Functional Outcome Analysis of bicolumn plating in bicondylar tibial plateau fractures

Yuvaraja, M (2013) Functional Outcome Analysis of bicolumn plating in bicondylar tibial plateau fractures. Masters thesis, Masras Medical College, Chennai.

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Abstract

INTRODUCTION: Fractures of tibial plateau involve the articular surface of proximal tibia. The injuries span a wide spectrum, ranging from low energy unicondylar fractures to high energy bicondylar and comminuted fractures. The surrounding soft tissues are severely damaged in high energy injuries and this complicates management of these challenging lower limb fractures. The treatment of bicondylar tibial plateau fractures still remains a highly demanding surgical procedure with a wide variety of perioperative complications. The goal of treatment of high energy tibial plateau fractures are to restore joint line congruity, joint stability and alignment with minimal soft tissue dissection to allow for early mobilization and establishment of good function. AIM: The aim of our study is to analyze prospectively the functional outcomes of Schatzker type V and type VI tibial plateau fractures treated by dual incision bicolumn plating at the Institute of Orthopedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai between May 2010 and November 2012. MATERIALS AND METHODS: Our study was a prospective study, conducted at the Institute of Orthopedics and Traumatology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai between May 2010 and November 2012. Inclusion Criteria: • Age > 18 years, • Schatzker type V and VI tibial plateau fractures, • Closed fractures, • Grade I and II compound fractures, Exclusion Criteria: • Age < 18 years, • Grade III compound injuries, • Old fractures (> 4 weeks old), • Extensive soft tissue injury with healing period more than 3 weeks. RESULTS: 20 patients sustained injury as a result of road traffic accident, whereas one patient alone sustained train traffic accident. Functional analysis was done using Knee Society Score, which is a clinical scoring system filled by the surgeon. Lateral locking compression plate was used in 11 patients and lateral buttress plates were used in 10 patients. All patients also had medial plating – buttress plates in two patients and reconstruction plates in all other patients. Due to incomparable group numbers, medial column implant was not analysed separately in our study. Of the 11 patients, eight had excellent score, two had good score and one had fair scoring according to Knee Society Score. The average score was 83.63. CONCLUSION: From our study, we conclude that ;Bicondylar tibial plateau fractures have an excellent to good functional outcome with dual incision bicolumn plating with very minimal wound complications. •Early joint mobilisation is possible with this technique and this contributes to better final knee range of motion •Posteromedial plating provides buttressing against late varus collapse in patients with posteromedial fracture pattern. •Anatomical joint reduction and internal fixation provides the best outcome in patients with good soft tissue status, and this should not be deferred for fear of wound complications in cases with closed injuries with healthy soft tissue cover. •There is no significant difference in functional outcome between use of locking plate or buttress plate in lateral column for bicondylar fractures when medial plating has been done. This observation will have to be validated with longer follow up.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Functional Outcome Analysis ; bicolumn plating ; bicondylar tibial plateau fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 08:43
Last Modified: 16 Sep 2017 08:43
URI: http://repository-tnmgrmu.ac.in/id/eprint/3173

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