Effect of additional fixation in tibial plateau impression fractures treated with balloon reduction and cement augmentation

Abstract

Background: Isolated tibial plateau impression fractures can be reduced through minimally invasive techniques using balloon inflation and cement augmentation. No evidence exists yet if an additional fixation at all and which method of fixation is necessary in the treatment of these fractures. The purpose of this study was to compare a locking plate and a screw raft for additional fixation after balloon reduction and cement augmentation in isolated tibial plateau impression fractures. Loss of reduction was subsequently analysed without additional fixation.

Methods: Lateral tibial plateau impression fractures were created in eight matched pairs of human cadaveric tibiae. Reduction was performed using a balloon inflation system, followed by cement augmentation. Additional fixation was performed with a lateral locking plate or a screw raft (four 3.5-mm screws). Specimens were cyclically loaded at 20-240N, 20-360N and 20-480N. Subsequently, additional fixation was removed and the last cyclic interval (20-480N) repeated. Loss of reduction was assessed by measuring subsidence of the subchondral bone.

Findings: Fractures treated with plate fixation exhibited less subsidence at higher loads compared with those treated with screw raft fixation (P<0.05). Loss of reduction significantly increased after removal of the additional fixation.

Interpretation: This experimental study suggests that loss of reduction can be minimised by using locking plate fixation after balloon reduction and cement augmentation in the treatment of isolated tibial plateau impression fractures.

Keywords: Balloon; Fixation; Impression; Tibial plateau fracture; Tibioplasty.