| ABSTRACT: |
Thirty-nine patients with tibial plateau fractures
and concomitant ligament injury were evaluated at least one year after injury.
Ligamentous injury was determined by stress roentgenograms, plain roentgenograms,
operative findings, and Pelle-grini-Stieda's ossification. There were 22
isolated medial collateral, eight lateral collateral, one isolated anterior
cruciate, and eight combined ligament injuries. All types of tibial plateau
fractures were associated with ligamentous injury, although split compression
and local compression were most common. Twenty patients (Group 1) did not
have operative repair of the injured ligaments, and 19 patients (Group 2)
had primary repair of the injured ligaments. Open reduction and internal
fixation of the plateau fracture(s) were performed in 13 patients in Group
1 and 19 patients in Group 2. Follow-up evaluation (100-point scale), including
subjective, functional, and anatomic factors, revealed 12 excellent and
good, four fair, and three poor results in the 19 patients with ligamentous
repair. There were ten excellent and good, two fair, and eight poor results
in those without ligament repair. Ten of the 12 patients with 10 degrees
or more of instability had poor results. These poor results included five
unrepaired medial collateral ligaments, two unrepaired lateral collateral
ligaments, and three patients with cruciate ligament injury. This study
confirms the view that instability is a major cause of unacceptable results
in tibial plateau fractures. Operative repair of medial and lateral collateral
ligaments, with appropriate treatment of the bony plateau fracture, may
reduce late instability and may improve overall morbidity in these concomitant
injuries. Cruciate ligament injury associated with a tibial plateau fracture
carries a poor prognosis. |