Fixation of tibial plateau fractures with plate has been widely used. This prospective study was planned to compare locking plate fixation of tibial plateau fracture with nonlocking methods in terms of their functional outcomes. The subjects of the study were selected from consecutive patients suffering from tibial plateau fractures referred to Kashani Hospital in Isfahan, Iran, between 2012 and 2013 and were candidate for surgery. The final included patients were assigned to two groups, those who were treated with locking plate ( ) and those who were treated with nonlocking plates ( ). The mean duration of follow-up was 13.4 months (ranging between 10 and 17 months). The mean of knee scores was significantly higher in locking plate group than in nonlocking plate group at the follow-up time ( versus , ). Also, the mean VAS pain severity score was significantly lower in locking plate group compared with nonlocking plate group ( versus , ). This study confirmed superiority of the locking plate method over nonlocking plate method with regard to knee score as well as VAS pain score. 1. Introduction Proximal tibial fractures are important fractures involving one of the main weight-bearing joints whose serious injury results in movement and ability dysfunctions [1]. The main goal of the treatment of these fractures is to maintain the normal function of the knee joint, improve the joint instability, prevent lower limb malalignment and deformity, and prevent knee osteoarthritis [2–4]. Applying effective preventive approaches can lead to maintained articular surface, uniform plateau level, and a near normal range of knee joint motion. The main defined criteria in functional assessment of patients with proximal plateau fractures of tibia include knee range of motion, time to achieve union, patient’s ability to walk, patient’s ability to climb stairs, the pain severity while walking as well as at rest, muscle strength, severity of instability in the knee, and loss of active extension of the knee [5–8]. Unfortunately, there is no gold standard treatment approach for various types of tibial plateau fractures; therefore, different methods have been employed depending on the type of fracture. Tibial plateau fixation with plate especially nonlocking plates has been widely used in recent years [9, 10]. One of the commonly applied types of these plates is the locking compression plate that provides greater stability in these unstable fractures and creates a stronger connection between the articular components [11]. Stabilizing the joint surface by this method, due to its
References
[1]
D. Schneidmueller, E. Gercek, M. Lehnert, F. Walcher, and I. Marzi, “Proximal tibial fractures,” The American Journal of Sports Medicine, vol. 31, pp. 404–407, 2011.
[2]
M. Bhandari, L. Audige, T. Ellis et al., “Operative treatment of extra-articular proximal tibial fractures,” Journal of Orthopaedic Trauma, vol. 17, no. 8, pp. 591–595, 2003.
[3]
S. G. Agnew, “Tibial plateau fractures,” Operative Techniques in Orthopaedics, vol. 9, no. 3, pp. 197–205, 1999.
[4]
S. N. Maripuri, P. Rao, A. Manoj-Thomas, and K. Mohanty, “The classification systems for tibial plateau fractures: how reliable are they?” Injury, vol. 39, no. 10, pp. 1216–1221, 2008.
[5]
J. Schatzker, R. McBroom, and D. Bruce, “The tibial plateau fracture. The Toronto experience 1968–1975,” Clinical Orthopaedics and Related Research, vol. 138, pp. 94–104, 1979.
[6]
W. J. Mills and D. P. Barei, “High-energy tibial plateau fractures: staged management,” Operative Techniques in Orthopaedics, vol. 13, no. 2, pp. 96–103, 2003.
[7]
J. C. Kurylo and P. Tornetta, “Extra-articular proximal tibial fractures: nail or plate?” Instructional Course Lectures, vol. 62, pp. 61–77, 2013.
[8]
J. A. Lowe, N. Tejwani, B. J. Yoo, and P. R. Wolinsky, “Surgical techniques for complex proximal tibialfractures,” Instructional Course Lectures, vol. 61, pp. 39–51, 2012.
[9]
J. C. Krieg, “Proximal tibial fractures: current treatment, results, and problems,” Injury, vol. 34, supplement 1, pp. SA2–SA10, 2003.
[10]
J. A. Lowe, N. Tejwani, B. Yoo, and P. Wolinsky, “Surgical techniques for complex proximal tibial fractures,” The Journal of Bone & Joint Surgery. American, vol. 93, no. 16, pp. 1548–1559, 2011.
[11]
N. C. Tejwani, D. J. Hak, C. G. Finkemeier, and P. R. Wolinsky, “High-energy proximal tibial fractures: treatment options and decision making,” Instructional Course Lectures, vol. 55, pp. 367–379, 2006.
[12]
V. S. Nikolaou, H. B. Tan, G. Haidukewych, N. Kanakaris, and P. V. Giannoudis, “Proximal tibial fractures: early experience using polyaxial locking-plate technology,” International Orthopaedics, vol. 35, no. 8, pp. 1215–1221, 2011.
[13]
C. B. Jones, “Locked plates for proximal tibial fractures,” Instructional Course Lectures, vol. 55, pp. 381–388, 2006.
[14]
E. L. Freedman and E. E. Johnson, “Radiographic analysis of tibial fracture malalignment following intramedullary nailing,” Clinical Orthopaedics and Related Research, no. 315, pp. 25–33, 1995.
[15]
J. N. Insall, L. D. Dorr, R. D. Scott, and W. N. Scott, “Rationale of The Knee Society clinical rating system,” Clinical Orthopaedics and Related Research, no. 248, pp. 13–14, 1989.
[16]
S. Asif and D. S. Choon, “Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system,” Journal of Orthopaedic Surgery, vol. 13, no. 3, pp. 280–284, 2005.
[17]
J. P. Stannard, T. C. Wilson, D. A. Volgas, and J. E. Alonso, “The Less Invasive Stabilization System in the treatment of complex fractures of the tibial plateau: short-term results,” Journal of Orthopaedic Trauma, vol. 18, no. 8, pp. 552–558, 2004.
[18]
P. A. Cole, M. Zlowodzki, and P. J. Kregor, “Treatment of proximal tibia fractures using the Less Invasive Stabilization System: surgical experience and early clinical results in 77 fractures,” Journal of Orthopaedic Trauma, vol. 18, no. 8, pp. 528–535, 2004.
[19]
W. M. Ricci, J. R. Rudzki, and J. Borrelli Jr., “Treatment of complex proximal tibia fractures with the Less Invasive Skeletal Stabilization system,” Journal of Orthopaedic Trauma, vol. 18, no. 8, pp. 521–527, 2004.
[20]
J. A. Lee, S. A. Papadakis, C. Moon, and C. G. Zalavras, “Tibial plateau fractures treated with the less invasive stabilisation system,” International Orthopaedics, vol. 31, no. 3, pp. 415–418, 2007.
[21]
R. J. Krupp, A. L. Malkani, C. S. Roberts, D. Seligson, C. H. Crawford III, and L. Smith, “Treatment of bicondylar tibia plateau fractures using locked plating versus external fixation,” Orthopedics, vol. 32, no. 8, p. 559, 2009.
[22]
F. Biggi, S. Di Fabio, C. D'Antimo, and S. Trevisani, “Tibial plateau fractures: internal fixation with locking plates and the MIPO technique,” Injury, vol. 41, no. 11, pp. 1178–1182, 2010.
[23]
J. Littlechild, J. Keating, and K. Kahn, “A comparative study of locked fixation and non-locked plating for the treatment of tibial plateau fractures,” The Journal of Bone & Joint Surgery. British, vol. 94, article 73, 2012.
