Double Reverse Traction Repositor Assisted Closed Reduction and Internal Fixation Versus Open Reduction and Internal Fixation for Treatment of Lateral Tibial Plateau Fractures Among the Elderly

BackgroundIn elderly tibial plateau fractures (TPFs), the lateral condyles are involved frequently. This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) and double reverse traction repositor (DRTR) assisted closed reduction and internal fixation (CRIF) in elderly patients with lateral TPFs.MethodsFrom January 2015 to July 2020, we retrospectively reviewed 68 patients treated surgically at our trauma center for lateral TPFs (Schatzker type I-III). 31 patients were eventually assigned to the DRTR assisted CRIF group, whereas 37 patients were assigned to the ORIF group. The primary outcomes included surgical details, radiological assessment, follow-up knee function, and complications.ResultsThe DRTR assisted CRIF group experienced a 43.6 mL decrease in intraoperative blood loss (161.3 mL vs 204.9 mL, P = .033), and the operation duration was 32.1 min shorter than the ORIF group (83.8min vs 115.9min, P < .001). No statistical difference was found between the two groups in terms of transfusion rate (3.2% vs 8.1%, p = .394), and postoperative hemoglobin level was lower in the ORIF group than in the DRTR assisted CRIF group (111.8 +/- 13.3 g/L vs 104.5 +/- 12.7 g/L, p = .025). There was no statistically significant difference in terms of widening of the tibia plateau (WTP), depth of articular depression (DAD), medial proximal tibial angle (MPTA) and posterior tibial slope angle (PTSA) preoperatively, immediately after surgery and at the last follow-up. No differences in malreduction (P=.566) or reduction loss (P =.623) were observed between the groups, and Lysholm and HSS scores were similar between the two groups (83.6 +/- 15.8 vs 83.4 +/- 5.1, P = .934; 89.3 +/- 7.8 vs 86.9 +/- 6.2, P = .172; respectively). However, ORIF was associated with a greater increase in postoperative complications than DRTR assisted CRIF (3.2% vs 27%, P = .008).ConclusionBoth types of internal fixation provide good radiological outcomes and knee function in the treatment of lateral TPFs in the elderly. However, DRTR assisted CRIF has the advantage of a shorter duration of surgery, less blood loss, and fewer postoperative complications, and appears to be a better treatment option for elderly patients with lateral TPFs.