Complex Tibial Plateau Fractures Research Articles

Comparison of virtual reality and computed tomography in the preoperative planning of complex tibial plateau fractures.

Preoperative planning is a critical step in the success of any complex surgery. The pur-pose of this study is to evaluate the advantage of VR glasses in surgical planning of complex tibial plateau fractures compared to CT planning. Five orthopedic surgeons performed preoperative planning for 30 fractures using either conventional CT slices or VR visualization with a VR headset. Planning was performed in a randomized order with a 3-month interval between planning sessions. A standardized questionnaire assessed planned operative time, planning time, fracture classification and understanding, and surgeons' subjective confidence in surgical planning. The mean planned operative time of 156 (SD 47) minutes was significantly lower (p < 0.001) in the VR group than in the CT group (172min; SD 44). The mean planning time in the VR group was 3.48min (SD 2.4), 17% longer than in the CT group (2.98min, SD 1.9; p = 0.027). Relevant parameters influencing planning time were surgeon experience (-0.61min) and estimated complexity of fracture treatment (+ 0.65min). The use of virtual reality for surgical planning of complex tibial plateau fractures resulted in significantly shorter planned operative time, while planning time was longer compared to CT planning. After VR planning, more surgeons felt (very) well prepared for surgery.

A STUDY OF FUNCTIONAL OUTCOME IN THREE COLUMN FIXATION OF COMPLEX TIBIAL PLATEAU FRACTURES

Introduction: The treatment of complex tibial plateau fractures (TPF), especially those caused by high-energy trauma, remains a challenge in many respects. Tibial plateau fractures are one of the commonest periarticular fractures. These fractures include 1% of all fractures and 8% of fractures in elderly. Motor vehicle accidents account for the majority of these fractures in younger individuals with good bone stock, but in elderly individuals these fractures may result from simple fall due to osteopenic bone. Conservative methods may result in malunion and articular congruity cannot be restored. Surgical treatment can regain articular congruity and restore mechanical alignment, and can allow early range of motion. Open reduction and internal fixation techniques had been associated with wound complications. Aim Of The Study: To evaluate functional outcome in patients of complex tibial plateau fractures treated by three column fixation. Materials and Methods: In our institution 20 patients with displaced tibial plateau fractures with posterior column involvement were selected for the study. This is a prospective study done from AUGUST 2023 to APRIL 2024(9 months).Patients were evaluated with X rays (AP and lateral views) and Computed Tomography (axial, coronal, sagittal with 3D reconstruction views). Fractures classified based on 3 column concept classification. Mean follow up period was 6 months .Functional and radiological outcome was assessed using functional knee score , modified rasmussen score and WOMAC score. Inclusion Criteria: 1. Patients admitted with complex tibial plateau fractures involving medial, lateral and posterior column of tibia. 2. Both sexes 3. Age 20-60 yrs. Exclusion Criteria: 1) Bad skin status of the fractured site. 2) Patients with co morbidities not fit for surgery. 3) Patients with neurovascular deficit. 4) Patients not willing for surgery. Results:In our study, 70% of the patients were in active productive age group (30-50 years). 85% of the patients were male. The fractures were left sided in 75% patients. 85% patients in study sustained injury due to road traffic accident. 80% cases in the study were type 5 schatzker type 5 fractures and all the cases included in the study were 3 column fractures. 8 cases out of 20 cases in the study required epidural analgesia instead of a repeat spinal as the duration of the surgery was longer. Conclusion: To conclude,3 column fixation in high energy displaced tibial plateau fractures with three column fractures resulted in Good clinical and radiological outcomes.

Patient-Reported Outcomes following Tibial Plateau Fractures: Mid- to Short-Term Implications for Knee Function and Activity Level.

