Two-level fixation with headless compression screws for tibial plateau fractures

Abstract

Purpose: Reduction and fixation of tibial plateau fractures associated with small, "floating" intra-articular fragments proposes a challenge. We use fully threaded headless compression screws for (interfragmentary) fixation of such fragments before final plate fixation when standard fixation of intra-articular fragments with k-wires or lag screws is deemed insufficient. Our aim is to describe our technique and clinical experience of this two-level fixation.

Methods: Between 2006 and 2021, 29 patients with a comminuted tibial plateau fracture were treated with this two-level fixation in this retrospective case series. Clinical baseline and surgical variables were collected for all patients. Clinical outcome variables were available for 28 patients with a median follow-up of 16.5 months (IQR 5-24). Functional outcomes were measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and reported by 22 patients at a median of 5.2 years (IQR 3.5-9.8).

Results: Reduction was anatomic or good in 82% of cases, fair in 14%, and a malreduction in 4%. Arthrosis was graded as grade 0 in 25% of cases, 1 in 39%, 2 in 21%, and 3 in 14%. Flexion was 110 degrees (IQR 100-130). Five patients had an extension deficit of 5 to 10 degrees. Median KOOS for symptoms and stiffness was 69 points (IQR 45-78), for pain 71 (IQR 45-88), for ADL 85 (IQR 52-95), for sports 30 (IQR 11-55), and for quality of life 34 (IQR 19-56).

Conclusion: The use of fully threaded headless compression screws is a simple and helpful addition in the treatment of comminuted tibial plateau fractures.

Keywords: Fracture; Plateau; Reduction; Screw; Tibial.

Fig. 1

Example of inter-fragmentary fixation in a 52-year-old female with a Schatzker type V fracture of the left knee with two lateral fragments (patient 26). A Pre-operative axial CT-scan showing the two lateral fragments. B Intra-operative fluoroscopy displaying the HCS used for inter-fragmentary fixation of the lateral fragments and their placement as close to the surface as possible. Two HCS are used to fixate the tibial eminence. C Post-operative axial CT-scan showing the concept of “two-level” interfragmentary fixation, where the fused fragment is reduced and fixated with an overlying plate with rafting screws. D Radiograph 10 months after treatment with the HCS

Fig. 2

Superimposition of the HCS used for interfragmentary fixation in the lateral tibia plateau. The arrow indicates the two screws that migrated