Cases Of Tibial Plateau Fractures Research Articles

The Clinicoradiological Outcome of Arthroscopic-assisted Reduction and Internal Fixation of Tibial Plateau Fractures

Abstract Background: The fractures of the tibial plateau are intraarticular fractures accounting for 1% of all fractures. Surgical management of such fractures is often challenging because they require anatomical reduction and stable fixation, which will allow for early rehabilitation. Arthroscopy has evolved nowadays and arthroscopically assisted reduction and fixation is a good option among the available surgical options. Materials and Methods: This prospective study included 50 cases of tibial plateau fractures managed surgically by arthroscopic-assisted reduction and fixation starting from August 2019 to December 2022. Results: The patients were 39 years old on average and were mostly men (58%). The right knee was the most usually injured (53%), and the most common cause of injury (41.5%) was a fall from a height. The majority of these fractures (44.5%) belonged to Schatzker type 2, followed by type 1 (37%) and type 3 (18.5%). The average time to complete weight-bearing for a Schatzker type I fracture was 10 weeks, 11.5 weeks for a type II fracture, and 13.5 weeks for a type III fracture. The average time to union for Schatzker type I was 13 weeks, 15.5 weeks for type II, and 16 weeks for type III. The mean clinical and radiological scores using the modified Rasmussen criteria were 26.3 and 7.3, respectively. Conclusions: A good surgical outcome of tibial plateau fracture is acquired when anatomic articular surface reconstruction with the elevation of depressed bone fragment is combined with rigid stable fixation, which permits early rehabilitation. Arthroscopy helps in achieving these goals by providing a good visualization of the articular surfaces, adequate fracture reduction, and anatomical restoration of the joint surface and aids in thorough joint lavage to remove the intraarticular debris.

Primary Versus Secondary Total Knee Arthroplasty for Tibial Plateau Fractures in Patients Aged 55 or Over—A Systematic Review and Meta-Analysis

BackgroundTotal knee arthroplasty allows immediate postoperative weight-bearing and is increasingly recognized as a suitable treatment option for older patients who have tibial plateau fractures (TPFs). This systematic review evaluated the clinical and functional outcomes associated with primary versus secondary TKA for the treatment of TPFs in patients aged ≥55 years. MethodsVarious databases were searched from inception to December 2021. Studies investigating outcomes of primary TKA (pTKA) as the initial treatment for TPFs in patients of mean age ≥55 years or those investigating outcomes of secondary TKA (sTKA) following any other primary treatment for TPFs were included. Quality of included studies was assessed using a methodological scale. Of 767 potentially relevant studies, 12 studies comprising 341 patients were included: 121 patients underwent (pTKA) and 220 patients underwent sTKA. There were 3 high-quality studies. Patients in the sTKA cohort were significantly younger at the time of TKA compared with those undergoing pTKA (mean 61.3 versus 72.2 years, P < .001, 95% confidence interval (CI) 8.2 to 13.6). ResultsIntraoperative and postoperative complication rates were lower with pTKA; in particular, sTKA was associated with a significantly increased rate of stiffness requiring reintervention and patella tendon rupture. Functional outcome was greater after pTKA, but this did not reach statistical significance (85.2 versus 79.9%, P = .359, 95% CI -16.7 to 6.1). ConclusionPrimary TKA was associated with lower complication rates than secondary TKA after TPF. In appropriate cases of TPF in older adults, it may be preferable to proceed with TKA as primary treatment rather than delaying until after fracture union or malunion.

“A STUDY OF FUNCTIONAL OUTCOME OF TIBIAL PLATEAU FRACTURE OPERATED BY PLATE OSTEOSYNTHESIS”

