Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 125 cases

Tibial plateau fractures occur due to a combination of axial loading and varus/valgus applied forces leading to articular depression, malalignment and an increased risk of posttraumatic osteoarthritis (OA) [14, 19]. When treating intra-articular fractures, the goal is to obtain a stable joint permitting early range of motion for cartilage nourishment and preservation [19]. Various treatment modalities have been used over the years, with mixed results. These include traction [3] or closed treatment with cast bracing [9, 16]. Surgical procedures including circular frames [1, 2, 18], percutaneous screw fixation [17], open reduction/internal fixation (ORIF) [1, 5, 6, 10, 28] and arthroplasty have also been advocated. More recent techniques such as the use of fixed angle devices [12, 20], arthroscopically-assisted reduction [8], calcium based cement augmentation [26, 29] and the use of novel grafting methods to address articular depression [4], constantly gain popularity amongst orthopaedic surgeons. Protection from weight bearing and length of immobilisation receive varied emphasis among authors [2, 11, 27]. Despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury [14, 21]. In young patients this could be detrimental as it can lead to total knee replacement (TKR) at an early age. In addition, these fractures may have significant socio-economic influence, mainly due to time taken off work. In order to assess the effect of these injuries on functional outcome and development of OA, we retrospectively reviewed a series of tibial plateau fractures treated in our institution.