Functional outcomes of patients with direct vs indirect fixation of tibial plateau fractures with posterior column involvement

Abstract

Background: The study was undertaken to compare the effectiveness of direct fixation of the posterior column of the tibial plateau versus indirect fixation using medial or lateral approaches, using the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire as the primary outcome measure.

Methods: A retrospective comparative study was conducted, with a minimum follow-up of two years on surgically treated patients, comparing direct fixation of the posterior column of the tibial plateau versus indirect fixation of the posterior column via a medial or lateral approach of the tibial plateau. These procedures were performed from January 2018 to January 2023 at the Orthopedic Hospital of the Red Cross in Mérida, Yucatán, Mexico.

Results: A total of 59 patients were obtained, of which 28 patients underwent direct posterior column fixation and 31 were operated with indirect posterior column fixation from classic medial or lateral approaches. Patients treated with direct posterior fixation showed significantly higher scores on the KOOS questionnaire in the symptoms (76.57 vs 70.0, p = 0.03), pain (83.21 vs 77.94, p = 0.02), and activities of daily living (87.54 vs 82.74, p = 0.03) subscales, as well as in the total scale score (75.14 vs 70.13, p = 0.04). No significant differences were found in the sports and quality of life subscales.

Conclusion: It was determined that patients undergoing direct posterior fixation presented significantly higher scores on the KOOS questionnaire, particularly in the symptoms, pain, and activities of daily living subscales. This suggests better long-term functional outcomes in patients undergoing direct fixation via a posterior approach.

Level of evidence: 3