Background: Tremendous advance in mechanization and fastness of travel have been accompanied by steep increase in number and severity of fractures and those of tibial plateau are no exception. Knee being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. Objective: 1. This study is to analyze the functional outcome of ORIF with plating with or without bone grafting in tibial plateau fractures in adults. 2. To study complication of operative management Methods: Conrmed cases of Tibial plateau fractures admitted in Department of Orthopaedics in Basaweshwara Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Kalaburagi. The purpose of the study is to include with tibial plateau fractures diagnosed with history taking, Examination and investigations: knee X ray-AP and Lateral view. The need of operative intervention is assessed based on the Shatzker`s classication and intervention done by techniques like anterolateral plating bicondylar plating, posteromedial plating. Patients will be reviewed at 6 weeks, 3 months and 6 months interval and their assessment done by Rasmussens functional and radiological scoring. In our Results: series, majority of the patients were males, middle aged, with road trafc accident being the commonest mode of injury, Most of the cases were Type I fractures i.e., split fracture of lateral condyle according to Schatzker`s classication, Surgery was performed with in 6.48 average days, Union was noted clinically and radiologically and functional evaluation was done by Rasmussen functional and radiological score. Excellent results were present in 23 patients (76%), 4(20%) good and 1(4%) poor results. Achieving and maint Interpretation /Conclusion: aining anatomical reduction with plates with less soft tissue dissection helps in early mobilization and hence obtaining good functional and radiological outcomes of tibial plateau fractures early physiotherapy for rehabilitation

Joint depression in tibial plateau fractures: To bone graft or not to bone graft?

Tibial plateau fractures with significant joint depression and metaphyseal comminution pose a challenge. In order to prevent the collapse of the articular surface, some authors propose filling the subchondral void created during reduction with bone graft/substitute, which can add further complications. We present two cases of tibial plateau fractures with severe joint depression of the lateral condyle; both treated with a periarticular rafting construct, in one caseadditional bone substitute was used and in the other case no bone graft/substitute was used; their final outcomes were reported. The treatment of joint depression in tibial plateau fractures using periarticular rafting constructs without bone graft, may be also a valid option, to achieve good final results without the morbidity associated with the use of bone graft/substitutes.

Proximal avulsion of five ligaments and revised diagonal principle in tibial plateau fractures

PurposeThe aim of the study was to analyze the incidence of proximal avulsion of the five main ligaments and to revise the diagonal tension/compression concept in tibial plateau fractures. MethodsComputed tomographic images of 1263 cases of tibial plateau fractures were retrospectively analyzed by the OTA/AO classification and four-column nine-segment classification. The correlation between proximal avulsion of five ligaments and the injury mechanism was analyzed. ResultsIn total, 1263 tibial plateau fractures in 1253 patients were included. A total of 92 cases (7.3%) associated with proximal avulsions were identified among the 1263 tibial plateau fracture cases obtained from our institution's database. The 92 avulsions occurred in 82 patients, among whom 10 patients had two different avulsions in a single knee. The incidence of proximal avulsion fracture of the medial and lateral collateral ligament was 3.6% (45/1263) and 2.1% (26/1263), respectively. The incidence of avulsion of the anterior cruciate ligament and avulsion of the posterior cruciate ligament was much lower at 0.2% (2/1263) and 0.1% (1/1263), respectively. Proximal avulsion of the patellar ligament occurred in 18 cases (incidence rate = 1.4%). Several combinations of injuries, composed of distal tibial plateau fractures and proximal avulsion of ligaments, were identified. ConclusionsAmong the patients with tibial plateau fracture, the incidence of proximal avulsion of the five ligaments was 7.3% (92/1263). The four-column and nine-segment classification is an exhaustive method for recording injuries in these ligaments. The revised diagonal injury concept is useful for understanding the injury mechanism and choosing the appropriate surgical strategy.

Interobserver Reliability of Schatzker, AO Foundation-Orthopaedic Trauma Association, and Luo Classifications for Tibial Plateau Fractures: Does Three-Dimensional CT Improve Outcomes?

ObjectiveTo assess the interobserver agreement of the most widely used classification systems (Schatzker, AO Foundation-Orthopaedic Trauma Association (AO-OTA), and Luo) and investigate the impact of multiplane CT scans on their reliability.MethodsTwelve raters (seven consultants and five senior trainees) were invited to classify 25 cases of tibial plateau fracture randomly selected out of a large database. Initially, they were asked to classify the fracture according to Schatzker, AO-OTA, and Luo based on plain anteroposterior (AP) X-ray and axial CT images. This procedure was applied for 25 cases consecutively. Next, the raters are given access to the multiplanar CT views of the same cases and were requested to reclassify each case. The interobserver agreement was calculated using the Fleiss kappa coefficient.ResultsAn overall fair inter-rater agreement was observed for the Schatzker classification based on the plain AP X-ray (k=0.361) with a slight improvement after three-dimensional (3D) plane CT views (X-ray: k=0.361; 3D CT: k=0.364). For the AO-OTA classification, the relevant values were 0.204 and 0.231 based on plain X-ray and multiplanar CT, respectively. Finally, the Luo classification achieved the highest scores among the three classification systems (k=0.498), but its inter-rater agreement can still be characterized as moderate. No statistically significant improvement in the interobserver agreement was found for any classification even if only the consultants’ subgroup was included in the data analysis.ConclusionAll three classification systems failed to achieve a substantial agreement among the raters, with only a nonsignificant improvement after providing advanced imaging. This finding reflects the intrinsic weaknesses of the classification systems themselves rather than the disagreement on the fracture pattern due to unsatisfactory imaging.

