Unstable bicondylar tibial plateau fractures: a clinical investigation.
OBJECTIVE
To evaluate fracture patterns in bicondylar tibial plateau fractures and their impact on treatment strategy.


METHODS
Prospective data analysis with documentation of initial injury and treatment strategy, computed tomography scans, conventional x-rays, long-term evaluation of radiographs, and functional assessments.


METHODS
Level 1 regional trauma center.


METHODS
Prospective data acquisition of 14 consecutive patients (10 male and 4 female) with a bicondylar tibial plateau fracture (AO Type C).


METHODS
Application of a stepwise reconstruction strategy of the tibial plateau starting with the reposition and fixation of the posteromedial split fragment using a 3.5 buttress plate, followed by reposition and grafting of the lateral compartment and lateral fixation with a 3.5 plate in 90 degree to the medial fixation device.


METHODS
All patients were evaluated with full-length standing film, standardized x-rays, Lysholm score for functional assessment, and patient's self-appraisal.


RESULTS
Most of the complex bicondylar fractures follow a regular pattern in that the medial compartment is split in a mediolateral direction with a posteromedial main fragment, combined with various amounts of multifragmental lateral compartment depression. The technique introduced allows for accurate and stable reduction and fixation of this fracture type. The final Lysholm knee score showed an average of 83.5 points (range: 64.5-92).


CONCLUSIONS
Complex bicondylar tibial plateau fractures follow a regular pattern, which is not represented in existing 2-dimensional fracture classifications. A 2-incision technique starting with the reduction of the posteromedial edge results in accurate fracture reduction with low complication rates and excellent knee function.
Eggli
Stefan
S
Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland. stefan.eggli@insel.ch
Hartel
Maximilian J
MJ
Kohl
Sandro
S
Haupt
Uli
U
Exadaktylos
Aristomenis K
AK
Röder
Christoph
C
D000328:Adult; D000368:Aged; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D018460:Fractures, Comminuted / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000601:surgery*; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013978:Tibial Fractures / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult