Abstract
Displaced tibial plateau fractures often require surgical treatment and plate and
screw constructs are the most common method of fixation. There has been increased
usage of locking plate technology for both complex and simple fracture patterns without
any evidence demonstrating their advantage. The purpose of this study was to compare
the clinical use of locked versus nonlocked plating for repair of displaced Schatzker
type-II (OTA Type 41B) tibial plateau fractures. Seventy-seven consecutive patients
treated operatively with one of two types of plate and screw constructs in a nonrandomized
fashion for Schatzker type II tibial plateau fractures and they were prospectively
followed over a 5-year period. A total of 35 (45.5%) patients were treated using a
locked plate and screw construct and 42 (54.5%) patients were treated with a nonlocked
plate and screw construct. All patients received the same pre- and postoperative care
and there was no difference in plate morphology and length between cohorts. Clinical
outcomes were assessed using Short Musculoskeletal Functional Assessment (SMFA) scores,
Visual Analogue Score for pain, and knee ranges of motion. Radiographic outcome was
assessed with plain radiographs at all follow-up points. Implant costs for both types
of constructs were calculated from hospital purchasing records. Patients were assessed
at a mean period of 18.5 months (range: 12–72 months). There was no difference in
demographic factors, physical examination parameters, radiographic outcomes, and SMFA
scores between cohorts. In terms of cost, the cost of locked construct was $905 more
than the nonlocked construct. Based on clinical outcomes and cost per implant, we
found no evidence to support the routine use of locked plating for simple split depression
fractures of the lateral tibial plateau. The use of standard nonlocked, precontoured
implants provides adequate fixation for these fracture patterns.
Keywords
tibial plateau - locked plating - nonlocked plating - Schatzker type II