FUNCTIONAL AND RADIOLOGICAL OUTCOME OF TIBIAL PLATEAU SCHATZKER TYPE V AND TYPE VI TREATED WITH DUAL PLATING

Background: The bicondylar fractures are common fractures. These high Energy fractures are associated with the various complications like malalignment, Varus collapse, Postoperative Stiffness, Wound complication. This Study aims to Study the Functional Outcome and stability of Dual Plating for these fractures.&#x0D; Methods: Total 25 cases of tibial plateau fractures V and VI treated with Dual Plating from 1st January 2016until 30th December 2019 in Chitwan Medical College Nepal were included in the Study. These fractures were operated with Anterolateral approach and Medial approach and Dual Plating was done. Clinical and Radiological Outcome was evaluated.&#x0D; Results: The functional outcome of our patients was assessed with Rasumssens functional score which showed excellent (60%), good (36%) and fair in (4%) of the patient. 4 cases had superficial infection. There was no secondary loss of reduction, malalignment in the study. The Medial Proximal Tibial plateau angle (MPTA) of the Last visit and uninjured Limb had no significant statistical differences, However Proximal Posterior Tibial Plateau angle (PPTA) showed Significant difference p=0.025.&#x0D; Conclusion: The open reduction and Internal fixation with Dual plating for Bicondylar Proximal Tibia fracture is Biomechanically efficient in Preventing collapse and malalignment, however an accurate intraoperative reduction is the most. The Stable fixation allows Early ROM and Rehabilitation and thus provide Excellent to Good Functional outcome with minimal Complication.

Tibial plateau fractures in a limited-resource setting: A prospective study of surgical techniques and outcome over three years

Introduction: Tibial plateau fractures form a wide spectrum of injuries accounting for 1.2% of all fractures and a prevalence of 10 cases per 100,000 inhabitants. Methodology: A prospective consecutive multicentre study from May 2018 to May 2021 was carried out in Yaounde. All consenting cases of tibial plateau fracture underwent surgical treatment while patients with pathologic fractures, previous knee osteoarthritis, medically unfit for surgery, and discharging against medical advice were excluded. Data was analysed with SPSS 26.0 and the level of significance set at p&lt;0.05. Results:Eighty-four (84) cases of tibial plateau fractures were sampled and 68 consented to surgery. The mean age was 42 ±13.6 years and sex ratio 2.4. Estimated prevalence was 2.2 cases per 100,000 inhabitants. Schatzker type II fractures were most represented (33.3%). The left leg was affected in 57.1%. Motorbike accidents were the main cause of injury (66.7%). Of the 68 operated, 63.3% by plating osteosynthesis, 32.4% by external fixation, and 4.4% by screws fixation. Tricortical iliac bone graft was realised in 4 cases. The minimum follow-up was 6 months, with a median of 18 months (5 to 37 months). Plating osteosynthesis (p&lt;0.001), operative time between 60 to 120 minutes (p&lt;0.02) and a good radiologic fracture healing (p&lt;0.04) were associated with a satisfactory outcome. Poor prognosis was seen with open fractures (p&lt;0.001), bridging external fixation (p&lt;0.001), and Schatzker VI fractures (p&lt;0.02). Complications included post-traumatic osteoarthritis (64.7%), post-traumatic osteomyelitis (29.4%), knee ankylosis (5.9%), and limb malalignment (30.9%). Conclusion:The prevalence of tibial plateau fractures remains lower than reported in literature but it is projected to rise. Plating remains a viable treatment option. A larger scale study will establish the burden of this entity in our context.

