Fixation Of Tibial Plateau Fractures Research Articles

Subchondral rafting wires reduce tibial plateau fracture subsidence.

To determine if subchondral rafting wires retained as adjunctive tibial plateau fracture fixation affect postoperative articular subsidence. A retrospective cohort study was conducted at one Level 1 trauma center and one academic university hospital. Consecutive adults with closed, displaced OTA/AO 41B/C tibial plateau fractures treated between 2018 and 2023 with open reduction internal fixation were included. Patients who were not ambulatory, with contralateral injuries limiting weight bearing, and without follow-up radiographs of the injured extremity were excluded.The intervention was retention of subchondral rafting wires as definitive fixation. The primary outcome was linear articular surface subsidence between postoperative and follow-up AP knee radiographs. Linear subsidence was compared between groups using Welch's two sample t test. Associations of linear subsidence with patient, injury, and treatment characteristics were assessed by multivariable linear regression. We identified 179 patients of a mean age of 44 ± 14years, of whom 15 (8.4%) received subchondral rafting wires. Median follow-up was 121days. No patients who received rafting wires as definitive implants experienced linear subsidence ≥ 2mm, while 22 patients (13.4%) who did not receive rafting wires experienced linear subsidence ≥ 2mm (p = 0.130). Subchondral rafting wires were associated with less linear subsidence (0.3mm [95% confidence interval - 0.3-0.9mm] vsersus 1.0mm [- 0.9-2.9mm], p < 0.001). The depth of linear subsidence was significantly associated on multivariable regression with male sex, depressed plateau area, active smoking, and retained rafting wires. Subchondral rafting wires were associated with a small reduction in articular subsidence after internal fixation of tibial plateau fractures. Routine rafting wires may be useful for patients and fractures at high risk of articular subsidence.

Early Versus Delayed Definitive Fixation Relative to Fasciotomy Closure in High-Energy Tibial Plateau Fractures With Compartment Syndrome.

To evaluate the timing of definitive fixation of tibial plateau fractures relative to fasciotomy closure with regard to alignment and articular reduction. Retrospective case series. Four Level I trauma centers. Patients with tibial plateau fractures (TPF) with ipsilateral compartment syndrome treated with fasciotomy between 2006 and 2018 met inclusion criteria. Open fractures, patients younger than 18 years, patients with missed or delayed treatment of compartment syndrome, patients with a diagnosis of compartment syndrome after surgical fixation, and patients whose plateau fracture was not treated with open reduction and internal fixation were excluded. Patients were divided into 2 groups depending on the relative timing of fixation to fasciotomy closure: early fixation (EF) was defined as fixation before or at the time of fasciotomy closure, and delayed fixation (DF) was defined as fixation after fasciotomy closure. Radiographic limb alignment (categorized as anatomic alignment (no varus/valgus), ≤5 degrees varus/valgus, or >5 degrees varus/valgus) and articular reduction (categorized as anatomic alignment with no residual gap or step-off, <2 mm, 2-5 mm, and >5 mm of articular surface step-off) were compared between early and delayed fixation groups. In addition, superficial and deep infection rates were compared between those in the EF and DF cohorts. Subgroup analysis within the EF cohort was performed to compare baseline characteristics and outcomes between those that received fixation before closure and those that underwent concurrent fixation and closure within one operative episode. A total of 131 patients met inclusion criteria for this study. Sixty-four patients (48.9%) were stratified into the delayed fixation group, and 67 patients (51.1%) were stratified into the early fixation group. In the EF cohort, 57 (85.1%) were male patients with an average age of 45.3 ± 13.6 years and an average body mass index of 31.0 ± 5.9. The DF cohort comprised primarily male patients (44, 68.8%), with an average age of 46.6 ± 13.9 years and an average body mass index of 28.4 ± 7.9. Fracture pattern distribution did not differ significantly between the early and delayed fixation cohorts ( P = 0.754 for Schatzker classification and P = 0.569 for OTA/AO classification). The relative risk of infection for the DF cohort was 2.17 (95% confidence interval, 1.04-4.54) compared with the EF cohort. Patients in the early fixation cohort were significantly more likely to have anatomic articular reduction compared with their delayed fixation counterparts (37.5% vs. 52.2%; P < 0.001). This study demonstrated higher rates of anatomic articular reduction in patients who underwent fixation of tibial plateau fractures before or at the time of fasciotomy closure for acute compartment syndrome compared with their counterparts who underwent definitive fixation for tibial plateau fracture after fasciotomy closure. The relative risk of overall infection for those who underwent fasciotomy closure after definitive fixation for tibial plateau fracture was 2.17 compared with the cohort that underwent closure before or concomitantly with definitive fixation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Application of a combined cancellous lag screw enhances the stability of locking plate fixation of osteoporotic lateral tibial plateau fracture by providing interfragmentary compression force

