The most common joint to sustain damage these days is the complex knee joint, which is a result of an increase in car accidents and sports-related injuries. Tibial plateau fractures are common intra-articular fractures, accounting for 2.2% of all fractures. [1] There are two age categories in which fractures are more common: younger patients have higher-energy fractures, while elderly patients have lower-energy fractures due to osteopenia.[2] Two injuries that, in a younger population, are associated with a higher prevalence of sequelae include non-union, infection, limited mobility, and post-traumatic arthritis.[3] Every type of fracture has a different morphology, therapy response, and other distinctive features. Fractures can range in severity from straightforward non-displaced fractures to severely comminuted fractures that also cause neuromuscular and soft tissue damage. In addition to tibial plateau injuries, meniscal tears and ligament damage should be evaluated. [4] The various indications are treated surgically with implants and external fixators in addition to casts. The kind and degree of the fracture determine the course oftreatment. [5]

Results after surgery are also influenced by the experience of the surgeon. Among the implant fixation surgery procedures that offer superior clinical results in cases of complicated proximal tibia fractures are ORIF and MIPO. [6,7] For this reason, internal fixation of fractures has replaced conservative treatment as the primary option for orthopaedic surgeons treating proximal tibia fractures. Conservative treatment may result in non-union, malunion, or knee stiffness. Implants with locking compression plates are used in surgical procedures to achieve the best possible clinical outcomes, fracture union, and patient outcomes. In this clinical trial, improvements are evaluated retroactively using VAS, radiographs, and ROM during the follow-up visit following proximal tibia plate surgery in order to measure post-operative results.

Tibia plate system

The tibia plate system consists of both dynamic compression plates and locking plates. The locking plates are often used because of the locking screw and plate provide stable construct the provide stability to the fractures. [8] The plates also feature compression holes which provide compression when a non-locking screw is inserted through them. The locking plates construct are also available in axial and poly-axial constructs. Both are fixed angle constructs. The main difference between such plates is that in fixed angle locking, the locking screw can be implant only in nominal angle whereas in multi-axial construct, the screw can be fixation the cone angle on 15° which in result provide better result as this construct allows fixation of many fractures that are not treatable through standard compression plates.[9]

The following images show the plates that are used in this study that includes locking plates. Different plates system includes LISS (less invasive stabilization system) plates, variable angle locking and non-locking plates (Figure 1)

Figure 1

From September 2021 to July 2022, 30 patients who received treatment at Jawahar Lal Nehru hospital in Mauritius with a tibia plate system were the subjects of this retrospective study. The hospital provides information on age, gender, fracture type, injury aetiology, and post-operative visits. The institutional ethics committee has given its approval for the project.

Inclusioncriteria
The study comprised male and female volunteers who were at least eighteen years old and who had sustained an accident between twelve and seventy-two hours prior to the pre-operative examination that resulted in a proximal tibia fracture. The study's subjects all experienced fractures that were reparable from the proximal tibia plates. The patient who has had three or more follow-up appointments in one year period.

ExclusionCriteria
Patients who were over 75 years old, had a compounded fracture, a proximal tibia fracture along with other limb fractures, or a pathological fracture were all excluded from this study. Other exclusion criteria included subjects with a history of alcohol abuse, those who were detained or in the process of being detained, patients with an infection at the site of the operation, patients with any ongoing local infections, patients with a metal allergy, and patients with neuromuscular diseases.

Treatment
Patients who had suffered traumatic proximal tibia fractures had their requirement for open reduction following initial therapy evaluated. The radiograph obtained during emergency care served as the basis for the assessment. After being admitted, the patients who needed open reduction were scheduled for surgery.

The procedure was carried out in accordance with the AO fracture care principles, which include early, aggressive mobilization, stable fixation after anatomic reduction, and blood supply preservation.

The surgery was carried out using proximal tibia locking plate. After removal of sutures, physiotherapy exercise started for early recovery and motion, which was done for a period of 25-30 days. Partial weight bearing also started after completion of physiotherapy.

