Risk analysis in tibial plateau fractures: association between severity, treatment and clinical outcome

Our retrospective study analyzes efficacy of treatment techniques we used for the reduction of tibial plateau fracture. A sample of 67 individuals is evaluated, 50 males and 17 females, and treated for a tibial plateau fracture from December 2003 to June 2008. The mean age is 46 (range 22-72). 35 patients were treated with cannulated screws alone, 21 were treated with plates alone, and 11 were treated with both plates and bone substitutes. All patients were clinically and radiographically followed up for an average time of 36.4 months (SD = 17.4; range 24-72). Data about patients sourced from the analysis of SF36, WOMAC and the Rasmussen score. Patients were divided into 4 groups and 2 subgroups, according to the synthesis method used and the severity of the fracture. The control group includes the patients diagnosed with a low-energy fracture treated with screws alone. The median of the total score of Rasmussen functional grading system resulted to be equal to 26; compared with the control group, there is strong relationship between the use of plates alone and the risk of obtaining a clinically less effective result (O.R. = 5.48; p = 0.003) even more when comparing Schatzker type IV, V, and VI (O.R. = 13; p = 0.0073). Radiographic evaluation shows less efficacy of bone substitute to reduce articular step-off. With regard to the SF36, patients treated with plate alone have been awarded the lowest score. The treatment of the most severe fractures of tibial plateau by means of internal fixation with plates can be improved with the use of bone substitutes.