Fixation Of Tibial Plateau Fractures Research Articles

Arthroscopic Assisted Reduction and Internal Fixation of Tibial Plateau Fractures by Viewing and Instrumentation Access Through Coexisting Meniscus Tear: Case Series.

The online version contains supplementary material available at 10.1007/s43465-022-00703-7.

Cost Variation in Temporizing External Fixation of Tibial Plateau and Pilon Fractures: Is There Room to Improve?

IntroductionExternal fixator costs have been shown to be highly variable. Current information on external fixator costs and cost drivers is limited. The aim of this study was to examine the cost variation as well as the patient-, injury-, and surgeon-related cost drivers associated with temporizing external fixation constructs in tibial plateau and pilon fracture management. Materials and MethodsA retrospective review was conducted to identify isolated tibial plateau and pilon fractures treated with temporizing external fixation from 2006-2018 at a level 1 trauma center. Inclusion criteria were based on fractures managed with primary external fixation, skeletal maturity, and isolated ipsilateral fracture fixation. Fracture patterns were identified radiographically using Schatzker, Weber, and OTA classification systems. Implant costs were determined using direct purchase price from the institution. The primary outcome was the external fixator total construct cost. Clinical covariates and secondary outcomes, namely unplanned reoperations, were extracted. Factors associated with cost (i.e. cost drivers) were identified via multivariable regression analysis. ResultsA total of 319 patients were included in this study (121 tibial plateau and 198 pilon fractures). Mean plateau construct cost was $5,372.12 and mean pilon construct cost was $3,938.97. Implant cost correlated poorly with demographic (r2=0.01 & r2=0.01), injury-independent (r2<0.01 & r2=0.03), and fracture pattern classifications (r2=0.03 & r2=0.02). Traumatologists produced significantly cheaper implants for pilon fractures (p=0.05) but not for plateau fractures (p=0.85). There was no difference in construct cost or components between patients that underwent unplanned reoperation and those that did not for both tibial plateau (p>0.19) and pilon (p>0.06). Clamps contributed to 69.9% and 77.3% of construct costs for tibial plateau and pilon, respectively. The most cost-efficient fixation constructs for tibial plateau and pilon fractures were the following respectively: of 5 clamps, 2 bars, and 4 pins; and of 4 clamps, 2 bars, and 3 pins. ConclusionsThere is large cost variation in temporizing external fixation management. Cost drivers included surgeon bias and implant preference as well as use of external fixator clamps. Introducing construct standardization will contain healthcare spending without sacrificing patient outcomes. LEVEL OF EVIDENCELevel III. Retrospective Cohort

Conversion Total Knee Arthroplasty After Tibial Plateau Fixation Is Associated With Lower Reimbursement, Greater Complication Rates, and Similar Opioid Use.

