The effectiveness of arthroscopy assisted fixation of Schatzker types I-III tibial plateau fractures: our experience at a tertiary centre

Abstract

Background: Tibial condyle fractures are high energy injuries which require anatomical reduction and stable fixation for early mobilisation of the knee joint. Arthroscopy assisted fixation of these fractures provide additional benefits of minimal dissection, accurate visualisation of the articular surface and faster rehabilitation. The present study describes our experience with this technique.

Materials & methods: Patients in the age group 15-65 years, presenting with closed tibial plateau fractures (Schatzker types I, II, III) at the advanced trauma centre of our institute within 3 weeks of injury, were recruited for this prospective case series. Open fractures, fractures of types IV, V and VI, fractures with associated knee dislocation, fractures presenting after 3 weeks and polytrauma patients with head injuries and/or blunt trauma to chest/abdomen, were excluded. Patients were evaluated according to Rasmussen numerical subjective evaluation chart at a minimum follow up of 6 months.

Results: There were 5 fractures of Schatzker type I, 8 of type II and 2 of type III, which were scoped and fixed percutaneously. The mean age of the 15 patients was 34.2 years with male to female ratio of 4:1. Diagnostic arthroscopy detected co existent lateral meniscal tears (peripheral) in 2 cases, while 1 case had a contused anterior cruciate ligament. Fixation of the fractures were done by 1 or 2 percutaneous screws in 9/15 cases; buttress plating in 4/15 cases and combination of plate and screw in 2/15 cases. The average overall Rasmussen score was 28.2/30 (range 22-30) and there were 1 patient each with postoperative stiffness and screw prominence while 3 cases had extensor lags.

Conclusion: The aim of this combination procedure is stable fixation by minimally invasive methods; this reduces surgical insult, improves articular surface visualisation, allows management of concomitant ligament injuries, and patients can be rapidly mobilised. Case selection is extremely important for good results.

Keywords: Schatzker; arthroscopy assisted; rasmussen score; tibial condyle fracture.

Figure 1

A 34 year old female with fracture of the lateral condyle (type I) due to a road traffic accident. A: Preoperative X-rays showing the split; B: Axial cuts in the CT scan showing the fracture line; C: Intra-operative image showing the method of percutaneously clamping the fracture and dual checking the reduction via the arthroscope and the C-arm; D: X-rays showing complete union of the fracture; E: Clinical pictures depicting normal range of knee movements.

Figure 2

Pie Chart depicting the Fracture patterns (Schatzker types) included in the study.

Figure 3

Individual Rasmussen scores of the patients.