The role of arthroscopy in the assessment and treatment of tibial plateau fractures.

This retrospective study compared arthroscopic treatment of certain tibial plateau fractures to traditional open techniques. From January 1989 through August 1992, 40 patients with tibial plateau fractures were evaluated. After reviewing the records and radiologic studies, 23 patients were included in the study based on fracture patterns. Using Hohl's revised classification system, patients with either local compression or split compression fractures were included. Twelve of these patients were treated with arthroscopic reduction and percutaneous fixation (ARPF; group A). The remaining 11 underwent open reduction and internal fixation (ORIF; group B). The results of the ARPF group were superior to those of the ORIF group. In the ARPF group, all reductions were anatomic and remained fixed at least 3 months postoperatively, whereas only six (55%) of the ORIF patients had anatomic reductions initially. Furthermore, one of these patients had further loss of reduction on follow-up radiographs. Iliac crest bone graft was used in two patients in group A and 10 in group B. The use of bone graft in the arthroscopically treated group had no effect on the final outcome. The average length of postoperative hospitalization for the ARPF patients with isolated tibial plateau fractures was 5.36 days compared with 10.27 days for patients who were treated with ORIF. Average time to full weight bearing was 8.95 weeks in the ARPF group and 12.30 weeks in the ORIF group. No patients in either group had medial collateral ligament repairs. No ARPF-treated patients experienced valgus laxity after treatment. One patient in the ORIF group had residual instability and another walked with a cane.(ABSTRACT TRUNCATED AT 250 WORDS)