BackgroundInsufficient interfragmentary compression force (IFCF) frequently leads to unstable fixation of osteoporotic lateral tibial plateau fractures (OLTPFs). A combined cancellous lag screw (CCLS) enhances IFCF; however, its effect on OLTPF fixation stability remains unclear. Therefore, we investigated the effect of CCLS on OLTPF stability using locking plate fixation (LPF).Materials and methodsTwelve synthetic osteoporotic tibial bones were used to simulate OLTPFs, which were fixed using LPF, LPF-AO cancellous lag screws (LPF-AOCLS), and LPF-CCLS. Subsequently, 10,000 cyclic loadings from 30 to 400 N were performed. The initial axial stiffness (IAS), maximal axial micromotion of the lateral fragment (MAM-LF) measured every 1000 cycles, and failure load after 10,000 cycles were tested. The same three fixations for OLTPF were simulated using finite element analysis (FEA). IFCFs of 0, 225, and 300 N were applied to the LPF, LPF-AOCLS, and LPF-CCLS, respectively, with a 1000-N axial compressive force. The MAM-LF, peak von Mises stress (VMS), peak equivalent elastic strain of the lateral fragment (EES-LF), and nodes of EES-LF > 2% (considered bone destruction) were calculated.ResultsBiomechanical tests revealed the LPF-AOCLS and LPF-CCLS groups to be superior to the LPF group in terms of the IAS, MAM-LF, and failure load (all p < 0.05). FEA revealed that the MAM-LF, peak VMS, peak EES-LF, and nodes with EES-LF > 2% in the LPF were higher than those in the LPF-AOCLS and LPF-CCLS.ConclusionIFCF was shown to enhance the stability of OLTPFs using LPF. Considering overscrewing, CCLS is preferably recommended, although there were no significant differences between CCLS and AOCLS.

Meniscus Tear Requiring Intraoperative Repair Does Not Influence Midterm Patient-Reported Outcomes in Operatively Treated Tibial Plateau Fractures.

Evaluate whether intraoperatively repaired lateral meniscus injuries impact midterm patient-reported outcomes in those undergoing operative fixation of tibial plateau fracture. Retrospective cohort study. Level I trauma center. All patients (n = 207) who underwent operative fixation of a tibial plateau fracture from 2016 to 2021 with a minimum of 10-month follow-up. The Patient-Reported Outcomes Measurement Information System Physical Function, Knee Injury and Osteoarthritis Outcome Score, and the PROMIS-Preference health utility score. Overall, 207 patients were included with average follow-up of 2.9 years. Seventy-three patients (35%) underwent intraoperative lateral meniscus repair. Gender, age, body mass index, Charlson comorbidity index, days to surgery, ligamentous knee injury, open fracture, vascular injury, polytraumatic injuries, Schatzker classification, and Orthopaedic Trauma Association classification were not associated with meniscal repair ( P > 0.05). Rates of reoperation (42% vs. 31%, P = 0.11), infection (8% vs. 10%, P = 0.60), return to work (78% vs. 75%, P = 0.73), and subsequent total knee arthroplasty (8% vs. 5%, P = 0.39) were also similar between those who had a meniscal repair and those without a meniscal injury, respectively. There was no difference in Patient-Reported Outcomes Measurement Information System Physical Function (46.3 vs. 45.8, P = 0.707), PROMIS-Preference (0.51 vs. 0.50, P = 0.729), and all Knee Injury and Osteoarthritis Outcome Score domain scores at the final follow-up between those who had a meniscal repair and those without a meniscal injury, respectively. In patients with an operatively treated tibial plateau fracture, the presence of a concomitant intraoperatively identified and repaired lateral meniscal tear results in similar midterm PROMs and complication rates when compared with patients without meniscal injury. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Research progress on biomechanics for internal fixation in tibial plateau fracture

To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic. The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed. Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient's condition is still a major difficulty in the surgical treatment of tibial plateau fractures. Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.