Lesional and Therapeutic Aspects of Tibial Plateau Fractures at the BSS University Hospital Center in Kati

Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobility of the knee and can compromise walking and standing. These fractures are on the increase, especially affecting young and active subjects. Orthopedic treatment is a rare indication apart from non-displaced or slightly displaced forms. Surgical treatment is required in displaced forms, particularly in depression fractures. The aim of this work was to report the lesional and therapeutic aspects of tibial plateau fractures in our department. Patients and Method: Patients and method: This was a retrospective study over 36 months from January 2019 to December 2021. Included in this study were patients treated for a tibial plateau fracture in our department and followed up for at least 10 months. The epidemiological and clinical data analyzed were age, sex, affected side, etiology, mechanism of injury, pathological anatomy and associated lesions. The fractures were classified according to the classification of Duparc and Ficat. The slightly or non-displaced forms were treated orthopedically while the displaced forms were treated surgically. The minimum follow-up was 10 months. The results were evaluated by the anatomical criteria according to Mazas and Duparc and functional according to Merle d’Aubigné. Results: The authors collected 71 cases of tibial plateau fractures. They accounted for 4.0% of all limb fractures, 5.8% of lower limb fractures and 33.8% of knee fractures in our service. The male sex was the most represented at 78.9% with a sex ratio of 3.7. The age group of [20 - 40] years was the most affected, i.e., 53.5%. The average age was 41 years with extremes of 17 and 82 years. The left side was affected (n = 47) and the right side (n = 24). Road traffic accident was the main cause. The mechanism of injury was mainly represented by lateral and sagittal compressions. Lateral unituberosity and bi-tuberosity fractures were the most frequent pathological types in our series, respectively 42.2% and 28.2%. The associated lesions were mainly represented by bone, ligament, skin and neurological lesions. The treatment was orthopedic in 52.1% and surgical in 47.9%. According to the functional criteria of PMA, our results were very good and good at 77.4%, Average at 14.1% and poor at 8.5%. Conclusion: It appears in this study that fractures of the tibial plateaus are frequent and serious because of their articular nature. Lateral and sagittal compressions are the most evoked injury mechanisms. Lateral unituberosity and bituberosity fractures are the most frequent pathological types. Functional and anatomical results are significantly better with surgical treatment.

Lesional and Therapeutic Aspects of Tibial Plateau Fractures at the BSS University Hospital Center in Kati

Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobility of the knee and can compromise walking and standing. These fractures are on the increase, especially affecting young and active subjects. Orthopedic treatment is a rare indication apart from non-displaced or slightly displaced forms. Surgical treatment is required in displaced forms, particularly in depression fractures. The aim of this work was to report the lesional and therapeutic aspects of tibial plateau fractures in our department. Patients and Method: Patients and method: This was a retrospective study over 36 months from January 2019 to December 2021. Included in this study were patients treated for a tibial plateau fracture in our department and followed up for at least 10 months. The epidemiological and clinical data analyzed were age, sex, affected side, etiology, mechanism of injury, pathological anatomy and associated lesions. The fractures were classified according to the classification of Duparc and Ficat. The slightly or non-displaced forms were treated orthopedically while the displaced forms were treated surgically. The minimum follow-up was 10 months. The results were evaluated by the anatomical criteria according to Mazas and Duparc and functional according to Merle d’Aubigné. Results: The authors collected 71 cases of tibial plateau fractures. They accounted for 4.0% of all limb fractures, 5.8% of lower limb fractures and 33.8% of knee fractures in our service. The male sex was the most represented at 78.9% with a sex ratio of 3.7. The age group of [20 - 40] years was the most affected, i.e., 53.5%. The average age was 41 years with extremes of 17 and 82 years. The left side was affected (n = 47) and the right side (n = 24). Road traffic accident was the main cause. The mechanism of injury was mainly represented by lateral and sagittal compressions. Lateral unituberosity and bi-tuberosity fractures were the most frequent pathological types in our series, respectively 42.2% and 28.2%. The associated lesions were mainly represented by bone, ligament, skin and neurological lesions. The treatment was orthopedic in 52.1% and surgical in 47.9%. According to the functional criteria of PMA, our results were very good and good at 77.4%, Average at 14.1% and poor at 8.5%. Conclusion: It appears in this study that fractures of the tibial plateaus are frequent and serious because of their articular nature. Lateral and sagittal compressions are the most evoked injury mechanisms. Lateral unituberosity and bituberosity fractures are the most frequent pathological types. Functional and anatomical results are significantly better with surgical treatment.