Background: Patients with complex proximal tibial plateau fractures (TPFs) tend to overestimate the prognosis of their injury, potentially due to factors such as a limited understanding, optimism, and the influence of the pain intensity. Understanding the reasons behind this misperception is crucial for healthcare providers to effectively communicate with patients and establish realistic expectations for treatment outcomes. The purpose of this study was to analyze the outcomes of TPFs, with a particular focus on patient-reported outcome measures concerning functional recovery, pain levels, and overall satisfaction with treatment. The authors aim to provide valuable insights into the realistic expectations and potential limitations that patients may encounter during their recovery journey. Methods: In this retrospective single-center study, all surgically treated TPFs between January 2014 and December 2019 with a minimum follow-up of 12 months were included. Several patient-reported outcome measures were obtained, including the International Knee documentation Committee Score (IKDC), Lyholm score, Tegner score, and visual analog scale (VAS) for pain. Fractures were classified according to Schatzker, and then subgrouped into simple (Schatzker I-III) and complex (Schatzker IV-VI) fractures. Results: A total of 54 patients (mean age 51.1 ± 11.9 years, 59.3% female) with a mean follow-up time of 3.9 years were included. Schatzker II fractures were present in 48% (n = 26) of the cases, with Schatzker III in 6% (n = 3), Schatzker IV fractures in 6% (n = 3), and Schatker VI fractures in 41% (n = 22) of the cases. All outcome scores showed a significant improvement between the first year after surgery and the last follow-up (mean: 3.9 years). Simple fractures showed significantly lower patient-reported outcomes when compared to the preinjury state; however, good to excellent results were observed. Patient-reported outcomes of complex fractures showed no significant changes in the study period with good to excellent results. When it comes to the Lysholm score, there were no significant differences in the outcome between simple and complex fractures. Furthermore, there was a return-to-sports rate of 100%, with high rates of changing sporting activity in 25% (simple fractures) and 45% in complex fractures. Conclusions: The data from this study showed that both simple and complex tibial plateau fractures show favorable outcomes at the midterm follow-up, and that injury severity does not correlate with worse results. While patients may tend to overestimate the recovery speed, this research highlights the importance of long-term follow-up, demonstrating a substantial improvement between one year post-surgery and the final evaluation. Return-to-sports rates were high, with adjustments needed for certain activities. However, patients should recognize the need to shift to lower-impact sports and the lengthy recovery process.

The prone posteromedial approach to the knee revisited: a safe and effective strategy for posterior tibial plateau fractures.

To compare outcomes of patients with posterior tibial plateau fractures who underwent repair indirectly with an anterior approach to those who underwent direct repair with a prone "Lobenhoffer" operative approach. A total of 44 patients with a posterior column tibial plateau fracture that underwent repair were identified. Twenty-two patients with 22 tibial plateau fractures were fixed using a prone Lobenhoffer approach. They were compared to 22 patients treated with an indirect reduction using a supine approach for similar fracture patterns. Data collection at minimum 1year included: patient-reported outcome scores (SMFA), patient-reported pain, knee range of motion, complications and need for reoperation. Radiographs were reviewed for knee alignment, residual depression and fracture healing. All demographics were similar between the groups except BMI, which was lower in the prone group (P < 0.05). Fracture type according to age, Schatzker and three-column classification was matched between cohorts. There was no difference in outcomes including: pain, radiographic knee alignment, residual articular depression, functional outcome (SMFA), complications and need for reoperations. Knee flexion at 1year was greater in the prone group (127.8 vs. 115.8; P = 0.018). In addition, surgical time was less in the prone group (mean 73.7min vs. 82.3min; P = 0.015). The Lobenhoffer approach with direct reduction of posterior fracture fragments for complex tibial plateau fractures is an excellent option for these injuries. It allowed for faster surgery with improved ultimate knee range of motion in posterior column tibial plateau fractures.

Assessment of Mean American Knee Society Scorefor Complex Plateau Fractures with Llizarov External Fixation

Objective: To determine clinical outcomes based on the AKSS (American Knee Society Score) in patients with complex tibial plateau fractures treated using Ilizarov external fixation. Methodology: This descriptive case series study was conducted at the Department of Orthopaedics, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from November 2020 to November 2021. The study included patients aged 20 to 55 of both genders with Schatzker type V or VI tibial plateau fractures who underwent Ilizarov external fixation and surgery within one week of the injury. Informed consent was obtained from all patients before undergoing Ilizarov external fixation. Pin tract infections were monitored weekly, and radiological assessments were performed monthly. The decision to remove the fixator was based on evidence of bone healing from two different angles, along with a successful stress test after removing the rods between the first two rings. After the fixator was removed, patients wore a removable brace for 3 to 5 weeks to protect their limbs during weight-bearing. Six weeks after external fixation, patients were assessed for pain levels, knee and ankle range of motion, limb alignment, and functional status according to the AKSS. Data were collected and analyzed using SPSS version 20. Results: The mean age of the patients was 32.4±8.7 years. Out of all the patients, 66.5% were male, and 33.5% were female. The AKSS score averaged 82.5±11.2, the mean duration of surgery was 41.5±9.3, and the mean range of motion (ROM) was 22.1±4.8. Clinical outcomes were classified as excellent in 47 (27.2%) patients, good in 57 (32.9%), while 48 (27.8%) and 21 (12.1%) had fair and poor clinical outcomes, respectively. Conclusion: The Ilizarov external fixation technique appears to be a reasonably effective method for treating complex tibial plateau fractures.