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.

Suprapatellar intramedullary nail combined with screw fixation has comparable surgical outcomes to minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures.

To compare union rate, union time, alignment, and complication rate in ipsilateral tibia plateau and shaft fractures treated via suprapatellar intramedullary nailing with screw fixation and minimally invasive locking plate fixation. A retrospective study was conducted on 48 patients who underwent minimally invasive plate fixation (n = 35) or suprapatellar intramedullary nailing with screw fixation (n = 13), for the treatment of ipsilateral tibial plateau and shaft fractures with at least 1-year follow-up. Union rate, union time, radiologic alignment, and complication rate such as malalignment, nonunion, and fracture-related infection (FRI) were investigated. Demographic data were not different between the two groups. Coronal plane alignment was 0.17 ± 4.23 in the plate group and -0.48 ± 4.17 in the intramedullary nail group (p = 0.637). Sagittal plane alignment was -0.13 ± 5.20 in the plate group and -1.50 ± 4.01 in the suprapatellar intramedullary nail group (p = 0.313). Coronal and sagittal malalignment recorded equal results: (p > 0.99), FRI (p = 0.602), nonunion and union times recorded (p = 0.656) and (p = 0.683, 0.829), respectively, and showed no significant difference between the two groups. Suprapatellar intramedullary nailing with screw fixation had similar surgical outcomes with minimally invasive locking plate fixation in ipsilateral tibial plateau and shaft fractures in terms of union rate, union time, alignment, and complication rate. Thus, frequent use of intramedullary nailing combined with screw fixation is anticipated in patients with ipsilateral tibial plateau and shaft fractures when the soft tissue condition is not desirable. Level III.

Translated article] Risk factors for infection of tibial plateau fractures

IntroductionTibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPFs) and to identify the risk factors for this. Material and methodsRetrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. ResultsOne hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (p=.002), Schatzker V and VI type fractures (p=.002) and the use of external fixation (p<.001). Regarding the surgical variables, only the longest ischemia time (p=.032) was identified as a risk factor. Staphylococcus aureus was the most frequently identified microorganism (43%), followed by Enterobacter cloacae (35.7%). ConclusionThe overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

Incisional negative pressure wound therapy may not protect against post-operative surgical site complications in bicondylar tibial plateau fractures.

To determine if incisional negative pressure wound therapy is protective against post-operative surgical site complications following definitive fixation of bicondylar tibial plateau fractures. A retrospective analysis of patients diagnosed with an acute bicondylar tibial plateau fracture (AO/OTA 41-C) undergoing ORIF from 2010 to 2020 was performed. Patients received either a standard sterile dressing (SD) or incisional negative pressure wound therapy (iNPWT). Primary outcomes included surgical site infection, osteomyelitis, and wound dehiscence. Secondary outcomes included non-union and return to the operating room. Multivariate logistic regression analyses were performed. 180 patients were included and 22% received iNPWT (n = 40) and 78% received standard dressings (n = 140). iNPWT was more common in active smokers (24.7% vs. 19.3%, p = 0.002) and the SD group was more likely to be lost to follow up (3.6% vs. 0%, p = 0.025). iNPWT was not protective against infection or surgical site complications, and in fact, was associated with higher odds of post-operative infection (OR: 8.96, p = 0.005) and surgical site complications (OR:4.874, p = 0.009) overall. Alcohol abuse (OR: 19, p = 0.005), tobacco use (OR: 4.67, p = 0.009), and time to definitive surgery (OR = 1.21, p = 0.033) were all independent risk factors for post-operative infection. In this series of operatively treated bicondylar tibial plateau fractures, iNPWT did not protect against post-operative surgical site complications compared to conventional dressings. Tobacco use, alcohol abuse, and time to definitive surgery, were independent risk factors for post-operative infection. Further studies are needed to determine if iNPWT offers a protective benefit in exclusively high-risk patients with relevant medical and social history.

Risk factors for surgical site infections following open reduction and internal fixation in patients with tibial plateau fractures.

