Functional Outcome of Medial Condyle Fractures of Proximal Tibia Treated using Posteromedial Locking Compression Plate

Durairaj, (2019) Functional Outcome of Medial Condyle Fractures of Proximal Tibia Treated using Posteromedial Locking Compression Plate. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Tibial plateau fractures represent a challenge, despite being common in incidence they are difficult to manage since they are mostly associated with soft tissue injuries. They usually occur as a result of high velocity injuries and are common in young age group turning into heavy socioeconomic burden to family. It is not uncommon in old age who have osteopenia and medical comorbidities. Tibial plateau is one of the most important weight bearing areas of the body with 80% borne by tibia and remaining by fibula. Any fracture in vicinity of the joint is of paramount importance since restoring articular congruity is an essential step for functional outcome. If unaddressed may lead to unstable knee and abnormal forces acting on it. Consequence of which may lead to early osteoarthritis of knee joint. In long term studies it is found that the axial alignment is more important factor rather than articular depression in developing a future osteoarthritis. AIM OF THE STUDY: To assess the functional outcome of patients with proximal tibial plateau fractures especially the medial condyle fractures who were treated using posteromedial locking compression plate. MATERIALS AND METHODS: The study was conducted at Government Royapettah Hospital Chennai and included 22 patients with Schatzker Type IV, Type V and Type VI proximal tibia fractures who fit the inclusion criteria. It was a prospective study with patients followed up for clinic-radiological outcome after obtaining a written informed consent from all patients. Inclusion Criteria: • Age above 18 years(After physeal closure). • Closed injury. • Fractures less than 2 weeks old. • Fractures involving the Medial column and Posterior column especially the posteromedial fragment regardless of the lateral column involvement. Exclusion Criteria: • Age < 18 years or > 60 years. • Fractures involving exclusively the Lateral column. • Fractures more than 14 days old. • Infection. • Medical Contraindications for surgery. DISCUSSION: In our study, fractures involving the medial condyle of the proximal tibia especially with the posteromedial fragment were treated with 3.5 mm system posteromedial locking compression plate. Functional outcome was measured using Lysholm Knee Score system which evaluates 8 parameters and rates the patient’s experience with a score in each section. The combined score is taken with maximum score of 100. Outcome graded into excellent,good fair and poor based on the scores. The outcome was comparable with other studies with excellent outcome in 14 patients, good outcome in 5 cases and one case with fair outcome. CONCLUSION: The study emphasizes the importance of the postero-medial fragment in the management of the tibial plateau fractures. 80 % of the mechanical load is being transferred to the concave congruent medial condyle. So accurate reduction and buttressing the fragment is essential for excellent functional outcome. Newer three column concept of the proximal tibia by Luo et al signifies the importance of the posteromedial and posterolateral corners of the knee joint. The goal of treatment of these fractures aims at stability and perfect articular reduction, both of them are not possible without reduction and fixation of the posteromedial fragment. With the advent of better imaging modalities like CT, the incidence of the fracture has increased. Computed tomography is essential in all cases of complex tibial plateau fractures and guides the management. It is now shown that the fractures of the posteromedial portion of the medial condyle of proximal tibia are not uncommon. Open reduction and internal fixation of the fragments with preferable a low profile plate is always indicated. The posteromedial approach being the safe one need to be used without any complications. Anterior approach warrants excessive soft tissue dissection and the direct posterior approach needs dissection through neurovascular bundle. Posteromedial approach is not associated any such complications. Thorough anatomy of the posteromedial portion of the knee is important. Lateral locking plates alone cannot achieve maintenance of fracture reduction and are often associated with varus collapse and decreased functional outcome. Antero-posterior lag screws are also insufficient in holding onto the reduced fragments. Posteromedial plate is biomechanically superior to the available implants. Fixation of the posteromedial tibia allows for early rehabilitation of the patient and has excellent function outcome with less incidence of complications. A wellplanned approach to the tibial plateau fracture with importance to the posteromedial fragment has excellent functional outcomes.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional Outcome, Medial Condyle Fractures, Proximal Tibia Posteromedial Locking Compression Plate.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 01 Sep 2019 10:56
Last Modified: 01 Sep 2019 10:56
URI: http://repository-tnmgrmu.ac.in/id/eprint/11370

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