Case Report: Standard rehabilitation protocol for complex tibial plateau fracture associated with fibular head fracture managed with plate osteosynthesis

Schatzker fracture belongs to the tibial plateau fracture. This fracture is frequently characterized by excessive trauma, such as a fall from a terrific height or an automobile collision. They are identified by a vertical break in the tibial plateau, which disturbs the joint surface and surrounding tissues. A schatzker type six fracture is a complex fracture that is difficult to manage conservatively and typically requires surgery to reestablish articular realignment and integrity. The purpose of this study is to examine the rehabilitation method and actual outcomes of a 41-year-old male patient who had a tibial plateau fracture as well as a fibular head fracture. This case study shows the need for a comprehensive rehabilitation program in assisting individuals with this specific fracture pattern to achieve their maximum functional potential. The patient undertook a rehabilitation program that comprised several therapy interventions such as range-of-motion training, enhancing power, balance and proprioceptive training, gait re-training, and pain control measures. To assess the patient's progress, objective measurements such as goniometry, muscular strength by manual muscle testing, functional outcome ratings, and patient-reported outcomes were employed. As demonstrated by the case study, a comprehensive treatment approach is required to properly treat tibial plateau fractures in conjunction with fibular head fractures. The patient achieved a considerable and favorable affiliation with the therapy techniques and the outcome measures rating.

Arthroscopic-assisted reduction and internal fixation for complex tibial plateau fracture: radiographic and clinical outcomes with 2- to 15-year follow-up

BackgroundTo investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with mid- to long-term follow-up.MethodsThis retrospective study reviewed complex tibial plateau fractures that underwent ARIF from 1999 to 2019. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), Kellgren–Lawrence classification and Rasmussen radiologic assessment, were measured and evaluated. The prognosis and complications were assessed by the Rasmussen clinical assessment with a minimum follow-up of 2 years.ResultsNinety-two consecutive patients (mean age: 46.9 years) with a mean follow-up of 74.8 months (24–180) were included in our series. Using AO classification, there were 20 type C1 fractures, 21 type C2 fractures, and 51 type C3 fractures. All the fractures achieved solid union. TPA was maintained well on average at the last follow-up and showed no significant difference compared to postoperatively (p = 0.208). In the sagittal plane, the mean PSA increased from 9.3 ± 2.9° to 9.6 ± 3.1° (p = 0.092). A statistically significant increase in PSA was also noted in the C3 group (p = 0.044). Superficial or deep infection was noted in 4 cases (4.3%), and total knee arthroplasty (TKA) was performed in 2 cases (2.2%) due to grade 4 osteoarthritis (OA). Ninety (97.8%) and 89 (96.7%) patients had good or excellent results in the Rasmussen radiologic assessment and Rasmussen clinical assessment, respectively.ConclusionsThe complex tibial plateau fracture could be treated successfully using arthroscopy-assisted reduction and internal fixation. Most patients achieve excellent and good clinical outcomes with low complication rates. In our experience, a higher incidence of increased slope was noted, especially in type C3 fractures. Reduction of the posterior fragment should be done cautiously during the operation.Levels of evidenceLevel III.

AUTOLOGOUS VERSUS SYNTHETIC BONE GRAFTS FOR THE SURGICAL MANAGEMENT OF TIBIAL PLATEAU FRACTURES: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Our objective was to conduct a systematic review and meta-analysis, comparing differences in clinical outcomes between either autologous or synthetic bone grafts in the operative management of tibial plateau fractures: a traumatic pattern of injury, associated with poor long-term functional prognosis.A structured search of MEDLINE, EMBASE, The Bone &amp; Joint and CENTRAL databases from inception until 07/28/2021 was performed. Randomised, controlled, clinical trials that compared autologous and synthetic bone grafts in tibial plateau fractures were included. Preclinical studies, clinical studies in paediatric patients, pathological fractures, fracture non-union or chondral defects were excluded. Outcome data was assessed using the Risk of Bias 2 (ROB2) framework and synthesised in random-effect meta-analysis. Preferred Reported Items for Systematic Review and Meta-Analysis guidance was followed throughout.Six comparable studies involving 352 patients were identified from 3,078 records. Following ROB2 assessment, five studies (337 patients) were eligible for meta-analysis. Within these studies, more complex tibia plateau fracture patterns (Schatzker IV-VI) were predominant. Primary outcomes showed non-significant reductions in articular depression at immediate postoperative (mean difference −0.45mm, p=0.25, 95% confidence interval (95%CI): −1.21-0.31mm, I2=0%) and long-term (&gt;6 months, standard mean difference −0.56, p=0.09, 95%CI: −1.20-0.08, I2=73%) follow-up in synthetic bone grafts. Secondary outcomes included mechanical alignment, limb functionality, defect site pain, occurrence of surgical site infections, secondary surgery, perioperative blood loss, and duration of surgery. Blood loss was lower (90.08ml, p&lt;0.001, 95%CI: 41.49-138.67ml, I2=0%) and surgery was shorter (16.17minutes, p=0.04, 95%CI: 0.39-31.94minutes, I2=63%) in synthetic treatment groups. All other secondary measures were statistically comparable.Our findings supersede previous literature, demonstrating that synthetic bone grafts are non-inferior to autologous bone grafts, despite their perceived disadvantages (e.g. being biologically inert). In conclusion, surgeons should consider synthetic bone grafts when optimising peri-operative patient morbidity, particularly in complex tibial plateau fractures, where this work is most applicable.