ObjectiveTotal knee replacement after previous open reduction and internal fixation for tibial plateau fracture (conversion total knee) increases the complexity of the procedure and the complication rate. However, very little research exists to report on opioid use and cost associated with total knee arthroplasty (TKA) following tibial plateau fracture fixation as compared to primary TKA patients with no history of tibial plateau fracture. The aim of this study is to compare the differences in opioid use, reimbursements, and complication rates between patients with and without a history of tibial plateau fracture undergoing TKA.Methods and materialsThis is a retrospective large database review study. The study included patients across the country and in various clinical settings including, but not limited to, institutions, primary and tertiary care centers, and private practice. The PearlDiver database was reviewed for patients undergoing TKA between 2010 and 2019. Patients who underwent TKA following surgical repair of a tibial plateau fracture were identified using Common Procedural Terminology (CPT) codes and the appropriate International Classification of Diseases Ninth and Tenth Revision (ICD-9, ICD-10) codes. This group was then matched by age, gender, Charleston Comorbidity Index (CCI) score, Elixhauser Comorbidity Index (ECI) score, obesity, tobacco use, and diabetes to a group of similar patients who underwent TKA with no history of tibial plateau fracture. Opioid use over the episode of care, evaluated by morphine milligram equivalents (MME), and 30-day reimbursed cost were compared between groups using an unequal variance t-test. Complication rates at 30 days, 90 days, and one year postoperatively, and revision rates at one and two years postoperatively were compared using the odd’s ratio (OR) with 95% confidence intervals (95%CI).ResultsThe episode of care cost for TKA was significantly lower for patients with a history of tibial plateau fracture ($11,615 ± $15,704) than it was for patients without a history of tibial plateau fracture ($16,088 ± $18,573) (p = 3.56E-14). At 30 days after knee arthroplasty, patients with a history of tibial plateau fracture had significantly more episodes of dehiscence (OR 2.665 [95% CI 1.327-5.351]; p = 0.006) and surgical site infection (SSI) (OR 1.698 [95% CI 1.058-2.724]; p = 0.028), which was significant at 90 days postop for both dehiscence (OR 1.358 [95% CI 0.723-2.551]; p = 0.001) and SSI (OR 1.634 [95% CI 1.100-1.802]; p = 0.015), as well as mechanical complications of the implant device (OR 2.420 [95% CI 1.154-5.076]; p = 0.019). There was no significant difference in the number of opioids prescribed postoperatively to patients with a history of tibial plateau fracture (2218 ± 3255 MME) compared to those without prior tibial plateau fracture (2400 ± 4843 MME) (p = 0.258). However, there was a small but statistically significant increase in the number of days postoperatively patients with a history of tibial plateau fracture were prescribed opioids (11.99 ± 7.73 days) compared to non-tibial plateau fracture patients (11.15 ± 7.18 days) (p = 0.004).ConclusionPatients with a history of tibial plateau fracture who then underwent conversion TKA have a lower reimbursed cost of TKA but a higher postoperative risk for dehiscence, mechanical complications, and surgical site infections. There is no significant difference in postoperative opioid use between the two groups.

Two-level fixation with headless compression screws for tibial plateau fractures

PurposeReduction and fixation of tibial plateau fractures associated with small, “floating” intra-articular fragments proposes a challenge. We use fully threaded headless compression screws for (interfragmentary) fixation of such fragments before final plate fixation when standard fixation of intra-articular fragments with k-wires or lag screws is deemed insufficient. Our aim is to describe our technique and clinical experience of this two-level fixation.MethodsBetween 2006 and 2021, 29 patients with a comminuted tibial plateau fracture were treated with this two-level fixation in this retrospective case series. Clinical baseline and surgical variables were collected for all patients. Clinical outcome variables were available for 28 patients with a median follow-up of 16.5 months (IQR 5–24). Functional outcomes were measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and reported by 22 patients at a median of 5.2 years (IQR 3.5–9.8).ResultsReduction was anatomic or good in 82% of cases, fair in 14%, and a malreduction in 4%. Arthrosis was graded as grade 0 in 25% of cases, 1 in 39%, 2 in 21%, and 3 in 14%. Flexion was 110 degrees (IQR 100–130). Five patients had an extension deficit of 5 to 10 degrees. Median KOOS for symptoms and stiffness was 69 points (IQR 45–78), for pain 71 (IQR 45–88), for ADL 85 (IQR 52–95), for sports 30 (IQR 11–55), and for quality of life 34 (IQR 19–56).ConclusionThe use of fully threaded headless compression screws is a simple and helpful addition in the treatment of comminuted tibial plateau fractures.

Revisiting the management of tibial plateau fractures

Three-dimensional imaging has changed the understanding and management of tibial plateau fractures. In the 1970s, Schatzker proposed a classification for tibial plateau fractures, which highlighted the morphology of the six principal types. More recently, this original classification was complimented by an extended one underscoring the importance of understanding where the split wedge fragment(s) is/are located in three dimensions. The extended classification introduced the split wedge fragment and the continuity of the rim as the determinants of joint stability and the critical role that this plays in the management of tibial plateau fractures. The current manuscript re-emphasizes contemporary concepts of tibial plateau stability and depicts key issues which must be considered when planning the definitive surgical fixation of tibial plateau fractures.

