Evaluation of role of fibula in functional outcome of tibial plateau fractures

Introduction: Tibial plateau fractures occur due to a combination of axial loading and varus/valgus applied forces leading to articular depression, malalignment and an increased risk of posttraumatic osteoarthritis (OA). Various treatment modalities have been used over the years, with mixed results. We present a study to report the functional results of tibial plateau fractures and to evaluate the association of proximal fibula fractures with respect to final outcome. Methods: Patients diagnosed with tibial plateau fractures from July 2012 to March 2016 were included in the study. Patients with open injuries or neurovascular compromise were excluded. Patients were divided into subgroups on the basis of presence or absence of proximal fibula fracture. 124 patients were managed by either conservative or operative means and followed for an average of 19 months and clinically monitored for functional outcome using Knee Injury and Osteoarthritis Score. Results: The study population consisted of 65 males and 59 females. Mean patient age was 46 years (range, 24-67 years). Mechanism of injury included road traffic accident (56), fall from height (14), and falls (54). Functional outcome as assessed by Knee Injury and Osteoarthritis Outcome Score was comparable to previous studies. Role of proximal fibula in supporting the lateral condyle was evident from better functional outcomes seen in patients with intact fibula and lateral condyle fracture. Conclusion: An intact fibula contributes to the mechanical stability of the lateral tibial plateau. Therefore, the knee joint will be affected by injury of the bone or soft tissue that may occur in fibula fractures. A consideration to presence of proximal fibula fractures should be given while classifying tibial plateau fractures.