Preoperative Mixed-Reality Visualization of Complex Tibial Plateau Fractures and Its Benefit Compared to CT and 3D Printing.

Various studies have shown the benefit of three-dimensional (3D) computed tomography (CT) reconstruction and especially 3D printing in the treatment of tibial plateau fractures (TPFs). This study aimed to investigate whether mixed-reality visualization (MRV) using mixed-reality glasses can provide a benefit for CT and/or 3D printing in planning treatment strategies for complex TPFs. Three complex TPFs were selected for the study and processed for 3D imaging. Subsequently, the fractures were presented to specialists in trauma surgery using CT (including 3D CT reconstruction), MRV (hardware: Microsoft HoloLens 2; software: mediCAD MIXED REALITY) and 3D prints. A standardized questionnaire on fracture morphology and treatment strategy was completed after each imaging session. 23 surgeons from 7 hospitals were interviewed. A total of 69.6% (n = 16) of those had treated at least 50 TPFs. A change in fracture classification according to Schatzker was recorded in 7.1% of the cases and in 78.6% an adjustment of the ten-segment classification was observed after MRV. In addition, the intended patient positioning changed in 16.1% of the cases, the surgical approach in 33.9% and osteosynthesis in 39.3%. A total of 82.1% of the participants rated MRV as beneficial compared to CT regarding fracture morphology and treatment planning. An additional benefit of 3D printing was reported in 57.1% of the cases (five-point Likert scale). Preoperative MRV of complex TPFs leads to improved fracture understanding, better treatment strategies and a higher detection rate of fractures in posterior segments, and it thus has the potential to improve patient care and outcomes.

A Novel Locking Buttress Plate Designed for Simultaneous Medial and Posterolateral Tibial Plateau Fractures: Concept and Comparative Finite Element Analysis.

The complex tibial plateau fractures involving both medial and posterolateral columns are of frequent occurrence in clinics, but the existing fixation system cannot deal with medial and posterolateral fragments simultaneously. Therefore, a novel locking buttress plate named as medial and posterior column plate (MPCP) was designed in this study to fix the simultaneous medial and posterolateral tibial plateau fractures. Meanwhile, the comparative finite element analysis (FEA) was conducted to investigate the discrepancy between MPCP and traditional multiple plates (MP + PLP) in their biomechanical characteristics. Two 3D finite element models of simultaneous medial and posterolateral tibial plateau fracture fixed with MPCP and MP + PLP system, respectively, was constructed. To imitate the axial stress of knee joint in ordinary life, diverse axial forces with 100, 500, 1000, and 1500 N were applied in the two fixation models, and then the equivalent displacement and stress nephograms and values were obtained. The similar trend of displacement and stress increasing with the loads was observed in the two fixation models. However, several heterogeneities of displacement and stress distribution were found in the two fixation models. The max displacement and von Mises stress values of plates, screws, and fragments in the MPCP fixation model were significantly smaller than that in the MP + PLP fixation model, except for the max-shear stress values. As a single locking buttress plate, the MPCP system showed the excellent benefit on improving the stability of the simultaneous medial and posterolateral tibial plateau fractures, compared with the traditional double plate fixation system. However, the excessive shear stress around screw holes should be paid attention to prevent trabecular microfracture and screw loosening.