High Altitude as a Risk Factor for Venous Thromboembolism in Tibial Plateau Fractures.

Background: Tibial plateau fractures are often significant injuries that can require complex surgical interventions with prolonged perioperative immobilization, thereby increasing the risk of developing venous thromboembolic (VTE) events, specifically, deep vein thrombosis (DVT) and pulmonary embolism (PE). Risk stratification is paramount for guiding VTE prophylaxis. Although high altitude has been suggested to create a prothrombotic state, virtually no studies have explored its clinical effects in lower extremity trauma. The purpose of this study was to compare surgical fixation of tibial plateau fractures at high and low altitudes and its effects on post-operative VTE development.Methods: The Truven MarketScan claims database was used to retrospectively identify patients who underwent surgical fixation of isolated and closed tibial plateau fractures using Current Procedural Terminology (CPT) codes over a 10-year period. Extraneous injuries were excluded using the International Classification of Diseases, 10th edition (ICD-10), and CPT codes. Patient demographics, comorbidities, and DVT chemoprophylaxis prescriptions were obtained. Patients were partitioned into high altitude (>4000 feet) or low altitude (<100 feet) cohorts based on the zip codes of their surgery locations. One-to-one matching and univariate analysis were used to assess and control any baseline discrepancies between cohorts; multivariate regression was then performed between cohorts to determine the odds ratios (OR) for developing VTEs post-operatively.Results: There were 7,832 patients included for analysis. There was no statistical difference between high and low altitude cohorts in developing VTEs within 30 days post-operatively. Higher altitudes were associated with increased odds of developing DVT (OR 1.21, p = 0.043) and PE (OR 1.27, p = 0.037) within 90 days post-operatively.Conclusions: Surgical fixation of tibial plateau fractures is associated with an increased risk of developing VTEs at high altitudes within 90 days post-operatively. Understanding such risk factors in specific orthopaedic patient populations is essential for optimizing DVT prophylaxis protocols. Further studies should investigate this relationship and the role of DVT prophylaxis regimens in this population.

ANALYSIS OF THE FUNCTIONAL AND RADIOLOGICAL OUTCOME OF TIBIAL PLATEAU FRACTURES TREATED BY OPEN REDUCTION INTERNAL FIXATION WITH LOCKING COMPRESSION PLATE BASED ON 3D CT THREE COLUMN FOUR SEGMENT SPECIFIC FIXATION - A PROSPECTIVE STUDY

Introduction: Tibial plateau fractures are caused by high-energy trauma. Historically, the Schatzker and AO/OTA classication systems are widely used, In 2010 Luo et al in china has developed Three-Column Four segment specific fixation for complex Tibial plateau fractures. Aim &amp; Objective: To analyse the functional outcome and radiological outcome of Tibial plateau fractures treated by Open Reduction Internal Fixation (ORIF) with Locking Compression Plate (LCP) based on Three-Column Four segment specic xation. Materials and Methods: This is a prospective study of 33 patients with Tibial plateau fractures with column specic involvement based on preoperative CT were selected for the study after getting ethical clearance in duration from Dec 2019 to June 2021. Outcome of surgery was evaluated using knee society scoring system and Modied Rasmussen Radiological Assessment criteria. Results: In our study we had all 100% study population (33 patients) had RTA as mode of injury with male predominance of 81% with age range of 20–60. In this, 73% had more than one column fracture. 2 patients temporarily stabilized with external xation while others with above knee slab, then denitive management by column specic xation by ORIF with LCP. We achieved union in all cases within range of 10-15 weeks of post operative period with few complications. We allowed full weight bearing after clinical and radiological signs of union at an average of 12-14 weeks. About 85% had good functional range of movements and able to perform their daily activities. Conclusion: Column based concept makes the surgeon to prepare better for the choice in approach, implant selection and column specic xation which gives better biomechanical strength and rigid construct than unilateral plating. Early joint mobilization and weight bearing was started around 2-3 months and contributes to better nal knee range of motion.

