Severe medial tibial plateau fractures: feasibility and functional and radiographic results of an extended approach with medial femoral epicondyle osteotomy

Abstract

Abstract Introduction This study aimed to evaluate the clinical and radiological outcomes of tibial plateau fractures involving the medial plateau by comparing an extended medial approach with medial femoral epicondyle osteotomy (med ECO) to a conventional approach without epicondyle osteotomy (non-ECO). Methods A retrospective cohort study was conducted at two level one trauma-centers. All fractures of the medial tibial plateau (OA/OTA Type B or C) treated with med ECO were classified according to the AO/OTA and 10-segment classification using pre-operative CT scans. A comparative cohort study was performed against non-ECO patients based on age, sex, body mass index (BMI), injury mechanism, and fracture patterns. The quality of fracture reduction was determined by post-operative CT scans. Functional outcomes and postoperative complications were assessed over a minimum follow-up of 2 years. Results Twenty-nine patients (mean age: 50.2 ± 10.2 years, mean follow-up 71.65 ± 18.9 months) were analyzed. Both groups consisted of patients with severe tibial plateau fractures, knee dislocations, high-velocity trauma and polytrauma and concomitant injuries requiring an average hospital stay of 24.9 ± 12.4 days. Radiological outcomes showed a medial fracture step > 2 mm in 10 cases (med ECO n = 5, non-ECO n = 5) and a gap > 5 mm in 8 cases (med ECO n = 3, non-ECO n = 5). The mean radiological Rasmussen score was 13.8 ± 2.8 (med ECO 14.1 ± 2.8 vs. non-ECO 13.4 ± 3.0, p > 0.05). The mean Knee Injury and Osteoarthritis Outcome Score (KOOS) was 60.4 ± 16.9 (med ECO 61.3 ± 12.7 vs. non-ECO 59.5 + 16.2, p > 0.05) and the International Knee Documentation Committee score (IKDC score) was 56.6 ± 16.9 (med ECO 58.8 ± 19.0 vs. non-ECO 52.6 ± 14.4, p > 0.05). Conclusion Both med ECO and non-ECO demonstrated good radiological results. No significant differences were observed in clinical and radiological outcomes during follow-up. However, severe medial tibial plateau fractures are devastating knee injuries, being a challenge to the functional outcome of patients due to multiple concomitant injuries. Thus, medial epicondyle osteotomy should be reserved for specific fractures, considering the added morbidity and invasiveness associated with the procedure. Level of evidence Retrospective Cohort Study, Level of Evidence = III.