Deep Learning-Based MRI in Diagnosis of Fracture of Tibial Plateau Combined with Meniscus Injury

This study aimed to explore the application value of magnetic resonance imaging (MRI) images based on deep learning algorithms in the diagnosis of tibial plateau fractures combined with meniscus injuries. The original MRI image was input into the deep learning convolutional neural network (CNN), and the knee joint undersampled and fully sampled MRI image data were used for training to obtain a neural network model that can effectively remove the noise and blur of the undersampled image. Then, the image was reconstructed by the Regridding model to obtain an image with less noise and clearer structure. At the same time, all subjects underwent knee MRI examinations, and algorithms were used to analyze the sensitivity, specificity, and accuracy of their images. It was found that of 160 menisci from 80 cases of tibial plateau fractures, 64 were normal meniscus and 88 were injured menisci. The sensitivity, specificity, and accuracy of optimized MRI in diagnosing fracture of tibial plateau combined with meniscus injury were 96.9%, 93.2%, and 95.3%, respectively. In conclusion, the restored MRI images have high sensitivity in the diagnosis of meniscus injury and high consistency with the intraoperative results. It suggests that the optimized MRI image is effective in the diagnosis of meniscus injury.

Comparison of two osteotomies in the treatment of medial compartment osteoarthritis

To compare the effectiveness of modified distal tibial tubercle-high tibial osteotomy (DTT-HTO) and open-wedge HTO (OWHTO) in the treatment of medial compartment osteoarthritis. A clinical data of 80 patients with medial compartment osteoarthritis treated with HTO between January 2016 and January 2019 was retrospectively analyzed, including 40 patients treated with DTT-HTO (DTT-HTO group) and 40 patients treated with OWHTO (OWHTO group). There was no significant difference in gender, age, body mass index, affected side, disease duration, Kellgren-Lawrence grading of osteoarthritis, and preoperative knee society score (KSS), Hospital for Special Surgery (HSS) score, knee joint visual analogue scale (VAS) score, hip-knee-ankle angle (HKA), posterior tibial slope (PTS), weight-bearing line ratio (WBL), Blackburne-Peel index (BPI), Caton-Deschamps index (CDI), and Insall-Salvati index (ISI) between the two groups ( P>0.05). The operation time, incision length, bleeding volume, hospital stay, and complications in both groups were recorded. The KSS, HSS, and VAS scores were used to evaluated the effectiveness. A self-made questionnaire was used to evaluate the recovery of low-impact sports ability of the knee. X-ray films were used to observe the osteotomy healing and measure the HKA, PTS, WBL, and the patellar height indexes (BPI, CDI, ISI). All operations successfully completed in both groups. The OWHTO group operated longer than the DTT-HTO group ( P<0.05). There was no significant difference in the incision length, bleeding volume, and hospital stay between the two groups ( P>0.05). All incisions healed by first intention in both groups. There were 2 cases of lateral hinge fractures in the OWHTO group, and 1 case of lateral hinge fracture and 2 cases of tibial plateau fractures in the DTT-HTO group. No other complications occurred. The patients in both groups were followed up 2-4 years with an average of 2.8 years. The HSS, KSS, and VAS scores in both groups significantly improved after operation when compared with preoperative scores ( P<0.05). All scores gradually improved with the time and there were significant differences between different time points ( P<0.05). The HSS, KSS, and VAS scores were significantly better in the DTT-HTO group than in the OWHTO group at 3 months after operation ( P<0.05). There was no significant difference between the two groups at 6 months, 1 year, and 2 years ( P>0.05). At 1 year, the low-impact sports ability of the OWHTO group was rated as excellent in 8 cases, general in 25 cases, and poor in 7 cases, and as excellent in 7 cases, general in 26 cases, and poor in 7 cases of the DTT-HTO group. There was no significant difference between the two groups ( Z=-0.715, P=0.475). X-ray film reexamination showed that the osteotomies healed in both groups. The healing time was (4.52±1.23) months in the OWHTO group, and (4.23±1.56) months in the DTT-HTO group, showing no significant difference ( t=0.923, P=0.359). At immediate after operation, the HKA and WBL of the two groups significantly improved when compared with the preoperative values ( P<0.05). However, the pre- and post-operational difference was not significant between the two groups ( P>0.05). The PTS of the OWHTO group was significantly higher than preoperative value ( P<0.05), while the PTS of the DTT-HTO group was lower than preoperative value ( P>0.05). The pre- and post-operational difference between the two groups was significant ( P<0.05). BPI and CDI in the OWHTO group were significantly lower than preoperative values ( P<0.05), but there was no significant difference in ISI when compared with preoperative value ( P>0.05). There was no significant difference in the BPI, CDI, and ISI of the DTT-HTO group between pre- and post-operation ( P>0.05). The pre- and post-operational differences of BPI and CDI between the two groups were significant ( P<0.05), and there was no significant difference in the pre- and post-operational difference of ISI ( P>0.05). The two osteotomies in the treatment of medial compartment osteoarthritis can significantly change the varus deformity and achieve satisfactory effectiveness. The early functional recovery of DTT-HTO is faster, which can avoid the increased PTS and patellar baja of traditional OWHTO. However, neither of the two surgical procedures can restore the patient's ideal low-impact sports ability of the knee.

