gms | German Medical Science

Objectives: Complex fractures of the tibial plateau are rare and serious injuries whose clinical outcome depends crucially on the anatomical reconstruction of the destroyed articular surface. The best possible visualisation and accessibility of the articular surface is essential for this, which can be achieved by means of osteotomy of the fermoral epicondyle. The aim of this study is to evaluate the outcome of medial tibial plateau fractures treated by osteotomy of the medial femoral epidondyle.

Methods: A total of 17 patients with severe comminuted and dislocation fractures of the medial tibial plateau were included in a retrospective clinical case series. Medial femoral epicondyle osteotomy was performed in all cases and combined with lateral femoral epicondyle osteotomy in five cases. In addition to analysing the inpatient stay, patient-specific scores (OKS, IKDC, mCKRS, Tegner-Lysholm Scale, KOOS score) were recorded after a minimum follow-up of 24 months. The reduction quality was objectified by means of postoperative imaging (CT and X-ray) and the Rasmussen score.

Results and conclusion: A total of 17 patients (7 female) with a mean age at time of surgery of 51 ± 10 years were analysed. 16 patients had severe bicondylar OTA-C3.3 fractures, 6 cases in combination with a knee dislocation (Schenck III-IV). One patient suffered an OTA-B3.3 dislocation fracture (Schenck III). There were 8 patients with an ISS score > 16.

Analysis of the postoperative CT revealed an average gap of 2.4 ± 3 mm, tibial slope of 7.5 ± 5 mm, plateau height difference of 2.0 ± 1 mm. The Rasmussen score was 14 ± 3. The most common complications were compartment syndrome and wound infections (both 24%, n=4). The patient-specific scores were collected after 67 ± 65 months (range 25 – 121) and showed an OKS of 35 ± 10, IKDC of 60 ± 18, mCKRS of 63 ± 20, Lysholm Score of 73 ± 20 and KOOS score of 63 ± 14 points. During the observation period, 8 patients underwent a follow-up operation on the affected knee joint: 24% of these involved the insertion of a knee prosthesis (n=4) and 12% (n=2) underwent valgus conversion osteotomies. In a total of 41% (n=7), the inserted foreign material was removed due to implant-associated complaints. With regard to the surgical approach and the medial epicondylar osteotomy, no specific complications or medial instabilities were detected.

Although the incidence of severe dislocated comminuted and dislocated fractures is notable, the majority of cases can be successfully anatomically reconstructed by osteotomy of the medial femoral epicondyle. However, patients with severe dislocation fractures with extensive soft tissue damage and associated injuries often require revision surgery. Such cases often present with long-term deficits in knee function, prompting consideration of valgus conversion osteotomies or knee arthroplasty. Patient satisfaction outcomes following these procedures can be highly variable, particularly when compared with outcomes in patients with a less severe clinical course.