Internal fixation of tibial plateau fractures using the AO instrumentation.

Between January 1970 and December 1985, 76 patients (76 fractures) underwent internal fixation for tibial-plateau fractures as recommended by the AO-group (14). Fifty patients were available for follow-up. The long term results of this retrospective study are reported. Subjective results were satisfying. Forty-four percent of the patients were painfree and only 8% had severe postoperative pain, which was clearly related to osteoarthritis. Eight-eight percent of patients had no instability at follow-up. Clinical and radiographic results were evaluated for mobility, laxity and osteoarthritis. Thirty-five patients had a loss of flexion averaging 16.6 degrees. In 12 patients the average decrease in extension amounted to 7.5 degrees. Valgus increase averaged 9.7 degrees in 17 patients, and the average varus increase was 7.5 degrees in 4 patients. Seventy-four percent of patients showed no laxity at follow-up. The finding of osteoarthritis on X-ray was well correlated with the postoperative incongruence of the articular surface. It was also found to develop earlier in patients who underwent (partial) meniscectomy. Some general considerations about tibial condyles fractures are presented, and the technique used by the authors is discussed at length. The indications for internal fixation are also evaluated. The importance of adequate reduction, stable internal fixation and vigorous postoperative rehabilitation is stressed.