Open Reduction and Internal Fixation Versus Suprapatellar Nailing and Condylar Bolts for the Management of Complex Bicondylar Tibial Plateau Fractures: A Clinical Study

TL;DR

This study compares two surgical methods for treating complex tibial fractures and finds that a minimally invasive technique offers faster recovery and better function without more complications.

Contribution

The study provides clinical evidence that the SNB technique is a safe and effective alternative to ORIF for complex tibial plateau fractures.

Findings

SNB resulted in significantly faster partial and full weight-bearing compared to ORIF.

Patients treated with SNB showed better knee function scores over time.

No significant differences in radiological outcomes or complication rates between the two methods.

Abstract

Purpose

The surgical fixation of bicondylar tibial plateau fractures is a challenging process. Open reduction and internal fixation (ORIF) is considered the “gold standard” treatment, while recently, a minimally invasive surgical technique that combines Suprapatellar Nailing and condylar Bolts (SNB) has been proposed for the fixation of these injuries. The present study compares ORIF and SNB techniques with the aim of providing information about the effectiveness of the SNB technique.

Methods

This clinical study examined 48 patients with complex tibial plateau fractures who were managed at the Orthopaedic Department of Evangelismos General Hospital in Athens, Greece, between 2019 and 2023. The patients were allocated into two groups: 24 patients underwent treatment with the SNB technique, while 24 patients were treated with ORIF. All patients were followed up for at least two years at regular intervals (1 m, 2 m, 3 m, 6 m, 12 m, and 24 m postoperatively). Three patients from the ORIF group were lost during the follow-up period. Our primary endpoint was knee functional capacity, as evaluated using the Oxford Knee Score (OKS). Secondary endpoints included the time needed for partial weight-bearing (PWB) and full weight-bearing (FWB), radiological assessment of the knee using the Rasmussen Radiographic Criteria (RRC), and the intra- and postoperative complication rate.

Results

The SNB method demonstrated statistically significant superiority compared to ORIF with respect to the time required for PWB and FWB, as well as improved functional outcomes assessed by the OKS. Patients treated with the SNB surgical technique achieved earlier mobilization and higher knee functional scores during the follow-up period. No statistically significant differences were identified between the two groups regarding radiological outcomes, as assessed by the RRC, or in the rates of intraoperative and postoperative complications.

Conclusion

The findings of this study suggest that the SNB surgical method represents a safe and effective alternative to ORIF for the treatment of bicondylar tibial plateau fractures. The technique appears to offer advantages in terms of earlier weight bearing and improved functional outcomes without increasing complication rates. Therefore, the SNB method may be considered a reliable minimally invasive option for the treatment of Schatzker type V and VI tibial plateau injuries.

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