Augmentation by Rafting Screw on Fixation of the Lateral Tibial Plateau Fractures

Background: Tibial plateau fracture is considered one of the most common intra-articular fractures, especially lateral condyle fractures. The purpose of this study is to evaluate clinical, radiological, and functional outcomes of using subchondral periarticular rafting screw above a lateral plate without bone grafting or substitute for Schatzker type II and type III fractures.

Methods: This prospective study was carried out on 43 patients above the age of 18, fit for surgery with closed tibial plateau fracture [lateral split depression (type II) and lateral depression (type III) according to Schatzker classification] time of trauma less than 14 days with no other skeletal injuries. All patients were followed up for at least six months. All patients were treated by open reduction and internal fixation (ORIF) and using subchondral periarticular screws as rafting construct to maintain articular surface and protect it from collapse. Analysis of clinical outcome was clinically based on Modified Rasmussen clinical scoring system and radiologically based on Rasmussen radiological knee scoring system.

Results: In our study, 28 females and 15 males with a mean age of 49.5 years, mechanisms of trauma were road traffic accidents in 26 cases, and fall from height in 17 cases, 24 cases with Schatzker type II fracture, and 19 with type III. According to functional Rasmussen score, acceptable results were 93.1%, (76.8% excellent & 11.6% good) while non-acceptable results were 6.9%, (4.6% fair & 2.3% poor). According to radiological Rasmussen score, acceptable results were 83.7%, (65% excellent & 18.7% good) while non-acceptable results were 16.3%, (9.3% & 7%). No significant difference was found between the studied groups regarding sex, side affected, type of fracture, and type of trauma. The final outcome was significantly affected by age, medical history.

Conclusions: Fixation using a subchondral periarticular rafting screws for lateral split-depression and lateral depression tibial plateau fractures without using bone graft or bone substitutes is a viable and good option during open reduction and internal fixation, helps surgeons achieve and preserve the anatomic joint line and normal mechanical axis, with superior functional results in the short term. Therefore, avoiding morbidity associated with bone grafting without compromising the fracture stability.