Clinical outcomes of open reduction and internal fixation for intra-articular complex tibial plateau non-union with 3-year minimum follow-up.

Background: A tibial plateau fracture is one of the most challenging fractures for both knee and trauma surgeons because of the high incidence of post-traumatic knee osteoarthritis. To our knowledge, there has been no study concerning the clinical outcomes after surgery in patients with non-union of complex intra-articular tibial plateau fractures. Thus, the present study aimed to assess and report the clinical outcomes in them.

Methods: The study included four patients with non-union of complex tibial plateau fractures who underwent failed initial fixation treatment or could not undergo initial fixation owing to concomitant injury and who were followed up with a diagnosis of non-union for a minimum of 6 months. At the latest follow-up, patient-reported outcome measures, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford 12-item Knee Score (OKS), were assessed. Additionally, the knee range of motion (ROM) was evaluated.

Results: The mean duration from the initial surgery to revision surgery was 8.8 months, and the mean duration from the revision surgery to fracture union was 4.8 months. At the latest follow-up, the mean WOMAC score was 9.8 and the mean OKS was 43.5. Additionally, the mean knee ROM values were -11 degrees of extension and 100 degrees of flexion. All four patients had become able to walk without any aid after averaged 4.5-years follow up.

Conclusion: Favorable clinical outcomes can be achieved following revision surgery involving open reduction and IF in patients with non-union of complex tibial plateau fractures after failed initial treatment.

Level Of Evidence: Level IV, Case report.