This retrospective cohort study aimed to identify the risk factors associated with postoperative wound infections in patients undergoing open reduction and internal fixation for tibial plateau fractures. The study was conducted between January 2019 and December 2022, with stringent inclusion and exclusion criteria. Data were collected from the Electronic Health Record system, including demographic information, lifestyle habits, comorbid conditions and surgical variables like preoperative American Society of Anesthesiologists (ASA) scores. The IBM Statistical Package for the Social Sciences, version 27.0, was utilized for rigorous statistical analyses. Univariate analysis identified several factors, such as body mass index (BMI), smoking status and diabetes mellitus, as significant predictors of postoperative wound infection. Multivariate logistic regression revealed that BMI, type of fracture (open vs. closed), surgery duration exceeding 150 min, preoperative albumin levels below 35 g/L and preoperative ASA score of 3 or higher were significant independent risk factors (p < 0.05). Patients with open fractures, preoperative malnutrition, elevated preoperative ASA scores and a history of smoking are at a heightened risk of developing postoperative wound infections. Timely preoperative evaluation of these risk factors is crucial for minimizing the risk of surgical site infections and optimizing clinical management.

Circular frame fixation of complex tibial plateau fractures in the elderly: Functional and radiological outcomes for Schatzker V and VI type fractures

Tibial plateau fracture fixation in the elderly poses a unique challenge due to poor bone stock, comminution and co-morbidities. There is limited evidence available in older patients sustaining multiple column Schatzker type V and VI injuries. In our institutions these injuries have traditionally been managed with circular frame fixation, often augmented with cross knee frame extension, internal screw fixation +/- bone graft substitutes. This study has reviewed the over 60-year-old cohort to better understand this complex injury. MethodsElectronic fracture databases were queried for ‘tibial plateau fracture’ and ‘Ilizarov frame’ between July 2009 and 2019. Inclusion criteria; age >60 years; CT identified multiple column (Schatzker V or VI) injuries; Ilizarov fixation; adequate follow-up data. Patient demographics, fixation technique, time to frame removal, residual radiological tibial deformity, joint incongruity, significant peri‑operative complications and progression to salvage TKA were reported. Results35 patients >60 years were treated with Ilizarov frame techniques for multiple column injuries. 84 % were female. Average age was 68 (62–81) with a follow-up of 6.6 years (2.3–11.3). 33 of the 35 patients investigated for osteoporosis had evidence of decreased bone mass (94 %). 94 % were Schatzker VI injuries. 22 cases required cross knee extension with a frame duration 155 days (range 103–317). Those without had a frame duration 128 days (range 93–212). 20 cases had a combined internal/external fixation technique and 9 cases required allograft or bone substitute. There was one case of non-union requiring salvage to constrained TKA. Three cases (9 %) of metalwork removal, two for prominent metalwork and one for deep infection. There were no VTE events and there was 0 % mortality in the two post-operative years. Oxford knee scores and SF-12 scores demonstrate that minimal residual deformities in the coronal and sagittal planes following frame removal are tolerated well within this age group. This study demonstrates Ilizarov techniques are highly successful at permitting early weight bearing and achieving union with associated low morbidity rates in an older population.

Fragment Specific Fixation for Tibial Plateau Fractures with particular reference to arthroscopic assisted surgery.

Fragment Specific Fixation for Tibial Plateau Fractures with particular reference to arthroscopic assisted surgery.

Does pes anserinus tenotomy affect surgical site infection rate in operative tibial plateau fractures?

To assess if pes anserinus tenotomy (PAT) during definitive open reduction and internal fixation (ORIF) of tibial plateau fractures is associated with a decreased risk of surgical site infection (SSI) and other postoperative complications. A retrospective review of all adults who underwent ORIF for tibial plateau fractures from April 2005 to February 2022 at single level 1 trauma center was performed. Patients who had a medial approach to the plateau with minimum three-month follow-up were required for inclusion. All patients with fasciotomy for compartment syndrome or with traumatically avulsed or damaged pes anserinus prior to ORIF were excluded. Two groups were created: those who received a pes anserinus tenotomy with repair (PAT group) and those whose pes anserinus were spared and left intact (control group). Patient demographics, injury and operative characteristics, and surgical outcomes were compared. The primary outcomes were rates of deep and superficial SSI. The PAT group had significantly lower rates of deep SSI (9.2% vs. 19.7%, P = 0.009), superficial SSI (14.2% vs. 26.5%), P = 0.007), and any SSI (15.8% vs. 28.9%, P = 0.005). Multiple logistic regression showed that heart failure (aOR = 7.215, 95% CI 2.291-22.719, P < 0.001), and presence of open fracture (aOR = 4.046, 95% CI 2.074-7.895, P < 0.001) were independently associated with increased odds of deep SSI, while PAT was associated with a decreased odds of deep SSI (aOR = 0.481, 95% CI 0.231-0.992, P = 0.048). PAT had significantly lower rates of unplanned return to the operating room (20.8% vs. 33.7%, P = 0.010) and implant removal (10.0% vs. 18.0%, P = 0.042). While these data do not allow for discussion of functional recovery or strength, pes anserinus tenotomy was independently associated with significantly lower rates of infection, unplanned operation, and implant removal. Level III.

