PROXIMAL TIBIAL FRACTURES: EARLY EXPERIENCE USING POLYAXIAL LOCKING PLATE TECHNOLOGY

Abstract

Purpose: Proximal tibia fractures present a difficult treatment challenge with historically high complication rates. The purpose of this study is to report the clinical outcome of proximal tibial fractures treated with of a variable-axis locking plate.

Patients and Methods: Between 2004 and 2007, 42 patients (23 males) with a mean age of 50 (21–67) with a total of 42 proximal tibia fractures were included in this prospective documented study. Fractures were classified according to the OTA system. All fractures were treated with the polyaxial locked-plate fixation system (DePuy, Warsaw, Indiana). Besides radiography, CT scanning was obtained for type B and C fractures. Clinical and radiographic data, including fracture pattern, changes in alignment, local and systemic complications, hardware failure and time to union were recorded. Functional outcome was measured using the Knee Society Score. Malalingment was defined the presence of more than 5°angulation in any plane at the post-op X-ray and at the final F.U. The mean follow up was 11 months (6–36).

Results: According to the OTA classification, there were 7 41-A, 11 41-B and 24 41-C fractures. There were 6 open and 36 closed fractures. The majority were isolated injuries 38/42. 19 cases required bone grafting. Fractures were treated percutaneously in 30% of the cases (MIPO). Double plating was utilised in 8 cases. All fractures but 2 progressed to union at a mean time of 3.8 months (3–5). The two fractures who failed to unite were complicated by deep sepsis and required further intervention. One patient required fasciotomies for compartment syndrome. Superficial infection was treated successfully with a short course of antibiotics in 2 cases. There was no evidence of varus collapse as a result of polyaxial screw failure. No plate fractured, and no screw cut out was noted. There was 1 case of lateral joint collapse (more than 10o) in a patient with open bicondylar plateau fracture. The mean Knee society score at the time of final follow-up was 89 points (59 – 100) and the mean functional score was 83 points.

Conclusion: The polyaxial locking plates provided stable fixation of extra-articular and intra-articular proximal tibia fractures and good functional outcomes with a low complication rate. These plates offer more fixation options without an apparent increase in mechanical complications or loss of reduction.