Staged Minimally Invasive Osteosynthesis with Nonanatomical T-shaped Locked Plates for Intra-articular Tibial Plafond Fractures

Background: Numerous studies have assessed the outcomes of extra-articular tibial plafond fractures following staged minimally invasive osteosynthesis with various locked plates (LCPs). Recently, the Taiwan National Health Insurance has been contemplating the inclusion of nonanatomical LCPs into a benefit package. For tibial plafond fracture patients, nonanatomical T-shaped LCPs may serve as an alternative choice for those unable to afford anatomical anterolateral LCP. Objectives: This retrospective study was designed to assess the outcomes of intra-articular tibial plafond fractures following staged minimally invasive osteosynthesis with nonanatomical T-shaped LCPs. Materials and Methods: From April 2010 to October 2016, 18 consecutive patients with intra-articular fractures of the tibial plafond underwent treatment through staged minimally invasive nonanatomical T-shaped LCP osteosynthesis. The median patient age of the cohort, comprising nine women and nine men, at the time of surgery was 49 (22–71) years. The first-stage treatment consisted of radical debridement, followed by external skeletal fixation, and the second-stage treatment consisted of minimally invasive osteosynthesis with nonanatomical T-shaped LCPs. In addition, we identified factors predictive of poor results, delayed union, or nonunion of the fractures. Factors such as age, sex, open fracture, fracture severity, concomitant injuries, presence of comorbidities, and arthrosis were analyzed. Results: At 6 months of follow-up, 3 (17%) patients had delayed/nonunion according to the radiographic definition of nonunion. At the final follow-up, 17 (94%) of the 18 patients achieved union, whereas 1 (6%) did not. Patients with open fractures and concomitant injuries tend to exhibit poor clinical and radiographic outcomes. Conclusions: We found a high rate of satisfaction and union and few complications with staged minimally invasive osteosynthesis with nonanatomical T-shaped LCPs for the treatment of patients with intra-articular tibial plafond fractures. We postulate that this technique is an effective and safe alternative for the treatment of tibial plafond fractures.