- N. Ahearn, BSc (Hons),MRCS (Eng), Speciality Registrar, Trauma and Orthopaedics1 ;
- A. Oppy, MBBS, FRACS FAOrthA, Orthopaedic Surgeon, Trauma Lead2;
- R. Halliday, BSc(Hons), MRes, Research Physiotherapist3;
- J. Rowett-Harris, RGN Dip. ANC (Ortho), Clinical Nurse Specialist & Research Nurse1;
- S. A. Morris, FRCS (Tr& Orth), Consultant Trauma and Orthopaedic Surgeon4;
- T. J. Chesser, FRCS (Tr&Orth), Consultant Trauma and Orthopaedic Surgeon4; and
- J. A. Livingstone, MD, FRCS (Tr & Orth), Consultant Trauma and Orthopaedic Surgeon1
Unstable bicondylar tibial plateau fractures are rare and there is little guidance in the literature as to the best form of treatment. We examined the short- to medium-term outcome of this injury in a consecutive series of patients presenting to two trauma centres. Between December 2005 and May 2010, a total of 55 fractures in 54 patients were treated by fixation, 34 with peri-articular locking plates and 21 with limited access direct internal fixation in combination with circular external fixation using a Taylor Spatial Frame (TSF). At a minimum of one year post-operatively, patient-reported outcome measures including the WOMAC index and SF-36 scores showed functional deficits, although there was no significant difference between the two forms of treatment. Despite low outcome scores, patients were generally satisfied with the outcome. We achieved good clinical and radiological outcomes, with low rates of complication. In total, only three patients (5%) had collapse of the joint of > 4 mm, and metaphysis to diaphysis angulation of greater than 5º, and five patients (9%) with displacement of > 4 mm. All patients in our study went on to achieve full union.
This study highlights the serious nature of this injury and generally poor patient-reported outcome measures following surgery, despite treatment by experienced surgeons using modern surgical techniques. Our findings suggest that treatment of complex bicondylar tibial plateau fractures with either a locking plate or a TSF gives similar clinical and radiological outcomes.
Cite this article: Bone Joint J 2014;96-B:956–62.
The authors would like to thank their colleagues for allowing them the analysis of their patients. Professor R. Atkins, M. Jackson, S. Mitchell, and F. Monsell from the Bristol Limb Reconstruction Unit, and W. Harries, M. Kelly and T. Ward, from Frenchay Hospital.
The authors would also like to thank P. White for the statistical analysis provided for this study.TJS Chesser reports personal fees from Stryker Corporation as design surgeon for AxSOS plates.
The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by S. P. H. Hughes and first proof edited by J. Scott.