From the Guidelines
Surgical treatment of tibial plateau fractures should prioritize open reduction and internal fixation (ORIF) with the use of plates and screws to restore articular congruity and provide stability, as this approach has been shown to be effective in achieving optimal outcomes in terms of morbidity, mortality, and quality of life. When considering the surgical techniques for treating tibial plateau fractures, several factors such as fracture pattern, displacement, and patient factors must be taken into account.
- The use of CT scans, as noted in the study by Spiro et al 1, can help in further classification and characterization of the fracture severity, predicting ligamentous and meniscal injuries, and guiding the decision for MRI to confirm or exclude these injuries.
- Open reduction and internal fixation (ORIF) is the most common approach, which typically involves lateral or medial plating, with locking plates being particularly useful for osteoporotic bone, as seen in studies focusing on fracture management 1.
- For complex bicondylar fractures, dual plating techniques may be employed with both medial and lateral plates.
- Minimally invasive plate osteosynthesis (MIPO) can reduce soft tissue damage while achieving fixation.
- Arthroscopy-assisted reduction is beneficial for visualizing and addressing intra-articular components.
- External fixation serves as either a temporary bridge to definitive surgery in cases with severe soft tissue compromise or as definitive treatment for certain fracture patterns.
- Bone grafting is often necessary to fill metaphyseal voids and provide structural support, using either autograft, allograft, or synthetic substitutes.
- For severely comminuted fractures in elderly patients with poor bone quality, primary total knee arthroplasty may be considered, as it offers a viable option for restoring function and alleviating pain in such challenging cases. The goal of these surgical techniques is to restore joint congruity, maintain mechanical alignment, and allow early range of motion to prevent stiffness while the fracture heals, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Surgical Techniques for Treating Tibial Plateau Fractures
The treatment of tibial plateau fractures involves various surgical techniques, including:
- Internal fixation with locking plates and the MIPO (Minimally Invasive Percutaneous Osteosynthesis) technique 2
- Open reduction and internal fixation (ORIF) 3, 4, 5
- Hybrid external fixation (HEF) 6, 4
- External fixation (ExFx) 6
Approaches to the Proximal Tibia
The choice of approach is dictated by the fracture pattern, soft tissue envelope, patient factors, and associated injuries. Commonly used approaches include:
- Anterolateral approach 5
- Other approaches that allow for the treatment of any proximal tibia fracture 3
Comparison of Surgical Techniques
Studies have compared the outcomes of different surgical techniques, including:
- ORIF versus ExFx 6
- ORIF versus HEF 4
- These studies have found that both techniques have their advantages and disadvantages, and the choice of technique should be based on the fracture pattern, soft-tissue condition, and injury stage 6, 4
Key Considerations
When treating tibial plateau fractures, it is essential to consider the following factors: