External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis
One hundred tibial plateau fractures in 96 patients were treated at three teaching hospitals. Seventy-three fractures were treated by closed reduction and early mobilization of the knee using a cast brace. Twelve fractures in this group also had percutaneous pin fixation under fluoroscopic control. The end results were graded by clinical functional criteria and by roentgenographic criteria. Eighty-nine percent of the patients treated by closed reduction methods had good to excellent functional results with a low complication rate (12%). Observations based on long-term roentgenographic examinations did not correlate with the functional end results. Many patients with less than satisfactory roentgenographic results had good to excellent functional long-term results. The indications for operative stabilization of these fractures should be based on testing for knee stability in full extension, rather than on any arbitrary roentgenographic criteria. For unstable fractures, closed reduction using ligamentotaxis and percutaneous fixation supplemented by cast brace support proved effective and relatively free of complications.