| ABSTRACT: |
Three hundred six tibial plateau fractures treated
at the authors' institutions and in private practice were analyzed in relation
to the use of a cast brace or fracture brace. One hundred forty-one of these
patients had had a cast brace or fracture brace as part of their treatment
program, either as the primary fracture treatment or after open reduction
or traction. The aims of this study were (1) to determine if cast bracing
could maintain alignment, fracture position, and range of motion and (2)
to compare its results with those of other major long-term studies of similar
fractures. There were 85 lateral, 24 medial, and 32 bicondylar fractures.
Cast bracing was used for one to 17 weeks, with a mean of eight weeks. Ninety-nine
of the 141 patients were followed for at least one year. Eighty-two of the
patients maintained alignment with less than 5 degrees of deformity, and
fracture position was maintained in 85% of cases, with only 15% having 4-8
mm of loss of position. Medial plateau and subcondylar fractures had an
increased incidence of fracture position loss. Ninety-seven percent of patients
had greater than 90 degrees of flexion, and 90% had full extension, i.e.,
less than 5 degrees of contracture. Pain was minimal or absent after heavy
exercise in 90% of patients using cast bracing. Arthritic changes on roentgenographic
analysis were absent or mild in 93.5% and moderate or severe in 6.5% of
patients. Complications, including phlebitis, pulmonary emboli, wound infection,
hardware slippage, and skin slough, occurred in nine patients.(ABSTRACT
TRUNCATED AT 250 WORDS) |