Elevation of depressed tibial plateau fractures using rafting one-third of the tubular plate

Background
Tibial plateau fracture is an intra-articular fracture for which the treatment requires not only anatomical reduction but also reliable fixation to maintain the position of the articular surface. The work aimed to study the effects and benefits of using one-third of the tubular plate as a rafting plate for elevation of the depressed (especially comminuted) tibial plateau fractures to avoid subsidence and collapse of the articular surface even with reliable subchondral fixation.
Patients and methods
This prospective case series study included 30 patients aged from 21 to 50 years old with closed depressed tibial plateau fractures (Schatzker type II, III, IV, and V) diagnosed by radiographs and computed tomography scan with no other skeletal injuries in the lower limb, mean±SD period from injury to surgery was 3.33±0.33 days. Radiological examination was performed using plain radiograph of the knee joint, and computed tomography scans with three dimensional for all patients. Rasmussen clinical and radiographic scoring systems were used for outcome evaluation. Minimum follow-up period was 3 months, and the maximum follow-up period was 12 months. In this study, Kirschner wires were used for temporary fixation. Also one-third tubular plate was used as a rafting plate for the elevation of the depressed tibial plateau fracture through making an osteotomy in the tibia (not <5 mm subchondral) or through the fracture itself. The plate was placed subchondral into the bone straight, then it was bent over the tibia (acting as a lever for elevating the depressed fracture). At the end, the plate was fixed to the tibia by two or three screws.
Results
Rasmussen’s clinical score at 3 months was excellent in eight (26.7%) cases, good in 13 (43.33%) cases, fair in six (20%) cases, and poor in three (10%) cases. Rasmussen’s clinical score at 6 months was excellent in 14 (46.66%) cases, good in 12 (40%) cases, fair in two (6.67%) cases, and poor in two (6.67%) cases. Rasmussen’s clinical score at 12 months was excellent in 16 (53.33%) cases, good in 10 (33.33%) cases, fair in two (6.67%) cases, and poor in two (6.67%) cases. Rasmussen’s radiographic score at 3 months was excellent in four (13.33%) cases, good in 11 (36.67%) cases, fair in nine (30%) cases, and poor in six (20%) cases. Rasmussen’s radiographic score at 6 months was excellent in seven (23.33%) cases, good in 18 (60%) cases, fair in two (6.67%) cases, and poor in three (10%) cases. Rasmussen’s radiographic score at 12 months was excellent in 17 (56.66%) cases, good in eight (26.67%) cases, fair in three (10%) cases, and poor in two (6.67%) cases. There was a significant relation between smoking and union after 3 months (P<0.001) as smokers had experienced delayed union. There was a significant relation between medical history and Rasmussen’s clinical score at 12 months (P=0.028). There was a significant relation between medical history and Rasmussen’s radiographic score at 12 months (P=0.014). There was no relation between age and Rasmussen clinical or radiographic scores at 3, 6, and 12 months. There was no relation between sex and Rasmussen clinical or radiographic scores at 3, 6, and 12 months.
Conclusions
The usage of the rafting plate to support the tibial plateau articular surface after the open reduction of depressed articular fractures is associated with good clinical and radiological outcomes and a low incidence of articular surface subsidence at 12 months postoperative.