Comparative study on the efficacy of structural support fixation vs. conventional fixation for depressed tibial plateau fractures

PURPOSE: To compare the clinical outcomes of structural support fixation vs. conventional fixation for depressed tibial plateau fractures (TPFs). METHODS: A retrospective analysis was conducted on patients who underwent surgical treatment for depressed TPFs at our hospital between November 2019 and September 2023. Forty-six patients with TPFs who had surgical indications were included. Based on the surgical procedures, patients were categorized into the structural support group receiving locking plate + cage fixation, and the conventional group receiving locking plate + granular bone grafting. The following parameters were evaluated and compared, including operative time, blood loss, time to full weight-bearing, fracture healing time, loss of tibial plateau height, quality of fracture reduction and alignment, hospital for special surgery knee score, and Western Ontario and McMaster Universities Osteoarthritis Index score. Intergroup differences were analyzed using independent-sample t-tests or the rank-sum test. RESULTS: A total of 46 eligible patients completed the follow-up (20 in the structural support group, 26 in the conventional group). No significant differences were observed between the 2 groups in the mean age, sex, body mass index, injury mechanism, or time from injury to surgery (p = 0.276, 0.860, 0.615, 0.160, 0.065, respectively). The mean operative time was 120.7 min in the structural support group and 164.2 min in the conventional group, with the mean blood loss of 120.0 mL and 168.5 mL, respectively. Neither operative time nor blood loss showed significant differences (p = 0.067 and p = 0.309). The mean follow-up duration was 20.2 months (structural support group) and 20.4 months (conventional group), with no significant difference (p = 0.987). At the final follow-up, the structural support group exhibited significantly less secondary step-off compared to the conventional group (0.3 mm vs. 0.7 mm, p < 0.001). While hospital for special surgery functional scores showed no significant difference (94.1 vs. 88.1, p = 0.066), the structural support group had significantly better Western Ontario and McMaster Universities Osteoarthritis Index scores (1.4 vs. 6.3, p = 0.001), with superior outcomes in pain, stiffness, and functional difficulty subscales (p = 0.009, 0.004, 0.003, respectively). No adverse events (e.g., infection, nonunion, or refracture) were found in both groups. CONCLUSION: Compared to conventional fixation, locking plate combined with cage effectively reduces secondary step-off in depressed TPFs and significantly improves pain relief and knee function.