The Tibia1 Plateau Fracture

Patients considered in this review were those treated in the teaching units of the Department of Surgery of the University of Toronto between the years of 1968 and 1975. There were 94 fractures in 94 patients with adequate documentation to be accepted for review. There were 56 females and 38 males. The average age of the patients was 57 years with a span from 19 to 89 years. The highest incidence of patients was in the sixth and seventh decade, Fifty-three patients (56%) were treated by closed methods and 41 (44%) were treated operatively. Seventy of the 94 (77%) were examined and X-rayed at a follow-up time from 9 to 74 months, with an average of 28.1 months. The results were grouped into the simple classification of acceptable (excellent, good) and unacceptable categories (fair and poor). The evaluation and grading was done on the basis of subjective complaints, comparative examination of both knees and roentgenographic studies. In the evaluation we considered the degree of extension, the extensor lag, the range of movement, the stability of thejoint, the muscle strength and work tolerance and pain. The criteria for grading the results were similar to those outlined by Hohl and Luck" and as used by Roberts,l0 Porter8 and Dovey and Heerf~rdt.~ Hohl and Luck4 graded a kneethatflexedto9Ooasacceptable.This, we felt, was an unacceptable result due to the need for greater than 90" flexion in normal daily activities. We have thus changed the classification accordingly, so that 90" or less of knee function was judged unacceptable. It became apparent in the course of the review that a collective approach to the tibial plateau fracture is misleading. Certain pathoanatomic factors, etiological factors as well as therapeutic features demand that certain types be grouped together. This gave rise to our classification published previously and used again in this paper."