Short Term Assessment of Functional Results of Surgically Treated Tibial Plateau Fractures

INTRODUCTION: Fractures of the proximal tibia involve a major weight-bearing joint and are serious injuries that frequently result in functional impairment. They were originally described as “the fender fracture” because they resulted from low-energy pedestrian versus car accidents. In recent literature, majority are reported from high energy motor vehicle accidents and falls from a height. The tibial plateau fractures make up 1% of all fractures and 8% of fractures in the elderly. Most injuries affect the lateral plateau (55% to 70%), medial plateau fracture in (10% to 23%) cases, both plateau fracture in 10-30% of reported series. The optimal treatment of tibial plateau fracture has been a source of controversy for a long time. Current thinking leave from for both operative and non-operative management depending upon the fracture pattern and clinical examination. AIM: The aim of this study is to analyse the short term assessment of functional results of 28 closed tibial plateau fractures treated by surgeries prospectively done in our institution during the period from August 2004 to October 2006. MATERIALS AND METHODS: This is a prospective study consisting of 28 patients conducted at Department of Orthopaedic surgery, Government General Hospital, Chennai during the period from May 2004 to March 2007. 6 patients were lost in their follow-up. The average age in our study population was 35.2 years with the range between 22 to 65 years. RESULTS: All patients were evaluated clinically and radiologically at various follow up periods. All the patients were analysed using Modified Hohl and Luck functional evaluation method. In our study 3 patients(10.7%) showed excellent results, 17 patients (60.7%) showed good results, 5 patients ( 17.8% ) showed fair results and 3 patients (10.7% ) showed poor results. In 5 patients treated with open or closed reduction and cancellous screw fixation, 1 had excellent results, 3 had good results, 1 had fair results. In 21 patients in open reduction and plating group, 3 had excellent , 13 had good,4 had fair and 1 had poor results. One patient treated with external fixation with limited internal fixation had fair result. CONCLUSION: The surgical management of Tibial plateau fracture is a difficult and challenging task. The techniques demand considerable skill and mature judgement on the part of the on the part of the surgeon. Delayed institution of proper management of fractures of proximal tibia gives poorer functional outcome. Hence proper evaluation of fracture pattern and early institution of appropriate management yields good results. Bone grafting to supplement the fixation methods in depressed fracture patterns is useful in restoring the articular congruity and early rehabilitation of patient. CT and MRI have a definite role in studying the correct personality of complex fracture patterns and deciding the appropriate treatment method. Rehabilitation and physiotherapy should be timely instructed for effective functional outcome of treatment methods. As this is only a short term study, further follow up and evaluation is essential to come out with a definitive conclusion