup of 12 months was obtained in 55 p atients (range, 12-59 months), All fractures had healed at the time of followup. Eighty-seven percent of the patients at followup had a succ essful outcome using Rasmussen's criteria. Fourteen of these patients had arthroscopic assisted reduction or evaluation, All seven patients who had poor outcomes had AO Type C3 fracture patterns, Severely depre ssed or comminuted fractures or fractures with significant metaphyseal diaphyseal extension may not be suitable for this technique and requi re the addition of an external fixation de,ice or buttress plate to ma intain the reduction and allow for early range of motion.