Cases Of Schatzker Type Research Articles

Functional outcome of minimally invasive plate osteosynthesis (MIPO) in proximal tibial fractures

Introduction: This study is undertaken to evaluate the outcome of the MIPO technique in Proximal Tibial Condyle Fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, fewer complications, and a better quality of life. Material and methods: Study design: Prospective cohort study carried out at C.U Shah Medical College. 30 cases of proximal tibia fractures (Schatzker type 1- VI) operated with the MIPO technique. Follow-up of these patients was done at 6 months and 9 months after surgery by using Sanders's 40-point functional scale. Results: There were 16 cases of Schatzker type I fractures, 5 cases of Type II, 4 cases of type III, 2 cases of type IV, 1 case of type V and 2 cases of type VI fractures. The healing process was determined by radiographically and functionally. Meantime to union was 17.6 weeks, with 50 % of fractures uniting in 14-16 weeks. Infection was observed in two cases (10%), two cases of collapse of fracture, and two cases of malunion. Sanders's score was applied to analyze the functional outcome among the cases. 63% of patients had excellent performance, 20% had good results, 13% had fair results and one patient performed poorly. Conclusion: MIPO is a good technique to stabilize the proximal tibia condyle fractures especially when used with meticulous intraoperative handling of soft tissues.

Minimally invasive plate oseosynthesis assisted by a self-designed lower limb axial tractor for treatment of complex tibial plateau fractures

Objective To investigate the clinical efficacy of minimally invasive plate oseoynthesis (MIPO) assisted by a self-designed lower limb axial tractor in the treatment of complex tibial plateau fractures. Methods The data were retrospectively analyzed of the 31 patients who had undergone surgical treatment for complex tibial plateau fractures from June 2015 to April 2018 at Department of Orthopeadics, Hospital Affiliated to Binzhou Medical College. MIPO was conducted with the assistance of the axial tractor in 17 of them. They were 12 men and 5 women with an age of 50.8±14.7 years, with 8 cases of Schatzker type Ⅴ and 9 ones of Schatzker type Ⅵ. MIPO was conducted without the assistance of the axial tractor but with the assistance of manipulation reduction in the other 14 patients. They were 9 men and 5 women with an age of 48.9±9.5 years, with 6 cases of Schatzker type Ⅴ and 8 ones of Schatzker type Ⅵ. The 2 groups were compared in terms of operation time, intraoperative bleeding, and Rasmussen scores for knee function and medial angle of the proximal tibia at the last follow-up. Results The 2 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The tractor and manipulation groups were followed up for a mean of 9.8 months and 10.9 months respectively. Bone healing was achieved in all patients. For the tractor and manipulation groups, respectively, the operation time was127.8±40.8 min and 174.1±66.8 min, and the intraoperative bleeding 115.6±41.7 mL and 184.3±91.4 mL, showing significant differences between them (P 0.05). Loss of force line was observed in none of the patients at the last follow-up. Conclusion Compared with conventional manipulation reduction, use of our self-designed lower limb axial tractor can shorten operation time, reduce bleeding and facilitate reduction of fracture fragments in the treatment of tibial plateau fractures of Schatzker types Ⅴ and Ⅵ. Key words: Knee joint; Fracture fixation, internal; Surgerical procedures, minimally invasive; Traction; Tibial plateau fracture

Single medial approach for the treatment of Schatzker IV tibial plateau fractures

