Tibial plateau fractures. An analysis of the results of treatment in 60 patients.

Sixty patients with fractures of the tibial plateau were reviewed and assessed in terms of fracture type, treatment method, adequacy of reduction, immobilization time, associated ligamentous and meniscal injury, and overall result in an attempt to define factors important in the prediction of outcome. Comminuted bicondylar fractures (Type IV) were the most common (39%). Thirty-eight of the 60 fractures were treated by open reduction and internal fixation, and 22 were treated by closed methods. Overall, 75% of the patients had a satisfactory result. Ligamentous and meniscal injuries were treated surgically and did not influence the final outcome. The single most important factor in predicting outcome in a patient with a tibial plateau fracture was the adequacy of reduction. The method of achieving the reduction and the length of the immobilization period of the knee were not as crucial. A residual step of greater than 5 mm on the weight-bearing area was universally associated with an unsatisfactory result.