title: Treatment of periprosthetic tibial plateau fractures in unicompartmental knee arthroplasty: plates versus cannulated screws.
abstract: BACKGROUND
  Periprosthetic tibial plateau fractures (TPF) are rare but represent a serious complication in unicompartmental knee arthroplasty. The most common treatment for these fractures is osteosynthesis with cannulated screws or plates. The aim of this study was to evaluate two different treatment options for periprosthetic fractures. The hypothesis was that angle-stable plates show significantly higher fracture loads than fixation with cannulated screws.
  
  
  METHODS
  Twelve matched, paired fresh-frozen tibiae with periprosthetic TPF were used for this study. In Group A, osteosyntheses with cannulated screws were performed, whereas in Group B plates fixated the periprosthetic fracture. DEXA bone density measurement and standard X-rays (AP and lateral) were performed before loading the tibiae under standardised conditions with a maximum load of up to 10.0 kN. After the specimens had been loaded, fracture patterns and fracture loads were analysed and correlated with BMD, BMI, bodyweight (BW), age and size of the tibial implant.
  
  
  RESULTS
  In the plate group all tibiae fracture occured with a median load of F (max) = 2.64 (0.45-5.68) kN, whereas in the group with cannulated screws fractures occurred at a mean load of F (max) = 1.50 (0.27-3.51) kN. The difference was statistically significant at p < 0.05.
  
  
  CONCLUSIONS
  Angle-stable plates showed significantly higher fracture loads than fixation with cannulated screws. Cannulated screws show a reduced stability of the tibial plateau. Therefore in periprosthetic TPF, osteosyntheses with angle-stable plates should be recommended instead of cannulated screws.
authors.affiliation: Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstraße 33, 35392, Giessen, Germany. joern.seeger@uk-gm.de
authors.forename: Joern Bengt
authors.initials: JB
authors.lastname: Seeger
authors.forename: S
authors.initials: S
authors.lastname: Jaeger
authors.forename: E
authors.initials: E
authors.lastname: Röhner
authors.forename: H
authors.initials: H
authors.lastname: Dierkes
authors.forename: G
authors.initials: G
authors.lastname: Wassilew
authors.forename: M
authors.initials: M
authors.lastname: Clarius
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D006801:Humans; D008875:Middle Aged; D057068:Periprosthetic Fractures / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013977:Tibia / Q000293:injuries / Q000601:surgery*; D013978:Tibial Fractures / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*