747 Ten Year Outcomes After Surgical Fixation of Tibial Plateau Fractures

Abstract Aim This study represents one of the largest clinical case series' evaluating long-term outcomes following surgical fixation of tibial plateau fractures over a 10-year follow-up. The primary aim is to evaluate the incidence of TKR and risk-factors associated with poor outcomes. Method Patients receiving surgical fixation of tibial plateau fractures between 2008 – 2012 were included. Those requiring arthroplasty or endoprosthesis post-injury were excluded. PACs was used to analyse case notes and radiographic imaging. Articular reduction and alignment (mPTA) were measured using pre-operative radiographs. Comparisons were made with radiographs post-fracture union (6-weeks to 6-months), assessing fracture reduction maintenance. Long-term outcomes were assessed for patients receiving imaging thereafter. Patients were checked using the Scottish National Imaging Archive. Results 130 patients presented various fractures (Schatzker I-III n = 78, IV n = 12, V n = 9, VI n = 29) and 2 open-fractures. 32 patients required further surgery, 13 required multiple operations - resulting in 47 operations. These included metalwork removal (n = 28, 21.5%), TKR (n = 12, 9.2%), washout for infection (n = 3, 2.3%), osteotomy (n = 2, 1.5%), sequestrectomy (n = 1, 0.8%), and above knee amputation (n = 1, 0.8%). ≥ 2mm articular reduction was maintained in the majority (84%); however, good articular reduction did not prevent progression to arthroplasty (average step 1.4mm in TKR versus 1.8mm in non-TKR). Good alignment correlated with favourable outcomes - average mPTA being 90.8° in non-TKR versus 93.5° in TKR. Conclusions These findings support previous literature in this field demonstrating that malalignment, rather than articular depression, increases the risk for post-traumatic arthritis requiring arthroplasty. The incidence of TKR after tibial plateau fracture fixation at 10-years was 9.2%.

Early versus Standard Weight Bearing Following Operative Treatment of Tibial Plateau Fractures: Do We Really Have to Wait So Long?

Postoperative management of tibial plateau fractures classically involves a prolonged period between 10 and 12 weeks of nonweight bearing or partial weight bearing. In recent years, there has been some support for earlier weight-bearing protocols although this remains controversial. The goal of this study was to investigate the difference in outcomes between early weight-bearing (EWB) and traditional weight-bearing (TWB) protocols. This investigation is a retrospective review of 92 patients treated with open reduction and internal fixation of tibial plateau fractures at a single institution, from August 2018 to September 2020. Subjects were divided into EWB (< 10 weeks) and traditional nonweight bearing groups (≥ 10 weeks). Key outcome measures collected include injury classification, mechanism of injury, surgical fixation method, bone grafting, time to full weight bearing, radiographic time to union, range-of-motion, all-cause complications, and subsidence at an average follow-up time of 1 year. The EWB group had an earlier average time to weight bearing versus the TWB group (6.5 ± 1.4 vs. 11.8 ± 2.3 weeks, p < 0.0001). There was no difference in the classification of fractures treated between the two groups, with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association B3 fractures the most common in the EWB group, and C3 fractures the most common in the TWB group. Radiographic time to union was no different between the two groups (93.5 ± 53.7 days for EWB vs. 103.7 ± 77.6 days for TWB, p = 0.49). There was no significant difference in complication rates or subsidence. Following operative treatment of tibial plateau fractures, patients who underwent a weight-bearing protocol earlier than 10 weeks were able to recover faster with similar outcomes and complications compared with patients who started weight bearing after 10 weeks or more. LEVEL OF EVIDENCE: III.

Determination of Posterior Tibial Slope Changes After Tibial Plateau Fracture Fixation: A Retrospective Case Series.

