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 stabilization was accomplished with the use of the AO/ASIF small T-plate (3.5-millimeter 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 (range, 24 to 75 months), all patients were evaluated radiographically and functionally. The incidence of local complications was specifically recorded. RESULTS:Postoperatively, the radiographs showed 86.7 percent anatomic or near anatomic reduction with respect to the articular joint surface. In three separate patients condylar widening, condylar narrowing or varus deformity was evident. In one patient, a minimal secondary displacement of less than two millimeters was observed before bony healing. All fractures healed within twelve weeks. At the latest follow-up, there were 53.3 percent excellent, 33.3 percent good, and 13.3 percent fair results. There were no infection or soft tissue complications. CONCLUSIONS:The use of small fragment implants combined with atraumatic soft tissue dissection potentially offers good results for the treatment of fractures of the proximal tibia. These initial results suggest that this technique may have the advantage of anatomic reduction while comparing favorably with less invasive methods regarding radiologic and functional outcome as well as incidence of complications.