Minimally invasive plating for high energy tibial plateau fractures

Objective A prospective study was conducted to evaluate the efficacy of minimally invasive plating (MIPO) for high energy tibial plateau fractures. Methods 17 cases of closed comminuted unstable tibial plateau fractures, 8 males and 9 females, were included in this study. Their mean age was 45.3 (20 66) yrs. According to AO classification, there were 3 cases of 41B and 14 cases of 41C; while by Schatzker classification, 2 cases were type Ⅱ, 4 cases were type Ⅴ, and 11 cases were type Ⅵ. An anterior lateral approach combined with a small posterior medial approach was used to reduce the risk of soft tissue complication. The main implant on the lateral side was inserted by minimally invasive method, leaving the blood supply around the fracture area undisturbed. All the patients were followed up at 1 month, 3 months, 6 months and 1 year postoperatively. Tibial plateau angle (TPA) and posterior slope angle (PA) of tibial plateau were measured to evaluate the stability of proximal tibia and knee alignment. HSS scoring was used as the parameter for knee function. Results The mean HSS score was 88.7(75 98)points one year after operation. Plate fixation was quite stable. The mean value of tibial plateau angle (TPA) and tibial plateau posterior tilting angle (PA) had no significant changes one year after operation (TPA: t= 0.979,P=0.342; PA: t = 0.659, P =0.519). The patients began full weight bearing at an average of 16.6 (9 27) weeks postoperatively, and their bony union was confirmed by X rays at an average of 15.4 (10 28) weeks postoperatively. The mean range of motion was from extension of 1.8°( 5° 5°) to flexion of 124°(120° 135°). No deep infection or other soft tissue complications were found in this group. Conclusion Minimally invasive plating is a safe and effective way to treat high energy tibial plateau fractures, for it provides rigid fixation for the fracture with low risk of soft tissue complications and good recovery of knee function.