Treatment of tibial plateau fractures with small fragment internal fixation: A preliminary report

Objective: To evaluate the use of small fragment implants for fractures of the proximal tibia. Design: Retrospective. Setting: Level I trauma center. Patients/Participants: Seventeen patients with AO Classification Type B and C fractures of the proximal tibia. Two patients were lost to follow-up. Intervention: After atraumatic dissection and open reduction, fracture stab ilization was accomplished with the use of the AO/ASIF small T-plate (3.5-m illimeter system). In two patients a medial uniplanar external fixator was applied as additional fixation. In six patients a cancellous autograft was performed. Main Outcome Measurements: At an average follow-up of forty-two months (ran ge, 24 to 75 months), all patients were evaluated radiographically and func tionally. The incidence of local complications was specifically recorded. Results: Postoperatively, the radiographs showed 86.7 percent anatomic or n ear anatomic reduction with respect to the articular joint surface. In thre e separate patients condylar widening, condylar narrowing or varus deformit y was evident. In one patient, a minimal secondary displacement of less tha n two millimeters was observed before bony healing. All fractures healed wi thin twelve weeks. Ar the latest follow-up, there were 53.3 percent excelle nt, 33.3 percent good, and 13.3 percent fair results. There were no infecti on or soft tissue complications. Conclusions: The use of small fragment implants combined with atraumatic so ft tissue dissection potentially offers good results for the treatment of f ractures of the proximal tibia. These initial results suggest that this tec hnique may have the advantage of anatomic reduction while comparing favorab ly with less invasive methods regarding radiologic acid functional outcome as well as incidence of complications.