Resultado funcional de las fracturas de meseta tibial tratada con fijador…(I)

Terence Y.P. Chin, , David Bardana, Michael Bailey, Owen D. Williamson, Russell Miller, Elton R. Edwards and Max P. Esser

Department of Orthopaedics and Trauma, The Alfred Hospital, Commercial Road, Prahan, Melbourne, Victoria, 3135, Australia

Summary Objective To review the functional outcome of patients with complex tibial plateau fractures treated with fine-wire fixation.

Design Retrospective review with follow-up of patients in outpatient clinic.

Setting Tertiary trauma center.

Patients All patients who had fine-wire fixation for tibial plateau fractures between 1996 and January 2001 were reviewed.

Interventions Fine-wire fixation with/without limited internal fixation for complex tibial plateau fractures.

Main outcome measures Knee range of motion, adequacy of articular surface reduction, mechanical axis, Knee Society Clinical Rating Scale and Short-Form 36 Health Questionnaire.

Results Eighteen of twenty-one eligible patients were available for follow-up. There were 14 Shatzker VI and 4 V fractures. Seven fractures were open. Average follow-up was 28.2 months. All fractures united. There were three cases of delayed union, all progressed to union following additional procedures and bone grafting. There were no cases of osteomyelitis, septic arthritis or deep vein thrombosis. Seven patients had Knee Society Clinical Rating Scores of good/excellent (38.9%), and 11 had fair/poor scores (61.1%). Abnormal mechanical axes and multiple co-morbid injuries were associated with poorer outcomes. Although SF-36 scores were lower in the study group compared to matched population norms, 15 of 18 patients had full or partial return to pre-injury levels of functioning.

Conclusion Fine-wire fixation with limited internal fixation is a satisfactory method of managing complex high-energy fractures of the tibial plateau where soft tissue injury and bony comminution make traditional techniques of open reduction and internal fixation unsuitable.