Posteromedial Buttress Plate for Schatzker 6 Fractures as Double Column Fixation

Objective: Treatment of Schatzker Type 6 fractures is to use a posteromedial buttress plate as part of a double-column fixation technique. Materials &amp; Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. patients with posterior medial fracture of Schatzker type 6 and having associated damage of some soft tissue present within the joint underwent surgery at our institutional operation theatre. In this Study setting we included total 20 patients (14 male [70%] and 6 females [30%]) who came with Bicondylar fractures having Comminuted Posteromedial Fragments of tibia. Results: Of the Patients, 12 (60%) had excellent results, 5(25%) had good results , and 3 (15%) had fair results. In total, 17 patients (85%) achieved cheering results. Walking, Stability, and motion were good or excellent in all cases. Practical Implication: One of the main advantages of the posteromedial buttress plate fixation technique is that it provides support to the medial column of the tibia, which is an important weight-bearing structure in the lower extremity. By restoring the structural integrity of the medial column, the technique can help promote early weight-bearing and facilitate early rehabilitation. All displaced posteromedial tibial plateau fractures should be surgically stabilized and buttressed using plate to restore joint congruity and prevent late subluxation and early arthritis. The aim is to study the role of posteromedial plating in the management of complex tibial plateau fractures with a posteromedial fragment Conclusion: Use of a posteromedial buttress plate as part of a double-column fixation technique can be an effective approach for treating Schatzker Type 6 fractures. Keywords: Fixation of Posterior Column, Buttress plate, Schatzker 6 fracture

Plating versus Ilizarov Technique for Complex Tibial Plateau Fractures: A Comparative Study on Functional Outcome and Patient Satisfaction

Objective To compare clinical and functional outcomes and complications of open reduction internal fixation (ORIF) by plating and Ilizarov technique in complex tibial plateau fractures. Methods This study is a randomized clinical trial accompanying 56 patients having Schatzker type V and VI tibial plateau fractures. We divided patients into two groups for management. Group I; open reduction internal fixation and Group II; ilizarov technique. We conducted study at the orthopedics department, Jinnah Post-Graduate Medical Center, Karachi, from April-2018 to Oct-2020. The endpoint was to assess patients’ satisfaction and clinical and functional outcomes up to an 18-month follow-up. Results The etiology of tibial fracture was mainly road traffic accident (RTA); 17 (70.9%) in ORIF versus 23 (71.8%) in the Ilizarov group. According to clinical outcomes, excellent extension lag was achieved in 100% of patients in both groups. Most patients had excellent knee flexion, thigh atrophy and instability outcomes (54.1% vs 59.37%, 87.5% vs 81.2% and 83.3% vs. 87.5%). The functional outcome assessment was done and recorded for 18 months of follow-up. There was no significant difference in normal walking, stair climbing, squatting, jumping and duck walking between the groups. The overall rate of complications was similar; 11 (45.8%) in ORIF versus 17 (53.12%) in the illizarov group (p=0.78). Conclusion Our study concludes that there is an excellent clinical and functional outcome found in both procedures as both are safe and effective procedures with fewer complications Keywords Complex Tibial Plateau Fractures, ORIF, Ilizarov Technique

Supplementary Posteromedial Plating for the Fixation of Complex Tibial Plateau Fractures: A Prospective Study.

Introduction The management of complex tibial plateau fractures (CTPF) involving the posterior tibial plateau remains challenging and achieving maintenance of an axially stable construct with a single lateral locked plate is uncertain. Dual plating for such fractures via separate incisions can provide better fixation with superior clinical and radiological outcomes. This prospective study aimed to evaluate the results of the management of Schatzker type V and VI complex tibial plateau fractures using a conventional anterolateral plate along with a posteromedial buttress plate via two separate approaches and the potential complications associated with it. Methods Fifty-six patients presenting with tibial plateau fractures to the Department of Orthopaedics at a tertiary care center in the northern part of the state of Uttar Pradesh, India, between January 2018 and July 2022 were screened. Subsequently, 28 patients with CTPFs (AO/OTA types 41C1, 41C2, AND 41C3) were included in the study, managed with dual plating, and followed up for a duration of 12 months. The clinico-radiological outcome was assessed using Rasmussen's Functional Grading System (RFS), Oxford Knee Score (OKS), knee range of motion achieved, and Rasmussen's Radiological Scoring System (RRS), and statistical analysis of the data was performed. Results A total of 24 (85.71%) patients had excellent OKS and good to excellent RFS at the final follow-up. The average knee range of motion was 3.21° to 122°, with only two patients reporting an extensor lag of more than 10°. The final follow-up radiographs showed a mean medial proximal tibial angle (MPTA) of 83.98° ± 6.89 (75.44-89.21) and a mean posterior tibial plateau angle (PTPA) of 12.31 ± 4.69 (5.12 to 16.49) with the RRS showing excellent or good radiographic results with a mean score of 14.1 ± 1.7 (range 8-16). None of the patients showed signs of deep infection, whereas superficial infection was reported in two patients. A single case of secondary loss of particular reduction was seen. Conclusion Supplementary posterior buttress plating, along with the conventional anterolateral plate for the management of CTPF, achieves rigid fixation with superior articular reduction, a high knee score, a good range of motion, lower complication rates, and limited deformities with a good radiological outcome, with a few demerits of prolonged operative time, technically demanding procedure, increased blood loss, and a protracted hospital stay which can be minimized in most instances using minimally open reduction techniques and careful soft-tissue handling.

