Minimally Invasive Plate Osteosynthesis for Tibial Plateau Fractures

Abstract

Purpose. To evaluate radiological and clinical outcome of minimally invasive plate osteosynthesis (MIPO) for tibial plateau fractures. Methods. 35 men and 6 women aged 19 to 75 (mean, 40; standard deviation [SD], 14) years underwent MIPO for displaced tibial plateau fractures. According to the Schatzker system, the tibial plateau fractures were classified as types I (n=3), II (n=9), III (n=11), IV (n=6), V (n=7), and VI (n=5). Six patients had open fractures; 2 of them underwent debridement before MIPO. 10 patients needed additional bone grafting. Radiological (at immediate postoperation) and clinical (at the 12-month follow-up) assessments based on the Rasmussen anatomic and functional scoring system were recorded using a proforma. Patients with acceptable and unacceptable outcomes were compared in terms of age. Results. The mean Rasmussen anatomic score was 15.1 (SD, 2.2; range, 10–18); the mean Rasmussen functional score was 25.3 (SD, 3.2; range, 14–29); and the mean range of knee motion was 118° (SD, 10°; range, 90°–140°). Anatomic outcome was excellent in 10, good in 28, and unacceptable in 3 patients (one each had Schatzker type-I, -II, and -III fractures). 27 (71%) of the 38 patients with acceptable anatomic outcome were aged ≤45 years, whereas 2 (67%) of the 3 patients with unacceptable anatomic outcome were aged ≥60 years (p=0.001). Functional outcome was excellent in 18, good in 19, and unacceptable in 4 patients (2 had Schatzker type-III and another 2 had Schatzker type-I or -II fractures). 37 of the patients had a range of knee motion of ≥120°; 27 (73%) of them were age d ≤45 years, whereas 3 (75%) of the 4 patients with unacceptable functional outcome were aged ≥60 years (p=0.001). Conclusion. MIPO for tibial plateau fractures achieved good outcome with minimal soft-tissue complications. Older age was the predictor of unacceptable outcome.