Arthroscopically Assisted Percutaneous Screw Fixation of Tibial Plateau Fractures.

This technique involves the use of both arthroscopy and fluoroscopy to facilitate reduction and fixation of the tibial plateau fracture. Through a minimally invasive technique, the depressed articular joint surface is targeted with use of preoperative computed tomography (CT) scans and intraoperative biplanar fluoroscopy. Reduction is then directly visualized with arthroscopy and fixation is performed with use of fluoroscopy. Lastly, restoration of the articular surface is confirmed with use of arthroscopy after definitive fixation. Modifications can be made as needed. The traditional method for fixation of displaced tibial plateau fractures is open reduction and internal fixation. Articular reduction can be visualized directly with an open submeniscal arthrotomy and an ipsilateral femoral distractor or indirectly with fluoroscopy. Visualization of the articular surface is essential to achieve anatomic reduction of the joint line. Inspection of the posterior plateau is difficult with an open surgical approach. Arthroscopically assisted percutaneous screw fixation of a tibial plateau fracture may allow for improved restoration of articular surfaces through enhanced visualization. Less soft-tissue dissection is associated with lower morbidity and may result in less damage to the blood supply, lower rates of infection and wound complications, faster healing, and better mobility for patients. In our experience, this technique has been successful in patients with severe osteoporosis and comminution of depressed fragments. If total knee arthroplasty is required, we have also observed less damage to the blood supply and fewer surgical scars with use of this surgical technique. Arthroscopically assisted percutaneous screw fixation of a tibial plateau fracture facilitates anatomical reduction through a less invasive approach. Patients undergoing this method of tibial plateau fracture fixation are able to engage earlier in rehabilitation2. Studies have shown early postoperative range of motion, excellent patient-reported outcomes, and minimal complications7,8. Arthroscopically assisted fixation can be applied to a variety of tibial plateau fractures; however, the minimally invasive approach is best suited for patients with isolated lateral tibial plateau fractures (Schatzker I to III) and a cortical envelope that can be easily restored. The cortical envelope refers to the outer rim of the tibial plateau. Fracture pattern and ligamentotaxis determine the cortical envelope, which can be evaluated on preoperative CT scans. In our experience, even depressed segments with a high degree of comminution may be treated with use of this technique with satisfactory results.Articular depression should be targeted with use of a preoperative CT scan and intraoperative fluoroscopy and arthroscopy.The surgeon should be careful not to "push up" in 1 small area; rather, a "joker" elevator or bone tamp should be utilized, moving anterior to posterior, which can be frequently assessed with arthroscopy.The intra-articular pressure of the arthroscopy irrigation fluid should be low (≤45 mm Hg or gravity flow), and the operative extremity should be monitored for compartment syndrome throughout the procedure. ACL = anterior cruciate ligamentK-wires = Kirschner wiresORIF = open reduction and internal fixationAP = anteroposteriorCR = computed radiography.

Functional Outcome and Quality of Life After Surgical Fixation of Tibial Plateau Fracture in a Tertiary Care Center of Nepal

IntroductionFunctional outcome and quality of life (QoL) of patients will change following tibial plateau fracture fixation. There are limited studies evaluating functional and radiological outcomes following tibial plateau fixation in Nepal, and none has evaluated QoL. We aim to evaluate functional outcome and QoL in patients with tibial plateau fracture with a follow up period of more than two years. MethodsThis was a cross sectional, observational study done at Dhulikhel Hospital, from August 2021 to January 2022. Western Ontario and McMaster Universities Arthritis Index (WOMAC) functional outcome and World Health Organization QoL-8 (WHOQoL-8) questionnaire were filled by patients operated for tibial plateau fracture from 2011 to 2019. Compound fractures, untraceable patients, and those managed with casts were excluded from the study. ResultsThere were 121 patients (male: female = 2.3:1) with a mean age of 37.1 years. Road traffic accidents (44.6%) were the most common mode of injury, and Schatzker type IV (30.6%) was the most common type of fracture. The average WOMAC score was 13.05±12.1 and the average WHOQoL-8 score was 30.24±4.1. The average WOMAC score in high-energy and low energy trauma patients were 17.07±12.29 and 8.21±10 respectively. The average WHOQoL-8 in high energy and low energytrauma patients were 29.28±3.59 and 31.38±4.38 respectively. ConclusionsSurgical reduction and stable internal fixation of tibial plateau fractures with long term follow up has a good functional outcome and quality of life. High energy trauma is associated with poor functional outcome and quality of life.