Preventable iatrogenic cause of foot-drop in knee injuries with literature review

PurposeCommon peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment. MethodsWe retrospectively reviewed the prospectively collected data of 7 cases of tibial plateau fractures in association with proximal fibula fracture from January 2019 to September 2019 who presented to emergency room of our hospital. ResultsIn addition to fibular neck fracture, the first case had type 6 tibial plateau displaced fracture and the second case had displaced acetabular fracture with instability of knee with tibial tuberosity avulsion. common peroneal nerve palsy developed following application of distal tibial skeletal traction in both the cases. Other 6 such cases remained neurologically intact as traction was not applied to them. ConclusionSuch iatrogenic complication could have been prevented if the injury pattern of "concomitant medial and lateral columns" of the proximal leg is kept in mind by the treating surgeon before applying skeletal traction.

Management of tibial plateau fractures with compromised soft tissue using hybrid external fixator

&lt;p class="abstract"&gt;Tibial plateau fractures with high energy trauma are complex injury due to its precarious soft tissue envelope. High energy trauma has high incidence of open fractures, articular depression, fracture comminution and displacement, soft tissue injury, and neurovascular compression. It is often difficult to achieve and maintain reduction and commonly predisposes to secondary arthritis. Hybrid external fixator minimizes the iatrogenic soft tissue damage, provides adequate fixation of the fracture, permits early range of motion, easy wound care and leave no large implant in subcutaneous position. This study was performed to evaluate the functional and radiological outcome with this procedure. In this case series, prospective study of 15 cases of tibial plateau fractures were treated with hybrid external fixator at tertiary care teaching hospital in southern Rajasthan from July 2018 to June 2019. The functional and radiological outcome was assessed by Rasmussen functional and radiological score. The mean interval between surgery and union was 16 weeks (range 13 to 18 weeks). Rasmussen functional results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Rasmussen radiological results were acceptable in 13 cases (86.66%) comprising excellent in 9 (60%), good in 4 (26.66%), and fair in 2 (13.33%). Minimal internal and hybrid external fixation for management of tibial plateau fracture with compromised soft tissue is more biological, require less surgical time, less hospital stay, very effective in compromised soft tissue, highly cost effective and has minimal complications with good functional outcome.&lt;/p&gt;

A strategy to prevent complications of hyperextension type tibial plateau fracture.

