Complications of internal fixation of tibial plateau fractures

Orthop Rev. 1994 Feb;23(2):149-54.


All cases of displaced tibial plateau fractures treated by open reduction and internal fixation at two university hospitals over a 3-year period were retrospectively reviewed. There were 47 fractures in 45 patients. Rigid fixation to allow early motion was the goal in all cases. There were 3 AO type I (wedge) fractures, 20 AO type III (wedge/depression) fractures, and 24 AO type IV (comminuted/bicondylar) fractures. Cases were classified into three groups depending on the amount of hardware used to obtain fixation (a single buttress plate, group 1; a buttress plate and interfragmentary lag screws, group 2; or medial and lateral buttress plates with or without lag screws, group 3). In group 1, there were 20 fractures and no instances of deep-wound infection or postoperative ankylosis. In group 2, infection occurred in 6 of 19 fractures (32%), all of which also developed significant ankylosis including 1 patient who underwent arthrodesis. In group 3, 7 of 8 (87.5%) knees became infected, and the patients experienced other devastating complications, including ankylosis (n = 3), arthrodesis (n = 2), knee disarticulation (n = 1), and above-knee amputation (n = 1). Patients whose knees became infected underwent an average of five subsequent surgical procedures. These results suggest that patients with comminuted tibial plateau fractures requiring either two buttress plates or a single plate with additional interfragmentary lag screws would probably be better managed by either non-operative treatment or limited internal fixation.

MeSH terms

  • Adult
  • Arthrodesis
  • Bone Plates
  • Bone Screws
  • Female
  • Fracture Fixation, Intramedullary*
  • Fractures, Malunited / surgery
  • Fractures, Open / surgery
  • Humans
  • Joint Dislocations / etiology
  • Joint Dislocations / physiopathology
  • Joint Dislocations / surgery*
  • Knee Joint*
  • Male
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Postoperative Complications / physiopathology
  • Postoperative Complications / surgery
  • Range of Motion, Articular
  • Reoperation
  • Retrospective Studies
  • Tibial Fractures / etiology
  • Tibial Fractures / physiopathology
  • Tibial Fractures / surgery*