Regional Anesthesia Associated With Decreased Inpatient and Outpatient Opioid Demand in Tibial Plateau Fracture Surgery.

Regional anesthesia (RA) has been used to reduce pain and opioid usage in elective orthopedic surgery. The hypothesis of this study was that RA would be associated with decreased opioid demand in tibial plateau fracture surgery. Inpatient opioid consumption and 90-day outpatient opioid prescribing in all patients ≥18 years of age undergoing tibial plateau fracture surgery from July 2013 to July 2018 (n = 264) at a single, level I trauma center were recorded. The presence or absence of perioperative RA was noted. Of 60 patients receiving RA, 52 underwent peripheral nerve blockade (PNB) with single-shot sciatic-popliteal (40.0%; n = 24), femoral (26.7%; n = 16), adductor canal (18.3%; n = 11), or fascia iliaca (1.7%; n = 1) block with ropivacaine. Ten patients received epidural analgesia (EA) with either single-shot spinal (11.7%; n = 7) blocks or continuous epidural (5.0%; n = 3). Additional baseline and treatment characteristics were recorded, including age, sex, race, body mass index (BMI), smoking, chronic opioid use, American Society of Anesthesiologists (ASA) score, injury mechanism, additional injuries, open injury, and additional inpatient surgery. Statistical models, including multivariable generalized linear models with propensity score weighting to adjust for baseline patient and treatment characteristics, were used to assess perioperative opioid demand with and without RA. RA was associated with reduced inpatient opioid usage from 0 to 24 hours postoperatively of approximately 5.2 oxycodone 5-mg equivalents (0.74 incident rate ratio [IRR]; 0.63-0.86 CI; P < .001) and from 24 to 48 hours postoperatively of approximately 2.9 oxycodone 5-mg equivalents (0.78 IRR; 0.64-0.95 CI; P = .014) but not at 48 to 72 hours postoperatively. From 1 month preoperatively to 2 weeks postoperatively, RA was associated with reduced outpatient opioid prescribing of approximately 24.0 oxycodone 5-mg equivalents (0.87; 0.75-0.99; P = .044) and from 1 month preoperatively to 90 days postoperatively of approximately 44.0 oxycodone 5-mg equivalents (0.83; 0.71-0.96; P = .011), although there was no significant difference from 1 month preoperatively to 6 weeks postoperatively. There were no cases of acute compartment syndrome in this cohort. In tibial plateau fracture surgery, RA was associated with reduced inpatient opioid consumption up to 48 hours postoperatively and reduced outpatient opioid demand up to 90 days postoperatively without an associated risk of acute compartment syndrome. RA should be considered for patients undergoing tibial plateau fracture fixation.

Biomechanical superiority of locking plate designed with cluster of head screws compared to conventional buttress plate for fixation of posteromedial tibial plateau fractures: A computational assessment

Biomechanical superiority of locking plate designed with cluster of head screws compared to conventional buttress plate for fixation of posteromedial tibial plateau fractures: A computational assessment

Weightbearing after combined medial and lateral plate fixation of AO/OTA 41-C2 bicondylar tibial plateau fractures: a biomechanical study

