Abstract
Background
Tibial plateau fractures (TPFs) are complex intra-articular injuries associated with
long-term disability if not optimally treated. In low- and middle-income countries
(LMICs), where high-energy trauma is prevalent and health system resources are constrained,
management strategies, and outcomes differ substantially from those reported in high-income
countries. This systematic review synthesizes evidence from LMICs on treatment approaches,
functional outcomes, and complications following TPFs.
Materials and Methods
We systematically searched PubMed, EMBASE, Scopus, and regional databases for studies
conducted in LMICs, published up to May 2025. Eligible studies included adult patients
with TPFs managed surgically, reporting functional or radiological outcomes. Data
were extracted on demographics, fracture type, surgical technique, and outcomes. Risk
of bias was assessed using the Newcastle–Ottawa Scale and Cochrane ROB-2 tools.
Results
Fifteen studies comprising 1,213 patients from South Asia, and Africa were included.
Patients were predominantly male (65–75%) with mean ages between 35 and 45 years;
road traffic accidents were the leading cause. Dual plating yielded superior alignment
and higher Knee Society Scores (75–85) but carried increased infection rates (10–18%).
Ilizarov and hybrid fixators achieved high union rates (>90%) with acceptable function,
although pin-tract infections (15–20%) and malalignment (10–12%) were common. Arthroscopic-assisted
fixation improved articular reduction but was limited to tertiary centres. A randomized
trial demonstrated that immediate weight-bearing enhanced gait recovery without increased
implant failure. Across studies, complication rates exceeded those reported in high-income
countries, reflecting systemic barriers such as limited rehabilitation access, implant
scarcity, and inadequate soft tissue care.
Conclusion
In LMICs, satisfactory union and functional recovery can be achieved following TPF
surgery, but complication rates remain high. Dual plating offers superior stability,
while Ilizarov fixation provides a resource-appropriate alternative. System-level
improvements in rehabilitation, infection prevention, and trauma infrastructure are
critical to narrowing outcome disparities with high-income countries.
Keywords
tibial plateau fracture - LMIC - external fixation - dual plating - Ilizarov - functional
outcome
Bibliographical Record
Elmuhtadibillah Babiker Yousif Gasoma, Mohamed Ahmed Sarhan, Moustafa Sameir Hussein
Aly. Tibial Plateau Fractures in Low- and Middle-Income Countries: A Systematic Review
of Treatment Modalities, Functional Outcomes, and Complications. Surg J (N Y) 2025;
11: a27195359.
DOI: 10.1055/a-2719-5359
