Over-reduction yielded protective effect on articular anatomy

NATIONAL HARBOR, Md. — Intraoperative over-reduction in older patients with tibial plateau fractures had a protective effect on final articular anatomy, according to a speaker here.

“Subsidence after internal fixation of tibial plateau fractures is a common complication in elderly patients,” Amrut Borade, MBBS, MS, said at the International Geriatric Fracture Society Annual Meeting that preceded the Orthopaedic Trauma Association Annual Meeting. “Over-reduction appears beneficial in achieving better final articular anatomy, hence it can have a preventative effect on the progression of arthritis.”

Researchers retrospectively reviewed the charts of 99 patients older than 50 years of age with Schatzker type I to V tibial plateau fractures. The patients had immediate postoperative and final follow-up radiographs.

Of 81 patients with isolated unicondylar fractures, 64% of patients with over-reduction were over-reduced or anatomically reduced at follow-up, while 100% of patients with anatomic reduction postoperatively were under-reduced. According to Borade, malalignment was associated with the occurrence of significant subsidence.

“As knee alignment appears to be associated with the occurrence of subsidence, the use of biological cement, protective weight-bearing, over-reduction of the tibial plateau and use of the femoral distractor to achieve over-reduction may be justified in patients with inherent lower limb malalignment,” Borade said.

Borade noted the major limitation in this study was the small patient population. – by Nhu Te

Reference:

Borade A. Association of knee alignment and quality of reduction with subsidence after internal fixation of tibial plateau fractures in elderly patients. Presented at: International Geriatric Fracture Society Annual Meeting; Oct. 5, 2016; National Harbor, Md.