Objective Try to treat the Schatzker Ⅳ tibial plateau fractures with a single medial approach. Methods A single medial longitudinal incision was used to treat 16 cases of Schatzker type Ⅳ tibial plateau fractures admitted to hospital from January 2013 to January 2016 which diagnosed by computed tomography (CT). The range of peeling up to the anterior edge of the tibia, the back side skipping over the posterior bone crest to expose the Posterior surface, persisting the joint capsule and the medial collateral ligament, and the far end reached 3-5 cm beyond the fracture line. As the lower limbs in the situation of external rotation with hip and knee flexion, open the medial fracture, using a strutting forceps to brace the bone block, made out he collapsing cartilage and subchondral bone which belong to de back column, Using the detacher to lift the subchondral bone together with the cartilage surface, lift up to the lateral side until it can’t be raised again, fixed them with 2-3 Kirschner-pins of 1.5 mm-diameter. And then used a large C type Matta forceps to clamp the fracture line for recovering the width of tibial platform. A Tomofix plate was used to fix the fracture in the position of posterior bone crest. The intercondylar eminence fracture of the anterior cruciate ligament was fixed under direct vision, and the supporting plate was placed in the posterior medial wall to fix the posterior medial small fracture. The standard X-ray films of bilateral knee joint were taken and compared after the operation. The knee joint activity was measured at 1 year follow-up after 1 years. The healing of subchondral fracture and no secondary collapse were performed by plain scan, and the function of the knee joint was evaluated by Lysholm scoring system. Results 15 cases were followed up for more than 1 years. All the X-ray showed fracture healing at half a year. CT confirmed that the fracture healed completely at the time of reexamination. The condylar crest avulsion fracture healed well, there was no secondary cartilage surface collapse, no obvious osteoarthritis, the average knee joint activity was 118°, and the average of Lysholm score was 87. Conclusion Combined approach is an effective method for the treatment of complex tibial plateau fractures, but for Schatzker Ⅳ fractures, a good reduction can be achieved with a single medial approach combined with some proper tools. Key words: Tibial plateau fractures; Medial approach; Schatzker Ⅳ

Fracture morphology and injury mechanisms of tibial plateau fracture: analysis of 200 cases

Objective To classify tibial plateau fractures based on the analysis of the morphology and injury mechanisms of 200 cases of tibial plateau feature. Methods We collected the X-ray and CT images of 200 consecutive cases of tibial plateau fracture in 199 patients who had been treated at our department from January 2010 to April 2011. They were 134 males and 65 females, from 15 to 77 years of age (average, 45.7 years). According to the Schatzker classification, 9 cases were type Ⅰ (4.5% ), 105 type Ⅱ (52.5% ), 19 type Ⅳ (9.5% ), 37 type Ⅴ (18.5% ), 30 type Ⅵ (15.0% ), and none type Ⅲ. The fracture morphology and injury mechanism of each case were analyzed to propose a new classification system. Results Fractures of tibial plateau can be classified into the following five types: (a) Lateral condylar fracture and valgus injury (100 cases, 50% ). The injury mechanism is the axial force on the valgus and extended knee joint. (b) Fracture-dislocation injury (24 cases, 12.0% ). This type includes typical Schatzker type Ⅳ, and some cases of Schatzker type Ⅵ associated with lateral subluxation. Its mechanism is a compound force of valgus, varus, rotational and axial stresses. The rotational force is the key factor leading to subluxation of the knee joint. (c) Double-condylar fracture (40 cases, 20.0% ). This type is caused by an axial force on the extended knee, including Schatzker type Ⅴ and some cases of Schatzker type Ⅵ not associated with knee subluxation. (d) Posterior condylar fracture and flexion injury (32 cases, 16.0% ). This type only involves the posterior condylar plateau, and is caused by an axial force on the flexed knee. Based on the morphology, posterior condylar fractures can be further divided into three subtypes: simple split of posteromedial condyle, simple collapse of posterolateral condyle, and a combination of the two. (e) Frontal plateau compression fracture and hyperextension injury (4 cases, 2.0% ). This type is caused by an axial force on the hyper-extended knee. It is characterized by significant compression of the anterior plateau and intact posterior plateau. Conclusion Based on the morphological features and injury mechanisms, tibial plateau fractures can be classified into 5 types: lateral condylar fracture, fracture-dislocation injury, double-condylar fracture, posterior condylar fracture, and frontal plateau compression fracture. Key words: Knee joint; Fractures, bone; Radiography; Injury mechanism; Fracture classification