BackgroundCombined medial and lateral plate fixation is recommended for complex tibial plateau fractures with medial fragments or no cortical bone contact. Although such fixation is adequate to resist forces during range of motion, it may be insufficient to support immediate postoperative weightbearing. Here, we analyzed displacement, stiffness, and fixation failure during simulated full weightbearing of bicondylar tibial plateau fractures treated with combined medial and lateral locking plate fixation.MethodsWe used 10 fresh-frozen adult human cadaveric tibias and mated femurs. Osteotomies were performed with an oscillating saw and cutting template to simulate an AO Foundation and Orthopaedic Trauma Association (AO/OTA) 41-C2 fracture (simple articular, multifragmentary metaphyseal fracture). Specimens were anatomically reduced and stabilized with combined medial and lateral locking plates (AxSOS, Stryker, Mahwah, NJ). Specimens were loaded axially to simulate 4 weeks of walking in a person weighing 70 kg. The specimens were cyclically loaded from 200 N to a maximum of 2800 N. Then, if no failure, loading continued for 200,000 cycles. We measured displacement of each bone fragment and defined fixation failure as ≥5 mm of displacement. Construct stiffness and load at failure were calculated. Categorical and continuous data were analyzed using Chi-squared and unpaired t-tests, respectively.ResultsMean total displacement values after 10,000 loading cycles were as follows: lateral, 0.4 ± 0.8 mm; proximal medial, 0.3 ± 0.7 mm; distal medial, 0.3 ± 0.6 mm; and central 0.4 ± 0.5 mm. Mean stiffness of the construct was 562 ± 164 N/mm. Fixation failure occurred in 6 of 10 specimens that reached 5 mm of plastic deformation before test completion. In the failure group, the mean load at failure was 2467 ± 532 N, and the mean number of cycles before failure was 53,155. After test completion, the greatest displacement was found at the distal medial fracture site (2.3 ± 1.4 mm) and lateral fracture site (2.2 ± 1.7 mm).ConclusionsAlthough combined medial and lateral plate fixation of complex tibial plateau fractures provides adequate stability to allow early range of motion, immediate full weightbearing is not recommended.

Functional Outcome Analysis of Fixation of Tibial Plateau Fractures using the Three-column Concept.

The aim of this study was to study the functional and radiological outcome after surgical fixation of complex intra-articular tibial plateau fractures managed by three-column concept. Ten patients with complex intra-articular tibial plateau fractures were included in this study. They were classified according to the three-column concept based on X-ray and computed tomography. All of them underwent osteosynthesis after meticulous planning and the columns were addressed using combined approaches. We obtained good to excellent radiological and functional outcomes with the column-based fixation of the intra-articular tibial plateau fractures. About 90% of the patients were able to return to pre-injury level of activity without complications. The posterior column is a vital component of the tibial plateau and needs to be separately addressed. Three-column concept is a beneficial adjunct, especially in complex and biplanar intra-articular tibial plateau fractures, both as a diagnostic and a pre-operative planning tool.

The comparison of clinical effect, knee function, prognosis of double plate fixation and locking plate internal fixation for tibial plateau fractures.

Objectives:The purpose of this study was to investigate the clinical effect, knee function improvement and prognosis of double plate internal fixation and locking plate internal fixation in the treatment of tibial plateau fractures.Methods:Clinical data from 96 tibial plateau fracture patients treated at our hospital were analyzed retrospectively. Of these, 46 had been treated using locking plate internal fixation and 50 were treated with double T-shaped plate fixation. Clinically related indices, Hospital for Special Surgery (HSS) score of knee function, and ability of daily living (ADL) score were evaluated during postoperative follow-up.Results:No significant differences were observed in pre-operative patient characteristics in both groups. Healing time, time to weight-bearing, tibial plateau angle (TPA) and lateral posterior angle (PA) were all superior in the locking plate fixation group compared to the double plate fixation group. At three months post-operative visit, range of motion, knee function, flexion deformity, muscle strength, pain, and stability metrics were all superior in the locking plate fixation group compared to the double plate fixation group. ADL scores were also higher in the locking plate fixation group than in the double plate fixation group at three and six months follow-up.Conclusions:The clinical effect, knee function improvement and prognosis of locking plate internal fixation in the treatment of tibial plateau fractures are better than those of double plate fixation.