Consequences of sagittal malalignment following reconstruction of complex tibial plateau fractures

Abstract Purpose Changes of posterior tibial slope following complex tibial plateau fractures have not been fully evaluated in the literature. Some studies indicated that arthritic changes that occur following tibial plateau fracture were more correlated to deformity and instability rather than articular surface step-off. The aim of this study was to evaluate the midterm clinical effects following changes in the posterior slope that might be associated with reconstruction of complex tibial plateau fractures. Patients and methods This retrospective cohort study was carried out on 112 patients operated by internal fixation following complex tibial plateau fracture within 4 weeks of the incident of injury. Modified Rasmussen score was used for both clinical and radiological evaluations in addition to final evaluation of the slope by computed tomography scan. The Knee Injury and Osteoarthritis Outcome Score was used for subjective evaluation of the clinical results, and Kellgren–Lawrence radiological grading was used for osteoarthritis grading. Results The mean flexion was 118.8 ± 13.0° (range, 90–140) in GI and 119.7 ± 13.5° (range, 70–140) in GII, and the mean extension deficit was 1.6 ± 2.7° (range, 0–10) in GI compared with 1.9 ± 2.9° (range, 0–10) in GII. The mean clinical Rasmussen score was 26.3 ± 2.9 (18–30) in GI and 26.1 ± 3.2 (16–30) in GII. The mean Knee Injury and Osteoarthritis Outcome Score in GI was 79.3 ± 5.1 compared with 77.7 ± 5.6 in GII. According to Kellgren–Lawrence grading system for osteoarthritis, there were 23 patients with grades 2 and 3 osteoarthritis in GI compared with 32 cases in GII. The study showed a statistically significant correlation between decreased tibial slope and limitation of extension. Otherwise, there were no statistically significances between changes of tibial slope and stability, pain, or the overall postoperative knee score. Conclusion Changes in posterior slope angle of the tibial plateau during fracture fixation is an important factor that can significantly affect range of motion, particularly extension. Osteoarthritis is higher in patients with disturbed posterior slope; however, a larger sample is needed for possible significance. Level of evidence: therapeutic level IV.

A study on functional outcome of communited tibial plateau fractures treated by modified frosch lobenhoffer approach

Background: When dealing with complex tibial plateau fractures, trauma surgeons face a significant challenge. Good articular reduction preserves congruity by lowering long-term complications. It has the potential to prevent or postpone the onset of post-traumatic osteoarthritis. It is well known that achieving the best possible articular congruity after a tibial plateau (TP) fracture is associated with long-term functional outcomes. Reduction in complex tibial plateau fractures is difficult, especially in the posterior segments of the lateral TP; impaired visualisation of this part of the articular surface through standard surgical approaches is the most important risk factor for mal reduction. Objectives: To study the functional outcome of complex tibial plateau fracture with different surgical approaches for proximal tibial plateau fractures. Design: A prospective study. Study site: At SVRRGG hospital Tirupati. Methods: This is a prospective study carried out in Department of orthopedics, S.V.R.R.G.G. Hospital, Sri Venkateswara Medical College, Tirupati. All patients with tibial plateau fracture which are admitted into hospital were evaluated. Cases satisfying inclusion and exclusion criteria were included into study. tibial plateau fractures were treated surgically by (using Locking Compression Plate, Buttress plates) via modified Frosch, Loben Hoffer approaches at our institution. The patients were evaluated clinically and radiologically for outcomes. Knee society score was used for evaluation at 3, 6 and 12 months respectively. All patients were followed up for an average of 12 months. Observation and Results: Average age of patient in our study was 34.6 years. There were 15 male and 9 female patients. 15 patients had fracture on right side while 9 patients had it on left. There were 20, 4 patients with schatzker type 5 and 6 respectively. We used Frosch approach in 8 patients while remaining had Loben Hoffer approach. Knee Society score was 65, 76 and 89 at 3, 6, and 12 months respectively. Conclusion: We recommend Frosch and Galla Loben-Hoffer approaches for proper reduction, fixation, and better functional outcome of posterior proximal tibial fractures.

