International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438 Volume 4 Issue 9, September 2015 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Functional Outcome of Surgical Management of Tibial Plateau Fractures: Case Series of 30 Cases Dr. Kulwinder Singh 1 , Dr. Manjeet Singh 2 , Dr. Rakesh Gautam 3 1, 2, 3 Department of Orthopaedics: M M Institute Of Medical Sciences & Research Mullana: Ambala ; Haryana: India Abstract: Study Design : Prospective consecutive series. Objective : To evaluate the functional outcome of Surgical management of Tibial Plateau Fractures. Summary of Background data : Earlier there was great reluctance towards operative management of these fractures because of lack of proper implants and adequate fixation techniques. But now due to the better understanding of biomechanics of knee joint, types of implant, principles of internal fixation, soft tissue care, the treatment of tibial plateau fractures is changing from conservative to surgical depending upon the fracture pattern to achieve good fracture union and optimal knee function. Methods: A Prospective study of 30 cases to assess the efficacy and functional outcome of tibial plateau fractures managed surgically by Closed/Open reduction and fixation with various internal fixation devices. Results : We found acceptable results in 83.3% cases which were comparable with several other studies which prove the advantage of Surgical management of Tibial Plateau Fractures. Keywords: Tibial Plateau Fracture (TPF), Biomechanics, Internal fixation, Knee Function. 1. Introduction Advances in mechanization and the acceleration of travel have resulted in increase in road traffic accidents which is associated with increase in the number of Tibial Plateau fractures. They were first called “bumper” or “fender” fracture by Cotton and Berg 1 (1929). Tibial plateau fractures constitute about 1% of all fractures and 8% of elderly people 2 .Tibial plateau fractures can range from a simple lateral split pattern to very complex bicondylar injuries that can be a source of great disability. Presently the majority of tibial plateau fractures are secondary to high speed motor vehicle accidents and fall from height 3 . The direction, magnitude and location of the force, as well as the position of the knee at impact, determines the fracture pattern, location, and degree of displacement 4 .Most studies have shown, that the most injuries affect the lateral plateau (55% to 70%), isolated injuries of the medial plateau occur in (10% to 23%) of cases, whereas involvement of both plateaus is found in (10% to 30%) of reported series 5 . Fractures of tibial plateau occur as a result of strong valgus or varus forces combined with axial loading 6 . The primary goal of the treatment of Tibial plateau fracture, is precise & congruent reconstruction of the articular surfaces, axial alignment, stable fixation and early mobilization to preserve normal knee function. Despite of various studies, done in the past years, the optimal method of surgical management remains controversial. Earlier there was great reluctance towards operative management of these fractures because of lack of proper implants, adequate fixation techniques and good antibiotics. But now due to the better understanding of biomechanics of knee joint, types of implant, principles of internal fixation, soft tissue care, antibiotics and asepsis, the treatment of tibial plateau fractures is changing from conservative to surgical depending upon the fracture pattern. Conservative treatment is associated with various complications like prolonged immobilization, knee stiffness or mal union. Surgical management prevents these complications. Closed/Open reduction and internal fixation depending upon the type of fracture has been advocated using various implants including percutaneous cannulated cancellous screws, buttress plates, and LCP (Proximal Tibial locking compression plate) etc, to achieve good fracture union and optimal knee function. Soft tissue-friendly approaches and minimally invasive techniques have all recently improved outcomes following these injuries. The purpose of this study was to assess the functional outcome of various modalities of surgical treatment in different types of Tibial plateau fractures and to compare our results with literature. 2. Materials and Methods Over a period of 3 years,30 cases of Tibial Plateau fractures admitted to our department were treated by various surgical techniques and there functional outcome evaluated. Inclusion criteria Patients above 18 years of Tibial plateau fractures with 5mm or more displacement or depression or step. Exclusion criteria Age less than 18 years, Compound fractures, fractures with <5mm displacement or depression or step, fractures with vascular injury. The patients on admission after stabilization and splintage to the affected limb, were evaluated by AP, lateral and oblique (if required) X Ray views of the affected knee including distal femur and upper tibia. Computed Tomography (CT) scan with or without 3D (Three Dimensional reconstruction Views) reconstruction was done wherever needed. The patients were closely monitored for any signs and symptoms of compartment syndrome after admission. Also the condition of the skin of the affected leg was observed for any blister formation. Pre-operative broad spectrum antibiotics were given before surgery. All fracture were classified according to Schatzker classification 7 from Type I toType VI Time of surgery was decided on the status of soft tissues and general condition of the patient. The surgery was performed with the patient under general or spinal/epidural anaesthesia. Pneumatic tourniquet was applied after taking proper precautions and the time of its inflation and release was noted. Surgery was performed with the patient supine on a Paper ID: SUB158226 905