OTA 1998 Posters

Percutaneous Plating of Tibial Plafond and Plateau Fractures: Preliminary Report

DuWayne A. Carlson, MD, Phoenix Orthopaedic Residency Program, Phoenix, AZ

Introduction: Soft tissue complications associated with tibial plafond (43-C) and Schatzker type V (41-C) and VI (41-A2) tibial plateau fractures are well known. This has led many to abandon classic plating techniques for external fixation to decrease complication rates.

Purpose: To determine if percutaneous plating of the medial tibial plateau and the medial tibial plafond decreases complication rates in treated fractures.

Materials and Methods: This is a retrospective review of tibial plateau and tibial plafond fractures from August 1996 to April 1998 that met criteria for percutaneous plating. Criteria for inclusion: perimetaphyseal fractures which could be reduced with indirect reduction techniques. 41-C tibial plateau fractures were treated with open reduction and plating of the lateral plateau with medial percutaneous plating. 43-C tibial plafond fractures were treated with open reduction and limited joint fixation through an anterior incision if closed reduction could not be achieved. Medial percutaneous plating was then performed.

Results: The index sixteen, consecutive percutaneous plates included eight tibial plateau and eight tibial plafond fractures. Each of the plateau fractures were closed. Seven of the eight tibial plateau fractures were Schatzker type V (41-C1.2, C1.3, C2.1, C3.1, and C3.3) and one was a Schatzker type VI (41-A2.1) fracture pattern. Joint reductions were excellent (<1 mm stepoff) in four, adequate (<2 mm) in three, and poor (>3 mm) in one. Metaphyseal alignment reductions were excellent in seven and poor in one. No infections, no soft tissue complications, and one loss of alignment was noted. Two medial plateau hardware removals were necessary.

There were eight tibial plafond fractures, one of which had a grade II open wound (41-A2.1). Closed fracture patterns included 43-C1.3, C2.2, and C2.3. Joint reductions were excellent in five and adequate in two. Metaphyseal alignment reductions were excellent in five, adequate (+3^o) in one, and poor (>4^o) in two. Superficial wound dehiscence was seen in one patient and treated with local wound care. One infection resulted (open fracture) and no loss of alignment was noted in any of the fractures.

Discussion: This relatively new technique needs further study to determine if there is a long term advantage to this form of fixation over the more traditional current techniques. It does seem to have many theoretical advantages, including stability without the soft tissue risks of open plating. It also avoids pin tract infections and possible secondary fracture or joint infection due to wires traversing fractures that extend intra-articularly as with hybrid external fixation.

Conclusion: Percutaneous plating of the medial tibial plateau and of the medial tibial plafond is a useful technique in preventing soft tissue complications.