• Traumatology

Bicondylar tibial plateau (BTP) fractures present complex challenges in surgical
management, necessitating a comprehensive understanding of patient characteristics,
treatment strategies, and potential complications. This study amalgamates insights
from five distinct investigations to elucidate various facets of BTP fracture
management.
Study I: A comprehensive review of clinical evaluation, imaging, and classification
systems for BTP fractures serves as a foundation for surgical management strategies.
Here, we review the clinical evaluation, imaging, and classification systems of BTP
fractures with a focus on surgical management before providing specific tips on how
to minimize complications and optimize clinical outcomes. We will highlight highly
debated issues related to complex BTP fractures such as the timing of surgical fixation,
single versus dual plating, 3-D imaging, and virtual reality applications, providing
practitioners with guidance to navigate complexities and enhance clinical outcomes.
Study II: This retrospective cohort study examines BTP fractures treated with open
reduction internal fixation (ORIF), differentiating outcomes based on age. Elderly
patients (>65 years) exhibited distinct injury patterns, often sustained through low-
energy mechanisms. Despite higher comorbidities and poorer bone quality, elderly
patients managed with ORIF showed comparable complication rates to their younger
counterparts, but exhibited poorer total arc motion and had reduced PROMIS-10
function score.
Study III: A retrospective comparative cohort study centers on a 2-stage protocol
involving acute spanning external fixation (ex-fix) followed by definitive ORIF. 78
fractures had retained elements of the original ex-fix prepped in situ during surgery for
definitive internal fixation, and 69 had the ex-fix construct completely removed before
prepping and draping. High rates of deep infection and reoperation were observed
across both groups, with no significant difference in whether the ex-fix was retained or
removed during the final fixation. These findings shed light on the impact of retaining
ex-fix elements in BTP fracture management.
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Study IV: This study focuses on aseptic failure following ORIF for BTP fractures,
conducting a retrospective case series to explore associated complications. Nonunion,
symptomatic malunion, loss of reduction, and hardware failure were analyzed.
Revision procedures included revision ORIF, realignment osteotomy, and total knee
arthroplasty (TKA). Union was achieved in varying degrees, emphasizing the
challenges of managing aseptic failure.
Study V: The objective of this study was to measure the percentage of disruption in
the cross-sectional area of the articular surface of the tibial plateau and to examine
the correlation between the extent of articular injury and the physical function reported
by patients. Existing classification systems for evaluating plateau fractures
demonstrate limited to moderate reliability and reproducibility. Through the utilization
of CT scans, we have devised a straightforward and dependable approach to quantify
articular surface damage in tibial plateau fractures. Our research indicates a
correlation between articular surface damage in tibial plateau fractures and functional
outcomes.
Together, these studies contribute to the understanding of BTP fracture management,
encompassing patient characteristics, treatment protocols, and potential
complications. By combining insights from diverse perspectives, this synthesis offers
a more nuanced perspective on optimizing surgical interventions and patient outcomes
in the realm of BTP fractures.