Salvage of proximal tibial malunion or nonunion with the use of angled blade plate

Introduction: Single buttress plating laterally was sometimes performed by a few orthopedists to treat complex tibial plateau fractures with medial compartment involvement. However, we might encounter cases with medial compartment collapse due to such treatment. The causes of failure, the technique of the revision surgery, and the methods of prevention were investigated retrospectively. The purpose of this study was to report our clinical results of a retrospectively followed series of patients treated with blade plate fixation for proximal tibial metaphyseal nonunions and malunions which were treated with unilateral plating. Materials and methods: Twenty-eight patients with failed treatment of complex tibial plateau fractures due to single buttress plating laterally underwent the revision surgeries. Removal of the buttress plate, proximal tibial corrective osteotomy, and insertion of an angled blade plate medially were performed. Postoperatively, exercise of the range of motion of the knee was encouraged as early as possible. Results: Twenty-five patients were followed-up for a median of 4.8 years (range, 1.2–6.8), and all fractures healed at a median of 4.0 months (range, 3.0–6.0). The proximal medial tibial angle (PMTA) was corrected to the acceptable range (80–99°) in all 25 patients (P<0.001) and knee function improved in 22 out of 25 patients (P<0.001). Conclusion: For clinical and biomechanical considerations, single buttress plating laterally was unsuitable for complex tibial plateau fractures with medial compartment involvement due to relatively huge compressive loads on the medial compartment. The stability provided by a few screws of the buttress plate laterally was normally insufficient. An angled blade plate could be a useful armament in the management of metaphyseal nonunion and malunions of the proximal tibia. Its better stabilization could normally provide a high success rate.