Tibial plateau fractures (TPFs) are the most common among periarticular fractures. Mechanism of injuries is most from varus/valgus and flexion injury. Hyperextension type injuries are rare and easily to be overlooked. We reported 12 cases of this fracture type. Complications of early cases were reported, and treatment strategies of late cases were suggested. From 2010 to 2016, we performed a retrospective analysis of 248 cases of TPFs in our institute and 12 cases of hyperextension bicondylar TPFs were diagnosed. Diagnostic method is from both plain films and CT scans. The features of this injury included sagittal plane malalignment with loss of the normal posterior slope of the tibial plateau, tension failure of the posterior cortex, and compression of the anterior cortex. Surgical approach is predominantly via an anterolateral and/or posteromedial double incision at the first. Then anteromedial with adequate grafting to support the bone defect was modified. Postoperative radiographic analysis, physical examination findings, and complications were reported. Patient reported outcome scores from the Knee Injury and Osteoarthritis Outcome Score (KOOS) were recorded. Twelve patients were followed up for a mean period of 16.6months (range 12-26months). The mean time to radiographic bony union was 3.6months (range 3-9months, SD 8.5). About complications, the incidence of popliteal artery occlusion received PTA was 8% (1/12). And 3/12 (25%) patients had either partial or complete peroneal nerve injury. 2/12 (16%) patients developed a leg compartment syndrome. 33% (4/12) demonstrated associated injuries including posterolateral complex injuries mostly and posterior cruciate ligament avulsion fracture in one case. The average range of motion of the affected knees was 3.4-130° postoperatively. Analysis of complication about surgery included inadequate reduction and fixation in two cases, insufficient bone grafting in one case. The mean mPTA was significantly improved after fixation (preoperative 82° postoperative 3months 86°). The mean posterior slope (PTA) was preoperative -3° and postoperative 3months 3°. And mean KOOS was 80. Hyperextension bicondylar tibial plateau fractures show a special characteristic of changes in posterior tibial slope angle and are easy to be overlooked. Complication rate is high after injury and after ineffective fixation. Choosing correct approach with sufficient grafting and stable fixation for treatment of hyperextension bicondylar tibial plateau fractures should be used to improve patients' outcome.

Predictors of functional outcome of surgical management in proximal tibia fractures

Background: Tibia plateau fractures constitute about 1% of all fractures and complex bicondylar fractures constitute 30% of all Tibial plateau fractures. These fractures pose an inherent difficulty in treatment due to the extent of soft tissue damage, fracture comminution, instability, displacement of articular fragments and increased risk of compartment syndrome. Present study was carried to find out functional outcome in different fracture management technique. Material and methods: A total 25 cases of tibial plateau fracture treated with different implants from April 2019 to September 2019 in Santokba Durlabhji Memorial Hospital were followed for minimum of 6months. Patients less than 18 years and more than 60 years of age, Compound trauma and fractures due to pathological conditions were excluded. Functional outcome was measured using Rasmussen’s grading system at 6month follow up. Results: Maximum study subjects (36%) were in age group of 31-40yrs, 80% had road traffic accidents as a mode of injury. 32% were of type V Schatzker fracture classification. 48% subjects were operated by ORIF with LCP Plating, 24% subjects were operated by LCP Plating plus CC screw, 20% were operated by bicondylar plating, 8% were operated by CC screw. Most of the subjects with plates had either excellent or good outcome. Conclusion: ORIF with plating gives excellent to good functional outcome with minimal soft tissue complications.

Assessment of the complications after percutaneous fixation with cannulated cancecellous screws among the cases of tibial plateau fractures in a tertiary healthcare institute: a cross sectional study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Fractures in the tibial plateau were first defined as car bumper fractures. Tibial plateau fractures are a diverse group of fractures that reflect a wide range of intensity, ranging from simple accidents to intricate fracture trends that test even the most qualified surgeons. The present study was conducted to study the result of minimally invasive technique for tibial plateau fractures by percutaneous fixation with cannulated cancellous screws and to study complications associated with it in a tertiary care center.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was a cross sectional study conducted among 13 patients with tibial plateau fractures during January 2016 to December 2016 admitted under department of orthopedics in a tertiary healthcare institute in northern Maharashtra. The criteria for selection of a case were a fracture of tibial plateau (Shatzker’s type I to type IV) with displacement or depression more than 8mm.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; One patient (7%) had compartment syndrome at the time of presentation. No patient in our series had early postoperative complication. One patient developed knee joint pain 16 months after operation due to early osteo-artgritic changes.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There was no early complication related to surgery like superficial or deep infection, damage to neurovascular structures, etc. Ten patients (76%) achieved full range of knee motion within 3 months after operation. All the fractures were united within 14 weeks duration.&lt;/p&gt;

Retrospective analysis of 514 cases of tibial plateau fractures based on morphology and injury mechanism