Treatment of the patient with bilateral tibial plateau fractures with posterior column involvement (clinical case)

Treating patients with bilateral tibial plateau fractures remains a difficult task, demanding in the majority of cases staged surgical tactics, thorough preop planning, and combination of approaches and implants. At the same time, various options of osteosynthesis are possible. The aim of the study: to demonstrate the preop planning technology and the possibilities of the use of proposed surgical approaches’ modifications and maneuvers to fix posterior tibial plateau. A clinical case is presented of a patient with bilateral tibial high impact fractures with posterior involvement. At admission, external fixing of fractures was performed. Later, after soft tissues’ normalization and preop planning based on computer tomography, consecutive internal osteosynthesis was done. Variations of surgical approaches and maneuvers for fixing the fragments and implants were used, that allowed for stable fixation of fragments after the articular surface fragments’ anatomical reposition. Good anatomical and functional mid-term result was achieved, without any worsening of the fragments’ position in dynamics or implants’ migration.The clinical case demonstrated that the combination of modified anterolateral and posteromedial approaches together with the use of anatomical implants granting subchondral support for articular surface fragments allows to stably fix even complex tibial plateau fractures. Restoration of axial correlations in the limb, preservation of the joint stability on the whole allows to wager on good functional results, even in case of extensive articular surface lesions.

Impacts of Circular Frame Fixator (Ilizarov) on Management of Compound fractures of proximal tibia

Aim: To determine the outcome of patients diagnosed with complex fractures of tibial plateau with associated soft tissue compromise treated by using Ilizarov fixator. Study design: Prospective observational study. Place and period of study: Orthopaedic unit, Chandka Medical College SMBBMU Larkana from January 2021 to December 2021 Methods: Patients diagnosed with complex tibial plateau fracture with associated soft tissue compromise fulfilling inclusion criteria were enrolled in study. All participants were managed with Ilizarov fixator and it was removed when fracture was united clinically and radiologically. Outcome of patients was evaluated on the basis aggregate score of knee society score and knee functional score at 6month follow up. Results: Twenty seven consecutive patients met the inclusion criteria, of which 19(70.37%) were male and 8(29.7%) were female. Average age of patients was 32.37 years. All fractures healed by the end of the 4th month. Ring fixator was removed routinely at 16th weeks after initial surgery in all patients. Transient peroneal nerve injury was found in 2 patients; no patients developed deep vein thrombosis, whereas pin site infection was most common complication and occurred in 5 patients (18.5%). According to knee society score results were excellent in 15(55.55%) patients, good in 08(29.62%) patients, fair in 03(11.11%) in patients and poor in 01(3.70%) patient. Practical implication most of proximal tibial plateau fractures with soft tissue compromise are kept under observation till the soft tissue status become favorable for open reduction and internal fixation, while fixing these type of fracture with Ilizarov fixator one can provide early relief to patients and results of this study will be help for operating surgeons while managing complex proximal tibia fractures. Conclusion: complex tibial plateau fracture can be effectively treated with Ilizarov fixation method without any complication, when exposed reduction and interior fixation with plate is contraindicated due to compromised soft tissue. Keywords: Tibial plateau, fractures, Ilizarov, fixation method, outcome, soft tissue compromise,

Functional outcome of column specific fixation in the management of complex tibial plateau fractures

Introduction: Complex tibial plateau fractures usually have complicated intra-articular fracture pattern, often associated with severe soft tissue injury and high risk of wound complications. Single or dual column plating fixation principle based upon conventional x-ray for such fractures may not address multiplanar comminution that often has posterior shearing or coronal fractures. Computed tomography based evaluation of such fractures and column specific approach allow direct fracture visualization and anatomic reduction that results in satisfactory outcome.&#x0D; Objectives: To assess the clinical and functional outcome and complications of complex tibial plateau fractures fixed with column specific fixation principle.&#x0D; Methodology: This prospective study was carried out from September 2019 to August 2021 in Orthopaedic department of Nobel Medical College, Biratnagar. Consecutive sampling was used among patient with complex tibial plateau fractures meeting the inclusion criteria. Among 30 patients, with closed and Gustilo grade I or II Schatzker type V-VI fractures or AO type-C injuries to the proximal tibia were operated on column specific approach and followed up for clinico-radiological evaluation.&#x0D; Results: In this study, most of the patients belonged to 31-40 years of age group with mean age of 40.47 years. Majority of patients were male( 76.7%). Fracture was highly associated with road traffic accident which accounted for 83%. Fourteen patients underwent anteromedial and anterolateral plating(46.67%), 10 patients underwent anterolateral and posteromedial plating(33.33%) and remaining 6 patients underwent triple column plating(20%). The Rasmussen’s functional score at final follow up was 27.17±2.793(range 21-30). 86.7% patients had acceptable clinical outcome. The mean Rasmussen’s radiological score at final follow up was 8.97±1.217(range 6-10). Thus 93.4% patients had acceptable radiological outcome.&#x0D; Conclusion: Column specific approach addresses all the fracture fragments of complex tibial plateau fractures to achieve acceptable clinical and radiological outcome.

