Residual radiographic fracture displacement in healed tibial plateau fractures: comparison after treatment with suprapatellar nailing versus lateral plating

Objectives: Compare maintenance of articular reduction and alignment in bicondylar tibial plateau fractures (OTA/AO 41-C2/C3) treated with suprapatellar intramedullary nailing (IMN) versus dual-plate open reduction and internal fixation (ORIF). Design: Retrospective Cohort Study. Setting: Single Level I academic trauma center. Patients/Participants: Fifty-eight adults treated between July 2012 and July 2022 (28 IMN, 30 ORIF); groups were matched for age, body mass index, and fracture pattern. Intervention: Semiextended suprapatellar IMN with ≥1 independent lag screw compared with dual-plate ORIF performed through standard open approaches. Main Outcome Measurements: Joint-line depression, condylar widening, medial proximal tibial angle (MPTA), and posterior proximal tibial angle (PPTA) at union (12 months). Results: Initial displacement was greater in the ORIF cohort (joint-line 8.2 mm vs. 5.6 mm, P = 0.014; widening 7.2 mm vs. 5.8 mm, P = 0.150). At 12 months, healed widening (0.6 mm IMN vs. 1.0 mm ORIF, P = 0.856), healed depression (2.0 mm vs. 1.1 mm, P = 0.991), MPTA (89.9° vs. 89.6°, P = 0.699), and PPTA (11.3° vs. 9.8°, P = 0.078) did not differ. No secondary loss of reduction requiring revision occurred. Conclusion: Suprapatellar IMN maintained healed joint line displacement, condylar widening, MPTA, and PPTA in OTA/AO C1, C2, and certain C3 fractures. The MPTA and PPTA were surgically restored and maintained. This technique may be useful in certain circumstances where ORIF of the tibial plateau fractures places the soft tissue envelope at risk or where an intramedullary implant is otherwise preferred. Level of Evidence: Level III.