Comparing postoperative outcomes of the single and double plating fixation in the treatment of proximal metaphyseal tibial fractures

Document Type: Original Article

Authors

1 Associate professor of orthopedic surgery, Orthopedic research center, Mazandaran university of medical science, Sari, Iran

2 Resident of orthopedic surgery, Orthopedic research center, Mazandaran university of medical science, Sari, Iran

3 Assistant professor of orthopedic surgery, Orthopedic research center, Mazandaran university of medical science, Sari, Iran

4 Associate professor of orthopedic surgery, Orthopedic research center, Mazandaran university of medical science, Sari, Iran.

5 Assistant professor of orthopedic surgery, Orthopedic research center, Mazandaran university of medical science, Sari, Iran.

6 Assistant Professor, Department of Radiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

10.30491/tm.2020.228779.1107

Abstract

Background:
Optimal management of the proximal tibial fractures remains a clinical challenge. Most of the studies have been conducted on the cadaver specimens, and much less has been done to compare the clinical outcomes of the single and double plating methods in these fractures.
Methods:
Our sample comprised 40 patients with metaphyseal tibial fracture who were treated with single or double plating methods (20 in each group). Patients were followed up after 2 and 6 weeks, and 3 and 6 months, and all were assessed for mal-union, non-union, and malalignment deformity.
Results:
In the double-plating group, we observed numerically better flexion and extension range that was not significant (p >0.05). However, regarding the interpretation of Lysholm Knee Score questionnaire, we found a significantly higher proportion of good and excellent postoperative outcomes in the double plating group (p=0.041). In the double plating method, 15%, 15%, 40%, and 30% of patients were categorized into poor, fair, good, and excellent outcomes, respectively. These proportions were 30%, 45%, 15%, and 10% for the single plating method, respectively. Moreover, we detected positive valgus stress test in the single plating method in 30% of the cases, compared with 5% in the double plating method (p=0.037). Similarly, we observed 20% of the cases with positive varus stress test in the single-plating method, compared with the double plating method that had no cases who tested positive (p=0.035). The observed significant differences survived after we controlled for the positive stress test using regression models. It should be noted that in the single plating group, one case of valgus malalignment with 10° and one case of varus malalignment with 5° were observed.
Conclusion:
Our results highlight that the choice of double plating method is associated with relatively better outcomes and fewer complications in the treatment of proximal tibial metaphyseal fracture.

Keywords



Articles in Press, Accepted Manuscript
Available Online from 28 June 2020
  • Receive Date: 29 April 2020
  • Revise Date: 26 May 2020
  • Accept Date: 22 June 2020