Combination of fine wire fixation and limited internal fixation for high-energy tibial plateau fractures: functional results at minimum 5-year follow-up.

OBJECTIVES

To assess knee function and the development of knee arthrosis, at 3 and 5 years postoperatively, in high-energy tibial plateau fractures that were treated with minimal internal fixation augmented by small wire circular frames.

SETTING

Level II trauma hospital.

DESIGN

: Retrospective study.

PATIENTS AND METHODS

Between October 1988 and December 1999, 145 consecutive high-energy tibial plateau fractures were treated with hybrid fixation including small wire circular or hybrid frames, minimal internal fixation, and occasionally provisional extension of the external fixation to the distal femur. One hundred twenty-seven patients with 129 fractures (89%) were included in the study. There were 68 (53%) C1, 20 (15%) C2, and 41 (32%) C3 fractures. Forty-seven (36.5%) of the total were open fractures. Clinical, subjective, objective, and radiographic results were evaluated at the time of union, at a minimum 3 years postoperatively, and at final minimum follow-up of 5 years.

RESULTS

Results were assessed according to the Honkonen-Jarvinen criteria. An excellent or good subjective result was noted in 106 fractures (82%) at a minimum 3-year follow-up, whereas an excellent or good score was achieved in 101 fractures (78%) at a minimum 5 years. A statistically significant deterioration (P = 0.001) of the post-traumatic radiographic arthritis was recorded at 5 years postoperatively.

CONCLUSIONS

High-energy tibial plateau fractures treated with minimal internal fixation augmented by small wire external fixation frames yielded a high percentage of cases exhibiting radiographic post-traumatic arthritis. However, because all the objectives of fracture treatment seemed to be obtained, the functional results remain satisfactory over time.