The posterior shearing tibial plateau fracture: treatment and results via a posterior approach
Bhattacharyya, Timothy ; McCarty, L. Pearce 3rd ; Harris, Mitchell B. ; Morrison, Suzanne M. ; Wixted, John J. ; Vrahas, Mark S. ; Smith, R. Malcolm
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Student Authors
Faculty Advisor
Academic Program
UMass Chan Affiliations
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Publication Date
Keywords
Accidents, Traffic
Adult
Aged
Aged, 80 and over
Bone Plates
Bone Screws
Cohort Studies
Female
Follow-Up Studies
Fracture Fixation, Internal
Humans
Injury Severity Score
Knee Injuries
Male
Menisci, Tibial
Middle Aged
Pain Measurement
Probability
Range of Motion, Articular
Recovery of Function
Retrospective Studies
Risk Assessment
Tibial Fractures
Treatment Outcome
Orthopedics
Rehabilitation and Therapy
Subject Area
Embargo Expiration Date
Abstract
OBJECTIVES: This study was designed to describe the fracture patterns and early results of treatment of posterior shearing tibial plateau fractures.
DESIGN: Retrospective case series.
SETTING: Tertiary care hospital.
PATIENTS: Thirteen patients identified from prospective trauma database with posterior shearing tibial plateau fractures.
INTERVENTION: Open reduction and internal fixation through a posterior approach to the knee.
MAIN OUTCOME MEASUREMENTS: Functional outcome assessed by Musculoskeletal Functional Assessment score and Visual Analogue Scale pain scores. Clinical and radiographic outcome.
RESULTS: A consistent fracture pattern was identified with a primary, inferiorly displaced posteromedial shear fracture with variable amounts of lateral condylar impaction. The average duration of clinical patient follow-up was 20 (range, 13-27) months. All fractures healed after index surgery. Two complications (1 wound dehiscence and 1 flexion contracture) were all managed nonoperatively. Three independent surgeons graded patients' articular reduction, with good interobserver reliability (intraclass correlation coefficient = 0.82). The average Musculoskeletal Function Assessment dysfunction score for the 9 patients who responded was 19.5/100, and average resting Visual Analogue Scale pain score was 1.8 cm/10 cm, indicating good function. The functional outcome score was significantly related to the quality of articular reduction (P < 0.017, R = 0.456).
CONCLUSIONS: Posterior shearing tibial plateau fractures form a consistent pattern. They can be successfully managed using a posterior approach with direct reduction and buttress fixation of articular fragments. Quality of articular reduction is one factor that influences short-term functional outcome.
Source
J Orthop Trauma. 2005 May-Jun;19(5):305-10.