الفهرس 
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Abstract
Summary
Treatment of depressed fractures of lateral tibial plateau, Schatzker type II and type III has always been a challenge for orthopaedic surgeons. They are common types of tibial plateau fractures with a bimodal distribution of incidence occurring in high-energy trauma in younger patients and as a result of low-energy falls in elderly.
These fractures may be difficult to manage. The goal of treatment of these fractures is restoration of normal alignment, joint congruity, joint stabilization and, ultimately, the prevention of degenerative osteoarthritis. A precise reduction and a stable fixation of the fracture fragments are the mainstay of good functional outcome.
There are many controversies regarding the best method of treatment of such fractures. The surgical technique usually used includes open reduction through elevation of the depressed fragment and fixation with augmentation of bone graft or bone graft substitute.
Since harvesting autogenous bone graft add insult to the patient with its own complications, prolongation of the time of surgery, and intraoperative and postoperative blood loss. Also, using bone graft substitute is expensive. We conducted our study by treating depressed tibial plateau fractures by the same line of treatment but without the use of graft or graft substitute.
Keeping the aim in mind, we conducted the present study to evaluate the clinical, radiographic and functional results in a cohort of patients who sustained open reduction and internal fixation without bone graft for Schatzker type II and type III lateral tibial plateau fracture in a prospective randomized controlled study.
Forty patients with depressed lateral tibial plateau type II and type III who met the inclusion criteria were treated by open reduction and internal fixation. They were followed up for minimum 1 year in the period between (February 2014 and February 2017)..Bone graft was used in ten patients of them to support the elevated fragment as a control group. All efforts were done to put proximal screws subchondrally to act as a raft in the treatment of study group.
The average follow up period was 14 months. Twenty one patients were males and nine were females in the study group, while eight patients were males and two patients were females in the control group. The mean age of the study group was 36.1 years, while in the control group it was 36.9 years. In the study group The fractures were classified as type II in 18 & 6 patients in the study and control group respectively. Type III was found in 12 & 4 patients in the study and control group respectively. The mean preoperative measurement of depression was 6.7 mm in the study group, and 7.6 mm in the control group.
Functional and radiological evaluations were based on Rasmussen functional and radiological score respectively. Radiological outcome of both groups have nearly equal outcomes just slightly better in the control group, in the study group: the mean score was 16.9 (93.3 %) in the form of; excellent results are obtained in 17 cases (56.7%) and good results in 13 cases (43.3%), while in the control group, the mean score was 17 (94.4%) in the form of; excellent results obtained in 6 cases (60%) and good results in 4 cases (40%).
Functional outcome was also nearly equal with also slightly better results in the control group, in the study group. The mean functional results were found to be 27 (90%) as follows; 25 cases (83.3%) have excellent results, 4 cases (13.3%) have good results, and 1 case (3.3%) has fair result. While in the control group the mean functional results was found to be 28 (93.3%) as follows; 8 cases (80%) have excellent results, 2cases (20%) have good results.
Bony union has occurred after a mean of 14.6 (rang, 11-19) weeks in the study group and 13.2 (rang, 8- 17) weeks. As regard to the VAS (Visual analogue score), operative time and operative blood loss, the study group have a better outcome than the control group.
No serious complications have been found in our study. In the study group, two patients (6.66%) have suffered from superficial infections and one patient (3.33%) suffer from knee stiffness that didn’t need any aggressive procedures. In the control group, two patients (20%) have suffered from injury to the lateral cutaneous nerve of the thigh; it was neuropraxia and resolved by time in both patients.
On comparing the results of the study group to those of the control group; study group have nearly the same functional and radiological outcomes as control group and provides low incidence of postoperative complications, decrease blood loss and minimize operative time. Also the results of our study were similar to those in the literature.
The hypothesis of the study was true as there was no difference in the clinical, radiological and functional outcomes in patients with lateral tibial plateau fractures type II and III treated without bone graft to the controlled group who was treated with bone graft when the depression is less than 2 cm.