A STUDY OF SURGICAL MANAGEMENT OF PROXIMAL TIBIA FRACTURES TREATED WITH LOCKING COMPRESSION PLATE

Dr. Sardar Jaideep Singh and Dr. Bala Chandranna Post Graduate, Professor, Department of Orthopeadics, Santhiram Medical College and General Hospital, Nandyal. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 08 March 2020 Final Accepted: 10 April 2020 Published: May 2020


Introduction:
Tibial plateau is one of the most critical load bearing areas in the human body. Fractures of tibial plateau affects knee alignment , stability and motion. Incidence of proximal tibia fractures is increasing due to increasing incidence of road traffic accidents. The recent development of locking compression plate (LCP) has revolutionized the treatment of proximal tibia fractures by overcoming the drawbacks of conventional buttress plate.The aim of the study is to evaluate the functional outcome of proximal tibial fractures fixed with locking compression plate. Materials and Methods: This study is 15 patients involving proximal tibia fracture managed using LCP [10 patients with minimally invasive plate osteo-synthesis, (MIPO) technique and 5 patients with Open reduction and internal fixation (ORIF) technique]. We followed up all the patients until complete union of fractures. Results: The average time for union of fracture was 16 weeks (range: 12-24 weeks). Overall 80% patients had acceptable outcome. Patients treated with MIPO technique healed earlier and more frequently had excellent results than those treated with ORIF. A total of three patients had complications (knee joint stiffness in 1, postoperative loss of reduction in 1 and infection in 1). Conclusion: Locking compression plate system acts as a good biological fixation for proximal tibia fractures even in difficult fracture situations. MIPO technique offers short duration of procedure, less blood loss, less soft tissue injury and wound healing was better and faster healing, and better clinical outcome than ORIF in patients with proximal tibia fracture. However MIPO demands more surgical techniques.

…………………………………………………………………………………………………….... Introduction:-
Tibial plateau is one of the most critical load bearing areas in the human body. Fractures of tibial plateau affects knee alignment , stability and motion. Incidence of proximal tibia fractures is increasing due to increasing incidence of road traffic accidents. fractures of proximal tibia are difficult to treat because of subcutaneous location of anteromedial surface. majority of the fractures are due to high speed velocity accidents or fall from height where fracture results from direct axial compression with varus or valgus force and indirect shear forces. Elderly patients are likely to sustain depressed type of fractures.
199 Appropriate management of fracture will be of paramount importance in maintaining mobility. The recent development of locking compression plate (LCP) has revolutionized the treatment of proximal tibial fractures by overcoming the drawbacks of conventional buttress plate.
The aim of the study is to evaluate the functional outcome of proximal tibial fractures fixed with locking compression plate.

Materials and Methods:-
We studied 15 patients involving proximal tibia fracture managed using LCP [10 patients with minimally invasive plate osteosynthesis, (MIPO) technique and 5 patients with Open reduction and internal fixation (ORIF) technique]. We followed up all the patients until complete union of fractures Patient was scrubbed draped and painted with betadine Through anterolateral approach, intraarticular fractures were exposed and reduced anatomically, whereas extraarticular fractures were treated through MIPPO technique.
After achieving reduction, appropriate sized plate was taken and fracture was stabilized using cortical and locking screws. Cortical screws were put before putting locking screws.
The average time taken for surgery in case of MIPPO technique was 50 minutes (range, 40-60 minutes) and 75 minutes (range, 60-90 minutes) in case of open reduction and internal fixation.
The major intra-operative problems encountered were in case of comminuted fractures that were tried to reduce by MIPPO technique and later converted to open reduction after unsuccessful attempts.
Tourniquet was released and haemostasis secured.
Wound closed leaving suction drain insitu.

Postoperative:
Postoperatively, the patients were mobilized after removal of drains, for 2-5 days the range of motion allowed was 0-20degree, from the 5th day the range of motion was gradually allowed to be increased to 90degree or more. After suture removal on 12-14th day if no complications, full range of movement was allowed. An immediate postoperative x-ray was also done. Intravenous antibiotics were given for 48 hours in case of closed fractures and more as required in case of open fractures. Analgesics were given till adequate pain relief was obtained. The patients were advised quadriceps exercises, early active knee mobilization and non-weight bearing crutch walking, on discharge. In case of comminuted fractures with unstable fixation, external support was given in the form of slab and mobilization was started after confirming the healing process clinically and radiologically.

Follow up:
After suture removal, follow up was done at 6 weeks during which patient were clinically evaluated and an x-ray was taken to look for signs of fracture union and loss of reduction if any. The second follow up was done at 3 months during which one more x-ray was done and a clinical evaluation of union done. Based on the clinical and radiological signs of union patients were allowed partial weight bearing and gradually progressed to full weight bearing. Partial weight bearing was delayed until 6 -8 weeks and full weight bearing allowed after 12-16 weeks if fracture union seen. The patients were then followed up at 6 months during which time the anatomic and functional evaluation was done

Results:-
Results were analysed in reference to age, gender, type of fracture, time of union, complications.