Functional Outcome of Hybrid Illizarov Technique in patients with Complex Tibial Plateau Fractures

Background:Tibial fractures are the most common long bone fracture, with approximately 25% being open. The majority of open tibial fractures result from a high velocity trauma, such as a motorcycle accident, or a low energy, torsional type injury, such as skiing. They are complex fractures to treat because of the lack of soft tissue coverage and blood supply of the tibial shaft. Aim: To determine the functional outcome of hybridillizarov technique in patients with complex tibial plateau fractures Study Design: Descriptive case series. Place of Study: Orthopedics Surgery Department, Jinnah Hospital, Lahore. Duration of Study: Study was carried out over a period of six months from 28-07-2021 to 28-01-2022 Methods: All the 73 patients fulfilling the selection with complex tibial plateau fractures of Schatzker's type V and VI were enrolled. Informed consent and demographic information were recorded. All the patients were evaluated for injuries, haemodynamically stabilized. Bone grafting and minimal internal fixation with cc screws was done in severely comminuted fractures. The functional results were measured by Rasmussen’s knee functional score (as per operational definition). Results: Distribution of the functional outcome of the patients was done, it showed that out of 73 patients 20(27.4%) were in excellent outcome, 41(56.2%) were in good outcome, 7(9.6%) were in fair outcome, 5(6.8%) were in poor. Conclusion: Based on our results, the use of hybrid illizarov fixation for the treatment of complex tibial plateau fractures is safe and effective in terms of low rates of complication and good functional results. Keywords: Functional outcome, Tibia plateau fracture, Hybrid ilizarov.

Short-term effectiveness of staged management in treatment of complex tibial plateau fracture with severe soft tissue injury

To evaluate short-term effectiveness of staged management for complex tibial plateau fracture with severe soft tissue injury. A clinical data of 12 patients with complex tibial plateau fractures and severe soft tissue injuries between July 2017 and March 2021 and met the selection criteria was retrospectively analyzed. There were 7 males and 5 females with an average age of 43.1 years (range, 33-58 years). All patients were traffic accident injuries and admitted to hospital within 24 hours after injury. The tibial plateau fractures were closed fractures. According to the Schatzker classification standard, the fractures were rated as type Ⅳ in 3 cases, type Ⅴ in 4 cases, and type Ⅵ in 5 cases. According to the Tscherne classification standard, the soft tissue injuries were rated as grade Ⅱ in 4 cases and grade Ⅲ in 8 cases. The treatment of all patients was divided into 3 stages. In the first stage, emergency trans-articular fracture fixation with external fixator was performed; in the second stage, the fracture reduction and internal fixation were performed and bone cement was implanted to fill the bone defect; in the third stage, the bone cement was removed and the bone graft was performed to repair defect. All patients performed joint function exercise after operation as early as possible. There was no neurological symptom after all staged managements, the incisions healed by first intention, and no complications such as incision infection or necrosis occurred. All patients were followed up 6-32 months (mean, 16.9 months). The fractures were all anatomical reduction confirmed by the X-ray films after operation. During follow-up, there was no obvious loss of reduction, loosening and rupture of internal fixator, or collapse of the articular surface. All fractures healed after 14-20 weeks (mean, 17.6 weeks). The posterior slope angle of the tibial plateau was (9.7±2.3)° and the varus angle was (3.9±1.9)° immediately after bone grafting, and were (8.5±2.9)° and (4.3±1.9)° respectively at 6 months after operation. There was no significant difference between the two time points ( t=0.658, P=0.514; t=-1.167, P=0.103). At last follow-up, the Hospital for Special Surgery (HSS) score was 85-96 (mean, 91.2), and the range of motion of knee was 110°-135° (mean, 120.9°). The staged management for complex tibial plateau fracture with severe soft tissue injury can obtain good short-term effectiveness, but the long-term effectiveness needs to be further followed up.