TIBIAL PLATEAU FRACTURES IN A LIMITED-RESOURCE SETTING: A PROSPECTIVE STUDY OF SURGICAL TECHNIQUES AND OUTCOME OVER THREE YEARS

Tibial plateau fractures in a limited-resource setting: A prospective study of surgical techniques and outcome over three years

Daniel Handy Eone^1*, Itambi Maxwell Asoh¹, Ernest Kikah Ndifor¹, Mbaga Ntjam Andre Claude¹, Fonkoue Loic², Muluem Olivier Kennedy¹, Guifo Marc Leroy³, Kaldadak Martin⁴, Ibrahima Farikou⁵

¹Orthopaedic and Trauma Surgery Unit, Yaounde Central Hospital. ²Orthopaedic and Trauma Surgery Unit, Yaounde Emergency Centre. ³Orthopaedic and Trauma Surgery Unit, Yaounde University Teaching Hospital. ⁴Orthopaedic and Trauma Surgery Unit, Yaounde Military Hospital. ⁵Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaounde I.

Introduction: Tibial plateau fractures form a wide spectrum of injuries accounting for 1.2% of all fractures and a prevalence of 10 cases per 100,000 inhabitants.

Methodology: A prospective consecutive multicentre study from May 2018 to May 2021 was carried out in Yaounde. All consenting cases of tibial plateau fracture underwent surgical treatment while patients with pathologic fractures, previous knee osteoarthritis, medically unfit for surgery, and discharging against medical advice were excluded. Data was analysed with SPSS 26.0 and the level of significance set at p<0.05.

Results:Eighty-four (84) cases of tibial plateau fractures were sampled and 68 consented to surgery. The mean age was 42 ±13.6 years and sex ratio 2.4. Estimated prevalence was 2.2 cases per 100,000 inhabitants. Schatzker type II fractures were most represented (33.3%). The left leg was affected in 57.1%. Motorbike accidents were the main cause of injury (66.7%). Of the 68 operated, 63.3% by plating osteosynthesis, 32.4% by external fixation, and 4.4% by screws fixation. Tricortical iliac bone graft was realised in 4 cases. The minimum follow-up was 6 months, with a median of 18 months (5 to 37 months). Plating osteosynthesis (p<0.001), operative time between 60 to 120 minutes (p<0.02) and a good radiologic fracture healing (p<0.04) were associated with a satisfactory outcome. Poor prognosis was seen with open fractures (p<0.001), bridging external fixation (p<0.001), and Schatzker VI fractures (p<0.02). Complications included post-traumatic osteoarthritis (64.7%), post-traumatic osteomyelitis (29.4%), knee ankylosis (5.9%), and limb malalignment (30.9%).

Conclusion:The prevalence of tibial plateau fractures remains lower than reported in literature but it is projected to rise. Plating remains a viable treatment option. A larger scale study will establish the burden of this entity in our context.

Keywords: Tibial plateau fracture, Treatment, Outcome, Complications

Free Full-text PDF

How to cite this article:
Daniel Handy Eone, Itambi Maxwell Asoh, Ernest Kikah Ndifor, Mbaga Ntjam Andre Claude, Fonkoue Loic, Muluem Olivier Kennedy, Guifo Marc Leroy, Kaldadak Martin, Ibrahima Farikou. Tibial plateau fractures in a limited-resource setting: A prospective study of surgical techniques and outcome over three years. American Journal of Orthopedic Research and Review,2022, 5:31. DOI: 10.28933/ajorr-2021-11-2807

References:

1. Mthethwa J, Chikate A. A review of the manage-ment of tibial plateau fractures. Musculoskelet Surg. 2018;102(2):119–27.
2. Papagelopoulos PJ, Partsinevelos AA, Themisto-cleous GS, Mavrogenis AF, Korres DS, Soucacos PN. Complications after tibia plateau fracture surgery. Injury. 2006;37(6):475–84.
3. Elsoe R, Larsen P, Nielsen NPH, Swenne J, Rasmussen S, Ostgaard SE. Population-Based Epidemiology of Tibial Plateau Fractures. Ortho-pedics. 2015;38(9):780–6.
4. Achor T, Taylor R. Tibial Plateau and Shaft Frac-tures. Orthopaedic Knowledge Update 12. 12th Edition. USA: AAOS; 2017. p. 494–509.
5. Marsh J. Tibial Plateau Fractures. Rockwood and Green’s Fracture in Adults. Eighth edition. China: Wolters Kluwer; 2015. p. 2814.
6. van Dreumel RLM, van Wunnik BPW, Janssen L, Simons PCG, Janzing HMJ. Mid- to long-term functional outcome after open reduction and in-ternal fixation of tibial plateau fractures. Injury. 2015;46(8):1608–12.
7. Zheng Z, Yu Y-Y, Chang H-R, Liu H, Zhou H-L. Establishment of Classification of Tibial Plateau Fracture Associated with Proximal Fibular Frac-ture. Orthop Surg. 2019;11(1):97–101.
8. Bizolé BY, Essi M, Handy E, Nseme E, Ibrahima F, Sosso M. Orthopedic itineraries and public health challenges in the management of fractures in a tertiary hospital in Yaoundé Cameroon. Int J Orthop Sci. 2019;5(2):674–7.
9. Cameroon Life Expectancy 1950-2020. Accessed on 29/9/2020. https://www.macrotrends.net/countries/CMR/cameroon/life-expectancy.
10. Ngaroua D, Mbo J, Natacha Aidego A, Yaouba D, Ngah J. Les Fractures Dues aux Accidents de la Voie Publique à l’Hôpital Régional de Ngaoundere (Cameroun). Health Sci Dis. 2016;17 (3) :24–8.
11. Handy ED, Bizole BDY, Essi MJ, Kaldadak K, Ngo Nonga B, Sosso MA. Epidemiological Aspects and Therapeutic Indications of Tibial Plateau Fractures in Adults: About 84 Cases Observed in Yaoundé. Med J Clin Trials Case Stud. 2017;1(3):000118
12. Bizolé BYD, Essi MJ, Handy ED, Ibrahima F, Sosso MA. Déterminants Épidémiologiques du Recours à la Biomédecine chez les Patients Vic-times de Traumatismes Orthopédiques : à Propos de 214 Cas à Yaoundé. Health Sci Dis. 2019;20(6):69–73.
13. Albuquerque R, Hara R, Prado J, Schiavo L, Giordano V, Amaral N. Epidemiological study on tibial plateau fractures at a level I trauma center. Acta Ortop Bras. 2013;21:109–15.
14. Giannoudis PV, Tzioupis C, Papathanassopoulos A, Obakponovwe O, Roberts C. Articular step-off and risk of post-traumatic osteoarthritis. Evidence today. Injury. 2010;41(10):986–95.
15. Schatzker J, McBroom R, Bruce D. The Tibia1 Plateau Fracture: The Toronto Experience 1968-1975. Clin Orthop Relat Res. 1979;(138):94–104.
16. McNamara IR, Smith TO, Shepherd KL, Clark AB, Nielsen DM, Donell S, et al. Surgical fixation methods for tibial plateau fractures. Cochrane Database Syst Rev 2015;(9):CD009679.
17. Jeong J-J, Oh S, Ji J-H, Park S-J, Ko M-S. Im-mediate arthroscopy following ORIF for tibial plateau fractures provide early diagnosis and treatment of the combined intra-articular patholo-gies. Knee Surg Sports Traumatol Arthrosc. 2019;27(10):3327–33.
18. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev. 2016;1(5):225–32.
19. Kampa J, Dunlay R, Sikka R, Swiontkowski M. Arthroscopic-Assisted Fixation of Tibial Plateau Fractures: Patient-Reported Postoperative Activity Levels. Orthopedics. 2016;39(3):486-91.