Dual plating for complex tibial plateau fractures

Objective A prospective study was conducted to evaluate the efficacy of modified dual plating for the complex fractures of tibial plateau. Methods From April to December 2001, 21 cases of comminuted, unstable tibial plateau fractures were treated with dual plating. The mean age of the patients was 45.2 years (20-66 years), which consisted of 12 males and 9 females. According to the AO classification, there were 7 of type B and 14 of type C; However, by the Schazker classification, 7 were of type Ⅳ, 6 of type Ⅴ, and 8 of type Ⅵ. The medio-lateral approach was used for the modified dual plating: the antero-medial approach combined with postero-medial approach was used for the fractures in Schatzker Ⅳ type, the 3.5 LC-DCP or 1/2 tubular plate was used to support the postero-medial key fragments; and the anterolateral approach combined with postero-medial approach was selected for the fractures in Schatzker Ⅴand Ⅵ types. The posterior fragments was buttressed as the above method, the lateral side was fixed with the Golf shaped plate. Results All 21 patients were available at follow up with mean duration of 15.6 months (range, 13-25 months). The flexion of the knee achieved 100.0°(ranged from 80°-135°) at the 1st month postoperatively; then it was improved to 117.1°(range, 90°-135°) at the 3rd month. A comparison concerning the tibial plateau angle (TPA) and posterior slope angle (PA) immediately after operation with that both at the 3rd month and one year postoperatively, the difference was of no significance (P0.05). According to the HSS system, the score was 89.6 (range, 75-98) averagely one year after operation. No any complications occurred, such as necrosis of the incision, deep infection, the loosening and breakage of the internal fixator. Conclusion The technique with modified dual plating for the complex fractures of the tibial plateau provides satisfactory function of the knee, it has many advantages, such as stable and durable fixation, avoiding the replacement and change of the knee mechanics, as well as diminish the problems about the incision and soft tissue.