Postoperative Outcomes of Single and Double Plating Osteosynthesis for Proximal Metaphyseal Tibial Fractures

Optimal management of proximal tibial fractures remains to be a clinical challenge. Most studies on this condition have been conducted on cadaver specimens, and few have compared the clinical outcomes of single and double plating methods in these fractures.
The current study aimed to compare the postoperative outcomes and complications of the single and double plating methods in the treatment of metaphysical proximal tibial fracture.
We treated 40 patients with metaphyseal tibial fracture with single or double plating methods (20 in each group). Patients were followed after 2 and 6 weeks, and 3 and 6 months; all were assessed for malunion, nonunion, and malalignment deformities.
In the double plating group, numerically better flexion and extension range was not significant (p >0.05). However, in the interpretation of the Lysholm Knee Score questionnaire, a significantly higher proportion of good and excellent postoperative outcomes were found in the double plating group (p=0.041). In the double plating group, 15%, 15%, 40%, and 30% of patients were categorized as having poor, fair, good, and excellent outcomes, respectively. These proportions were 30%, 45%, 15%, and 10% among the single plating group respectively. Moreover, we detected positive valgus stress test in the single plating method in 30% of the cases, compared with 5% in the double plating method (p=0.037). Similarly, we observed that 20% of the cases with positive varus stress test in the single plating method, compared with the double plating method that had no cases who tested positive (p=0.035). The observed significant differences survived after we controlled for the positive stress test using regression models. It should be noted that in the single plating group, one case of valgus malalignment with 10° and one case of varus malalignment with 5° were observed.
Our results highlight that the choice of the double plating method to be associated with significantly better outcomes and fewer complications in the treatment of proximal tibial metaphyseal fracture.