BackgroundTibial plateau fractures remain a clinical challenge due to the complexity of the fracture patterns which have been repeatedly categorized by many researchers. However, limitations do exist in some respects. So we aimed to reclassify tibial plateau fractures based on injury mechanism and morphological characteristics.MethodsFive hundred fourteen cases of tibial plateau fractures were enrolled. The X-rays and CT scans were analyzed.ResultsAccording to our observation and analysis, tibial plateau fractures can be categorized into the following six types: (1) Lateral condylar fractures (axial force applied while knee extending in valgus position). Two hundred fifty-one cases were included (48.83%). (2) Fracture dislocation (multiple forces especially rotational stress while knee extending). Fifty-five out of 514 cases belong to this pattern (10.70%). Correction of the subluxation remains primary and crucial during surgical procedures. (3) Simple medial condylar fractures (axial force applied while knee extending in varus position). One third of which were associated with an avulsion fracture of fibular head. Fifteen cases were included (2.92%). (4) Bicondylar fractures (axial forces applied while knee extending). One hundred twelve cases were included (21.79%). Surgical algorithm greatly depends on soft tissue conditions. (5) Posterior condylar fractures (axial stress applied while knee flexing). Sixty-five cases were seen in our study (12.65%), most of which were associated with an avulsion fracture of the intercondylar eminence (49/65, 75.38%). The fracture of posteromedial part, posterolateral part, and intercondylar eminence forms a unique pattern of injury defined as “Posterior Condylar Triad.” (6) Anterior condylar compression fractures (axial, varus, or valgus forces applied while knee overextending). Posterior structural complexes, crucial ligaments, or even popliteal arteries are prone to be damaged. Sixteen cases were identified (3.11%).ConclusionOur classification system has instructive significance in overall preoperative evaluation of fracture features and soft tissue problems as well as guiding clinical management for better functional outcomes.

Assessing the functional and Radiological outcome in surgically treated closed tibial plateau fractures in adults: A case series of 40 cases

Introduction: Knee being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. This study is to analyze the functional outcome of CRIF or ORIF with or without bone grafting in tibial plateau fractures in adults. Materials and Methods: 40 cases of tibial plateau fractures treated by various modalities were studied from 1-8-2013 to 31-8-2015 and followed for a minimum of 6 months. Fractures were evaluated using Modified Rasmussen’s Clinical, Radiological grading system.Results: The selected patients were evaluated thoroughly and after the relevant investigations, were taken for surgery. The fractures were classified as per the SCHATZKER’S types and operated accordingly with CRIF with Percutaneous cannulated cancellous screws, ORIF with buttress plate/LCP with or without bone grafting.Immobilization of fractures continued for 3 weeks by POP slab. Early range of motion was then started. Weight bearing up to 6- 8 weeks was not allowed. The full weight bearing deferred until 12 weeks or complete fracture union. The knee range of motion was excellent to very good, gait and weight bearing after complete union was satisfactory, knee stiffness in 3 cases, wound dehiscence and infection in 1 case and non-union in none of our cases was noted.Conclusion: Functional outcome is better in operatively treated tibial plateau fractures in adults, because it gives excellent anatomical reduction and rigid fixation to restore articular congruity and early motion thereby preventing knee stiffness.

Functional Outcome and Incidence of Osteoarthritis in Operated Tibial Plateau Fractures.

In the challenging tibial condyle fractures despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury. The aim of the study was to know incidence of osteoarthritis in our operated cases of tibial plateau fracture and to evaluate functional outcome. Our operated 60 patients of tibial plateau fractures between 2006 to 2013 were evaluated retrospectively. Pre-operative radiographs were classified using Schatzker classification. Patients were followed up clinically and radiologically and were assessed for functional outcome and development of osteoarthritis. The average duration of follow up was 76.32 months ranging from 42 to 130 months. The average age was 41.28 (20-73) years. According to Schatzker classification type VI accounted for 32.5% and type V for 20 %. Average VAS Score was 1.35 ranging from 0 to 4. According to American knee society scoring system, 47patients had excellent and 8 patients had good knee scores, while 52 patients had excellent, 4 patients had good and 1 patient had poor functional scores. According to Ahlback classification 25 patients had grade I, while 9 patients had grade II, 7 patients had grade III and 3 patients had grade IV osteoarthritis of knee. Incidence of osteoarthritis goes higher with Schatzker's grading. Despite presence of radiological arthritis patients can have good clinical function if the articular reduction and limb alignment are maintained. Treatment goals should include a congruent articular reduction, adequate knee stability, anatomical limb alignment and avoidance of complications. IV.