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Comparable outcomes with intramedullary nail and plate constructs for Schatzker VI tibial plateau fractures

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Outcomes data of intramedullary nail fixation (IMN) constructs for complex Schatzker VI tibial plateau fractures are scant in the literature. This study compares the clinical and radiographic outcomes of IMN, dual plate, and single plate constructs for Schatzker IV tibial plateau fractures.

Methods

Retrospective cohort study of sixty-two patients at a University-based Level 1 trauma center who underwent open reduction internal fixation for Schatzker VI tibial plateau fracture. Constructs evaluated were IMN (with or without raft screws), dual plating, and single plating. Demographic, clinical, and radiographic outcomes were recorded. All fractures were additionally classified based on the OTA classification for sub analyses. Mean follow-up was 13.2 (SD 13.3) months. Predictors of construct selection and outcomes were evaluated with bivariate logistic regression. Outcomes were compared between groups with independent samples t-tests and Chi Square tests.

Results

No significant demographic differences were found between IMN, dual plate or single plate construct cohorts. There was a higher proportion of open fractures within the IMN construct group versus the dual plate cohort (21.1% vs 3.6%). No statistically significant differences in radiographic outcomes were observed between cohort groups except for small but statistically significant differences in condylar width (CW) ratio change and tibial slope; when fracture cohorts were sub analyzed by specific OTA classification, there were no significant differences in any radiographic outcomes. There was a significant difference between the ratio of OTA 41C1, C2 and C3 fractures regarding treatment allocation (p = 0.004), favoring dual plate fixation for OTA 41C3 fractures. There were no significant differences found between treatment cohorts in terms of all cause complications (p > 0.05). IMN and single plate constructs were utilized when posteromedial condyle fractures were nondisplaced or minimally displaced.

Conclusion

Intramedullary nail fixation with or without supplemental raft screws produced similar short-term clinical and radiographic results compared to dual and single plate constructs among patients with Schatzker VI fracture types, regardless of OTA classification.

Level of Evidence

Level III retrospective cohort.

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Funding

No funding was required for this study.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, UF Orthopaedics and Sports Medicine Institute, University of Florida, PO Box 112727, Gainesville, FL, 32608, USA

    John Parker Chapman, Matthew R. Patrick, Christopher W. Reb, Kevin A. Hao, Heather K. Vincent & Jennifer E. Hagen

Authors
  1. John Parker Chapman
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  2. Matthew R. Patrick
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  3. Christopher W. Reb
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  4. Kevin A. Hao
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  5. Heather K. Vincent
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  6. Jennifer E. Hagen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JPC, M.D. and HKV, PhD. The first draft of the manuscript was written by JPC, M.D. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to John Parker Chapman.

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Authors have no financial or competing interests to disclose.

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This study was performed in line with the principles of the University of Florida International Review Board (IRB).

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Consent to participate and consent to publish was not applicable for this study.

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Chapman, J.P., Patrick, M.R., Reb, C.W. et al. Comparable outcomes with intramedullary nail and plate constructs for Schatzker VI tibial plateau fractures. Eur J Orthop Surg Traumatol 33, 1653–1661 (2023). https://doi.org/10.1007/s00590-022-03326-8

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  • DOI: https://doi.org/10.1007/s00590-022-03326-8

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