gms | German Medical Science

Objectives: Precontoured locking compression plates (LCP) are designed to provide optimum support of the reduced joint surface fragments in fractures to the lateral tibial plateau. The utilisation of these implants has especially been emphasised in patients with fragility fractures and reduced bone quality. To date, there is a lack of evidence supporting the broad utilisation of precontoured LCP in split depression fractures (AO 41B3) of elderly patients. Thus, aim of the present retrospective comparative study was to investigate the radiological outcomes after open reduction and internal fixation of these fractures in young versus elderly patients.

Methods: The hospital's database was screened for fractures to the tibial plateau. Patients with isolated split depression fractures (AO 41B3) as well as open reduction and internal fixation were included. CT scans and radiographs were analysed. Details of the operative procedures were collected from the patients' records. Patients between 18 and 49 years were attributed as young, patients ≥50 years as elderly. Additional sub-grouping was carried out into utilisation of precontoured LCP versus conventional implants. The Rasmussen Radiological Score (RRS) after a follow-up of approximately one year was set as primary outcome parameter. Secondary outcome parameters were the RRS postoperatively as well as the medial proximal tibial angle (MPTA) at any timepoint investigated.

Results and Conclusion: A total of 61 consecutive patients was included. The young group encompassed 29 patients and the elderly 32 patients. The mean age in the young group was 38.2±7.8 years compared to 61.3±9.4 in the elderly group. Across the two age groups, there were no significant differences regarding size and depression depth of the lateral joint surface fragments or the void volume. The radiological outcome measures revealed no significant differences between young (RRS 7.7±1.7; MPTA 90.3±2.3) and elderly patients (RRS 7.2±1.6; MPTA 90.5±3.3) at final follow up and prior to implant specific subgrouping. After separating precontoured LCP and conventional implants, the radiological outcome measures revealed significantly impaired results in young patients with conventional implants (RRS_C 6.9±1.6 vs. RRS_LCP 8.5±1.5, p=0.015; MPTA_C 91.5±1.9 vs. MPTA_LCP 89.1±2.1, p=0.01). The effect was even more pronounced in elderly patients, with highly significant deterioration of the radiological outcome measures for conventional implants compared to anatomically precontoured LCP (RRS_C 5.7±1.6 vs. RRS_LCP 8.2±0.8, p<0.001; MPTA_C 92.6±4.2 vs. MPTA_LCP 89.2±1.4, p=0.002).

The utilisation of precontoured LCP in the treatment of split depression fractures to the lateral tibial plateau is associated with improved radiological outcomes. This effect is significant in young but even more pronounced in elderly patients. Consequently, precontoured LCP should closely be considered for internal fixation of any AO 41B3 fracture, but especially in elderly patients.