Statistical statistics
The software Minitab will be used for all statistical analyses. For continuous variables, the results are presented as means ± standard deviations, and for nominal variables, as a number (%). Descriptive statistics (mean, median, standard deviation, minimum, maximum) are used to summarize the endpoints. Parametric tests will be used for analysis if the distribution is normal; otherwise, comparable nonparametric tests will be used. Using statistical software, do intragroup paired-t-tests at different follow-up points for data that are normally distributed. A P-value of less than 0.05 is deemed statistically significant.

Fifteen girls and twenty males, with a mean age of forty-two, are undergoing tibia plate fixation surgery (Table 1). Car crashes, falls from heights, and sports injuries are the main causes of proximal tibia accidents in adults, but low energy trauma, which includes falls from various activities, is the main cause in the elderly (over 60) (Table 2). The patients had fractures of the 41A, 41B, and 41C types, according to the AO classification. Both closed and open fractures affected the individuals. Gustilo-Anderson I, II, and III are used to categorize open fractures (Table 3). Five complicated fractures and thirty single fractures were treated independently.

A radiographic evaluation was done at every follow-up to gauge the progress of the bone union. With a range of 18–24 weeks, the total amount of time needed for full bone union was 21 weeks.

No patient exhibited non-union or delayed union. Table 4 lists the post-operative complications that included knee stiffness in 2 patients, valgus deformity in 0 patient, and infection in 10 patients that were treated with oral medication. Knee range of motion and pain assessment using a VAS score are included in the clinical assessment. Twenty-five patients reached the acceptable Knee ROM of more than 125°. Two patients had mild pain at the final visit, while 28 patients had no pain at all (Figure 2). There were no implant-related complications noted, and every patient reviewed showed excellent outcomes in terms of pain management, complete weight bearing, appearance, and ADLs (Activities of daily living) (Table 5)

TABLE 1: DEMOGRAPHICS

TABLE 2: AETIOLOGY

TABLE 3: INJURY DESCRIPTION

TABLE 4: POST-OPERATIVE COMPLICATION

TABLE 5: PATIENT SATISFACTION

This article's goal is to demonstrate how locking the proximal tibia plate helps treat and stabilize complicated proximal tibia fractures through radiological and clinical results. Soft tissue damage frequently coexists with high energy trauma-related proximal tibia fractures. For appropriate care, these injuries are essential. An external fixator should be used in conjunction with an emergency wound healing procedure for proximal tibia fractures.[10] These fractures are treated in phases; the MIPO technique is used to fix the fracture in the second stage once the wound has healed. When MIPO techniques are used to treat proximal tibia fractures, the best outcomes are achieved in terms of quick healing, minimizing soft tissue damage, preventing loss of function, and preventing non-union and mal-union.[11, 12]

The current study demonstrates the use of proximal tibia plates in the treatment of proximal tibia fractures. The plates used here are recommended for both intra- and extra-articular proximal tibia fractures. For various indications of split-type fractures of the lateral tibial plateau, lateral split fracture with associated depression, pure central depression fractures, split or depression fractures of the medial plateau, bicondylar combination of lateral wedge and depression fractures, and fractures with associated shaft fractures, the study uses the medial, lateral, and posterolateral plates for the proximal tibia. It has been noted that using these plates helps brides with comminuted fractures heal more quickly.[13]

Even so, ROM and pain were noted as the main clinical outcomes in the current trial, with data demonstrating good results in pain reduction in a shorter amount of time and meeting defined ROM requirements. Although several cases of infections were documented and treated with medicine, there were no significant complications related to non-union, malunions, or deep infections that could have needed re-surgery.The complaint of knee stiffness was noted following surgery, but it vanished by the time of the subsequent appointment. A patient with valgus deformity was seen. The sample size, retrospective methodology, and lack of statistical significance in the data analysis are limitations of the current study. The only data displayed are descriptive ones with mean, range, and frequency. With a large sample size and an alternative study design, these constraints can be circumvented.

Proximal tibial fractures are becoming more common and need for the best care possible because they affect mobilization and quality of life. There is a significant chance of infection with the fractures that have soft tissue attached. To create a stable and functional knee joint, the goal of treatment should be anatomic reduction, precise axial and articular alignment, and stiff fixation. employing the proximal locking tibia plate in the MIPO procedure. These plates are made to require less invasive surgery, which reduces the amount of soft tissue dissection and speeds up mobilization while lowering the risk of infection and stiffness and improving knee joint function.

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