Displaced Tibial Plateau Fractures: Is There A Role Of Conservative Treatment In The Present Scenario

Tibial plateau fractures require appropriate treatment and rehabilitation to obtain a stable, pain-free and mobile joint (1). The variables like extensor lag, condition of the articular cartilage, range of motion, instability, axial malalignment, and articular incongruity have been reported to determine the functional outcome in tibial plateau fractures (2-8) .A number of treatment modalities including dual plating, external fixators alone or in combination with plating, and conservative treatment have been reported to having satisfactorily treated the various types of tibial plateau fractures in different settings; at times a similar fracture has been preferred to be satisfactorily treated differently by the proponents of different modalities (2,9-11). The scarcity of studies from the developing countries on tibial plateau fractures, probably, facilitates the practice of conservative treatment of these fractures. Ironic though it may seem, this provided us an opportunity to obtain a data of both the operative and conservative treatments of similarly placed tibial plateau fractures.The aim of the present study is to Abstract This retrospective case series includes 92 closed tibial plateau fractures treated by operative (66 patients) and conservative (26 patients) methods at our institution.The means and mean differences of grades of the objective variables of extensor lag and range of motion and articular step were better in the surgically treated patients (p value <0.05), while those of axial alignment and side to side instability did not show any statistical significance. An average articular step of more than 1.6 mm significantly deteriorated the functional outcome.Achieving articular congruity is the most important factor for the successful outcome of tibial plateau fractures. Operative treatment in the presence of adequate expertise and infrastructure gives satisfactory results. Type V and VI fractures are highly unstable fractures and need to be treated by more stable fixation in the form of dual plating and/or locked compression plating. The variables like extensor lag, range of motion and radiological articular step directly correlate with the functional outcome of tibial plateau fractures. The conservative treatment should only be accepted as last option in case of displaced tibial plateau fractures.