Uniaxial Versus Polyaxial Plating in Tibial Plateau Fractures: Clinical, Functional, and Radiological Outcomes Following a Pilot Prospective Randomized Controlled Trial

Purpose: Polyaxial plates have been widely used in various anatomic regions for fracture management due to the 30° angulation of screw placement as opposed to the fixed trajectories in the monoaxial locking plates. No previous comparative studies have been undertaken among these plates in fractures of the tibial plateau. This study aimed to evaluate the clinical, functional and radiological outcomes following the use of uniaxial and polyaxial locking plates to treat tibial plateau fractures.

Methods: This pilot randomized controlled trial (RCT) enrolled 40 patients with tibial plateau fractures (AO/ OTA 41 B-C). Patients were stratified as low-grade (Schatzker 1, 2, and 3) and high-grade (Schatzker 4, 5, and 6) and were then randomized for fixation into uniaxial vs polyaxial locking plate groups. At a follow-up of 3, 6, 12, and 24 months postoperatively, we conducted clinical (VAS [visual analog scale] score and the Rasmussen clinical score), functional (Knee Society functional score and Knee Injury and Osteoarthritis Outcome Score) and radiological (Rasmussen Radiological score) assessments for each patient.

Results: A total of 32 high-grade and 8 low-grade fractures, predominantly in young males (M:F: 37:3; mean age 41.5 ± 9.38 years) randomized into the polyaxial and the uniaxial group (20 in each) were included in our RCT. We noted that the polyaxial plating group needed a shorter operative time and were associated with less radiation exposure intraoperatively. On clinical, functional and radiological assessment at 3, 6, 12, and 24 months no significant difference was noted in both the groups (P>0.05), although patients in the polyaxial group tended to fare better than those in the uniaxial group. In a subgroup analysis of high-grade tibial plateau fractures, patients in the polyaxial group were found to have a significantly better clinical outcome scores as opposed to the patients in the uniaxial group (P <0.05).

Conclusion: Polyaxial plating in tibial plateau fractures provide ease of fixation along with improvement in the intraoperative parameters. When compared with monoaxial plates, polyaxial plates are also associated with improved clinical outcomes in high-grade fractures, even though no significant radiological and functional differences were identified.

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