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Unstable Bicondylar Tibial Plateau Fractures: A Clinical Investigation

Eggli, Stefan MD*; Hartel, Maximilian J MD*; Kohl, Sandro MD*; Haupt, Uli MD*; Exadaktylos, Aristomenis K MD; Röder, Christoph MD

doi: 10.1097/BOT.0b013e31818b1452
Original Article
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Objective: To evaluate fracture patterns in bicondylar tibial plateau fractures and their impact on treatment strategy.

Design: Prospective data analysis with documentation of initial injury and treatment strategy, computed tomography scans, conventional x-rays, long-term evaluation of radiographs, and functional assessments.

Setting: Level 1 regional trauma center.

Patients: Prospective data acquisition of 14 consecutive patients (10 male and 4 female) with a bicondylar tibial plateau fracture (AO Type C).

Intervention: Application of a stepwise reconstruction strategy of the tibial plateau starting with the reposition and fixation of the posteromedial split fragment using a 3.5 buttress plate, followed by reposition and grafting of the lateral compartment and lateral fixation with a 3.5 plate in 90 degree to the medial fixation device.

Main Outcome Measurements: All patients were evaluated with full-length standing film, standardized x-rays, Lysholm score for functional assessment, and patient's self-appraisal.

Results: Most of the complex bicondylar fractures follow a regular pattern in that the medial compartment is split in a mediolateral direction with a posteromedial main fragment, combined with various amounts of multifragmental lateral compartment depression. The technique introduced allows for accurate and stable reduction and fixation of this fracture type. The final Lysholm knee score showed an average of 83.5 points (range: 64.5-92).

Conclusions: Complex bicondylar tibial plateau fractures follow a regular pattern, which is not represented in existing 2-dimensional fracture classifications. A 2-incision technique starting with the reduction of the posteromedial edge results in accurate fracture reduction with low complication rates and excellent knee function.

From the Departments of *Orthopaedic Surgery and †Emergency, Inselspital, and ‡Institute for Evaluative Research in Orthopedic Surgery, University of Bern, Bern, Switzerland.

Accepted for publication August 20, 2008.

The authors did not receive grants or outside funding in support of their research or preparation of the manuscript.

The devices that are the subject of this article are approved by the US Food and Drug Administration.

Reprints: Stefan Eggli, MD, Department of Orthopaedic Surgery, Inselspital, University of Bern, CH-3000 Bern, Switzerland (e-mail: stefan.eggli@insel.ch).

© 2008 Lippincott Williams & Wilkins, Inc.