Comparative study between arthroscopic reduction and internal fixation versus open-reduction internal fixation for tibial-plateau fractures

Background
Tibial-plateau fractures are challenging for orthopedic surgeons. The gold-standard treatment for most tibial-plateau fractures is open-reduction internal fixation using either screws only or plates and screws. Recently, arthroscopy has invaded the field of trauma as a useful aid in the management of intra-articular fractures. The main advantages of arthroscopic reduction and internal fixation for tibial-plateau fractures are direct visualization of intra-articular fractures, accurate fracture reduction, and diagnosis and treatment of meniscal and ligamentous injuries. This study was done to compare the results of open-reduction internal fixation versus arthroscopic reduction and internal fixation for tibial-plateau fractures.
Patients and methods
A prospective comparative study was held in EL Hadra University Hospital between January 2017 and December 2019 over 56 patients. In all patients, the fracture was fixed using two to three cannulated screws. In the first group, the fixation was done using arthroscopy, while in the second group, the fixation was done using arthrotomy. All cases were assessed using Rasmussen clinical and radiological forms, Lysholm, and International Knee Documentation Committee (IKDC) scores. The minimum follow-up was 24 months since index surgery.
Results
There was no statistically significant difference between the two groups regarding the clinical and radiological Rasmussen scores. Moreover, the results of the Lysholm and IKDC were comparable. However, the arthroscopic group had longer operative time than the arthrotomy group.
Conclusion
Arthroscopic fixation technique was not inferior to open technique for management of Schatzker I–III fracture types with excellent comparable clinical and radiological outcomes while avoiding the drawbacks of the open approach.