A tibial plateau fracture is an intra-articular fracture that affects the function and stability of the knee joint and requires careful evaluation and pre-operative planning. We determined the posterior tibial slope changes after tibial plateau fracture stabilization, aiming to help improve surgical success in maintaining the lower limb's natural axis. This retrospective case series involved all Golestan and Imam Khomeini hospital patients (Ahvaz, Iran) with Schatzker type IV-VI tibial plateau fractures from April 1, 2017, to March 30, 2020, who underwent surgical fixation. Data on the age, gender, body mass index (BMI), surgical approach, posterior tibial slope angle in the injured and healthy knees, pain, and knee joint instability were collected. We analyzed the data using SPSS version 22 and considered a significance level of P < 0.05. Among the 31 study participants, 24 (77.4%) were males. The mean age of the patients was 39.81 ± 14.41 years (21-78), with a mean BMI of 25.4 ± 2.7 (20.3-31.2) kg/m2 and hospitalization duration of 5.8 ± 9.3 days (3-29). Most patients had type VI fractures (48.3%). The posterior tibial slope angle shared no relation with age, gender, BMI, or surgical approach (P > 0.05). After tibial plateau fracture fixation, the posterior tibial slope angle significantly increased in the injured knee compared with the healthy knee (P < 0.05). Six months after the operation, the angle of the injured knee decreased but remained higher than that of the healthy knee (P > 0.05). The tibial slope's posterior column collapses more than its anterior column over time, reducing the posterior tibial slope angle. Therefore, the correct reduction of the tibial plateau's posterior slope is more important.

Factores de riesgo de infección de fracturas de meseta tibial

IntroductionTibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. Material and methodsRetrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. ResultsOne hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). ConclusionThe overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

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.

The Use of Vancomycin Powder in Tibial Plateau Fractures at Lower Risk of Infection.

To determine the effectiveness of vancomycin powder in preventing infection after plate and screw fixation of tibial plateau fractures considered at low risk of infection. Retrospective cohort study. Single, Level I trauma center. The study included 459 patients with tibial plateau fractures (OTA/AO 41-B/C) who underwent open reduction and internal fixation from 2006-2018, and were considered at low risk of infection based on not meeting the "high risk" definition of the VANCO trial. Vancomycin powder administration upon wound closure at time of definitive fixation. Deep surgical site infection with at least 1 gram-positive bacteria culture. Vancomycin powder administration was associated with reduction in gram-positive infection from 4% to 0% (OR, 0.12; 95% CI, 0.04-0.32; P < 0.01). No significant effect was reported in gram-negative only infections, which were observed in 0.3% in the control group, compared with 0.9% in the intervention group (OR, 2.71; 95% CI, 0.11-69; P = 0.54). Methicillin-resistant Staphylococcus aureus was the most common organism isolated in the control group, growing in 9 of 18 infections (50%). Among patients with low-risk tibial plateau fractures, vancomycin powder at time of definitive fixation showed a reduction in the incidence of gram-positive deep surgical site infection. The observed relative effect was relatively larger than that observed in a previous randomized trial on high-risk fractures. These data might support broadening the indication for use of vancomycin powder to include tibial plateau fractures at low risk of infection. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effects of sodium hyaluronate administration on levels of antioxidant enzymes, serum substance P and neuropeptide Y in patients undergoing locking plate fixation for tibial plateau fractures.

To analyze the effects of sodium hyaluronate administration on the serum levels of antioxidase, substance P (SP), and neuropeptide Y (NPY) in patients undergoing locking plate fixation (LPF) for tibial plateau fractures (TPF). We retrospectively analyzed the records of 66 patients with TPF who received treatment in the Beijing Chao-yang Hospital[PJMS1][2] from February 2017 to August 2020. According to the treatment records, 33 patients underwent LPF surgery (control-group), and 33 patients underwent LPF plus sodium hyaluronate treatment (observation-group). The levels of antioxidant enzymes (superoxide dismutase (SOD), catalase (CAT) and total antioxidant capacity (TAC)), SP and NPY. Seven days after LPF operations, both groups showed lower levels of SOD, CAT, and TAC compared to pre-surgery levels, while levels of SP and NPY were higher. However, the observation group showed higher levels of SOD, CAT, and TAC compared to the control group, and lower levels of SP and NPY in the control group (P<0.05). The treatment of TPF with LPF plus sodium hyaluronate administration has been shown to effectively reduce oxidative stress reactions, improve SP and NPY levels.[PJMS3][4].