A prospective study of management of tibial plateau fractures by locking compression plate in adults

Satish R. Gawali, Pradeepkumar S. Nair, Venktesh D. Sonkawade


Background: Tibial plateau fractures are one of the most complex and disabling fractures of the knee. The tibial plateau is important in transmitting load through the knee. These fractures need a meticulous management protocol in order to minimize patient's disability in range of movement, stability and reducing the risk of documented complications. The aim of the present study is to study the outcome of tibial plateau fractures managed with a locked compression plate.

Methods: This study was conducted at a tertiary-care medical college and hospital, Aurangabad specializing in post-graduate training, where all patients who underwent surgical treatment between September 2018 and October 2020 were included. Patients were assessed using the knee society score (KSS). These evaluations were done at 1, 3, 6, 9 and 12 months.

Results: In our study we included 55 patients out of which we found union in 98% of patients with 83% of patients showing good flexion at knee joint (>110 degrees). 85% patients achieved union within 6 months. An excellent KSS grade was seen in 38.2% patients with another 43.6% showing good outcome. 4 patients showed infection and 1 showed non-union. A single case of malunion was seen in our study.

Conclusions: Locked compression plates in tibial plateau fractures has revolutionized the way these fractures are managed. Anatomic reduction is of utmost importance. Early physiotherapy which plays key role in preventing knee stiffness, use of bone grafts and good fixation are important for successful outcome.


Tibial plateau fractures, Knee society score, Schatzker classification

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Charles M, Brown C. In: Fractures of tibia and fibula, Rockwood and Green’s “Fractures in Adults”. Vol. 2, 6th edition, Lippincott Williams and Wilkins. 2010;52.

Gustilo RB, Gruninger RP, Davis T. Classification of type III (severe) open fractures relative to treatment and results. Orthopedics. 1987;10(12):1781-8.

Henry SL, Ostermann PA, Seligson D. The antibiotic bead pouch technique: the management of severe compound fractures. Clin Orthop. 1993;295:54-62.

Ostermann PA, Henry SL, Seligson D. Timing of wound closure in severe compound fractures. Orthopedics. 1994;17(5):397-9.

Riechelmann F, Kaiser P, Arora R. Primary soft tissue management in open fracture. Oper Orthop Traumatol. 2018;30(5):294-308.

Cole PA, Zlowodzki M, Kregor PJ. Compartment pressures after submuscular fixation of proximal tibia fractures. Injury. 2003;34(1):43-6.

Kenneth EA, Edward S, Nirmal TC, Stephen SH, Frederick KJ, Kenneth KJ. Treatment of complex tibial plateau fractures using the less invasive stabilisation system plate: clinical experience and a laboratory comparison with double plating. J Trauma Injury Infect Crit Care. 2004;52(2):340-6.

Spagnolo R, Pace F. Management of the Schatzker VI fractures with lateral locked screw plating. Musculoskelet Surg. 2012.96(2):75-80.

Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator. J Bone Joint Surg Br. 1996;78(5):710-7.

Zeltser DW, Leopold SS. Classifications in brief: Schatzker classification of tibial plateau fractures. Clin Orthop Relat Res. 2013;471(2):371-4.

Insall JN, Dorr LD, Scott RD, Norman WS. Rationale, of The Knee Society Clinical Rating System, Clin Orthop Rel Res. 1989;248:13-4.

Jian Z, Ao R, Zhou J, Jiang X, Zhang D, Yu B. A new anatomic locking plate for the treatment of posterolateral tibial plateau fractures. BMC Musculoskelet Disord. 2018;19(319).

Jain RK, Shukla R, Baxi M, Agarwal U, Yadav S. Evaluation of functional outcome of tibial plateau fractures managed by different surgical modalities. Int J Orthop Res. 2016;2(1)

Van Nielen DL, Smith CS, Helfet DL, Kloen P. Early Revision Surgery for Tibial Plateau Non-union and Mal-union. HSS J. 2017;13(1):81-9.

Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. Int Orthop. 2010;34(2):271-81.

Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma. 2004;18(10):649-57.

Raza H, Hashmi P, Abbas K, Hafeez K. Minimally invasive plate osteosynthesis for tibial plateau fractures. J Orthop Surg (Hong Kong). 2012;20(1):42-7.

Colman M, Wright A, Gruen G, Siska P, Pape HC, Tarkin I. Prolonged operative time increases infection rate in tibial plateau fractures. Injury. Elsevier. 2013;44(2):249-52.

Khatria K, Sharma V, Goyal D, Farooque K. Complications in the management of closed high-energy proximal tibial plateau fractures. Chinese J Traumatol. 2016;19(6):342-7.

Ali AM, El-Shafie M, Willett KM. Failure of fixation of tibial plateau fractures. J Orthop Trauma. 2002;16(5):323-9.

Hussain SN, Subbukannu B. Study on complications of tibial plateau fractures. Int J Orthop Sci. 2016;2(2):64-6.

Kugelman DN, Qatu AM, Strauss EJ, Konda SR, Egol KA. Knee Stiffness After Tibial Plateau Fractures: Predictors and Outcomes (OTA-41). J Orthop Trauma. 2018;32(11):421-7.

Reahl GB, Marinos D, OʼHara NN. Risk Factors for Knee Stiffness Surgery After Tibial Plateau Fracture Fixation. J Orthop Trauma. 2018;32(9):339-43.

Swarup A, Rastogi A, Singh S, Swarn K. Functional outcome of surgical management of tibial plateau fractures in adults. Int J Res Med Sci. 2016;4(3).