Comparative study between arthroscopic reduction and internal fixation versus open-reduction internal fixation for tibial-plateau fractures

Background Tibial-plateau fractures are challenging for orthopedic surgeons. The gold-standard treatment for most tibial-plateau fractures is open-reduction internal fixation using either screws only or plates and screws. Recently, arthroscopy has invaded the field of trauma as a useful aid in the management of intra-articular fractures. The main advantages of arthroscopic reduction and internal fixation for tibial-plateau fractures are direct visualization of intra-articular fractures, accurate fracture reduction, and diagnosis and treatment of meniscal and ligamentous injuries. This study was done to compare the results of open-reduction internal fixation versus arthroscopic reduction and internal fixation for tibial-plateau fractures. Patients and methods A prospective comparative study was held in EL Hadra University Hospital between January 2017 and December 2019 over 56 patients. In all patients, the fracture was fixed using two to three cannulated screws. In the first group, the fixation was done using arthroscopy, while in the second group, the fixation was done using arthrotomy. All cases were assessed using Rasmussen clinical and radiological forms, Lysholm, and International Knee Documentation Committee (IKDC) scores. The minimum follow-up was 24 months since index surgery. Results There was no statistically significant difference between the two groups regarding the clinical and radiological Rasmussen scores. Moreover, the results of the Lysholm and IKDC were comparable. However, the arthroscopic group had longer operative time than the arthrotomy group. Conclusion Arthroscopic fixation technique was not inferior to open technique for management of Schatzker I–III fracture types with excellent comparable clinical and radiological outcomes while avoiding the drawbacks of the open approach.

Knee joint stability following fixation of tibial plateau fracture by angular locking plate fixation

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Injuries to the tibial plateau generally occur because of a force directed either medially or laterally an axial compressive force or both an axial force and force from the side. Tibial plateau fractures resulting frequently in functional impairment.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The total of cases included in the study was 47 in number. More than 20 years old patients of both sexes with tibial plateau fractures attended in the study. Proper informed consent was taken from the patients under the study and purpose of the study was explained. Ethical approval was obtained from the Institutional Ethics Committee. All data were processed, analyzed, and disseminated by MS Office and Statistical package for social sciences (SPSS) version 26 as per need.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;In this study, for majority (51%) patients &amp;lt;12 weeks were in needed for union. Besides these, for 23.40% and 21.28% patients, time for union were 12-14 and &amp;gt;14 weeks respectively. Unfortunately, in 4.26%% cases (n=2) incidence of non-union was occur. The mean period of radiological union was 12.75 weeks (12-16 weeks). Most of the patients were allowed complete weight bearing at 11 to 14 weeks. Average time gap for complete weight bearing was 13.5 weeks. In assessing the knee stability of the participants, we observed, the mean (±SD) angle of knee joints was 112.08 ±12.32 degree. The mean (±SD) Knee Society Score (KSS) was found 77.51 ± 8.16. As per the functional outcomes among all the participants, majority of them (57.45%) got ‘good’ results whereas 29.79% got ‘Excellent’ and 8.51% got ‘Poor’ results.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Satisfactory knee joint stability for patients with tibial plateau fracture angular locking plate fixation technic may be considered as an effective treatment method for orthopedic surgeons. &lt;/p&gt;

Study of functional outcome of tibial plateau fractures treated with anatomical contoured locking compression plate

Tibial plateau fractures tend to occur in patients with polytrauma and in elderly patients with history of significant fall. This study was undertaken to evaluate and explore new generation implant fixation in tibial plateau fractures which is expected to provide a stable fixation with minimum exposure, early mobilization, less complications and a better quality of life.About 43 cases who had sustained tibial plateau fractures (Schatzker type I-VI) and operated with anatomical contoured locking compression plate were included. Follow-up of these patients was done at 6 weeks, 3 months, and 6 months after surgery. We analyzed all our subjects using IKDC score for functional outcome and plateau depression measurement for radiological outcome at 3 months and 6 months.All the 43 fractures analysed in this study were graded in accordance to the Schatzker classification. It was observed that most of these fractures, i.e., 16 out of 43 (37.2%) were type VI and 13 out of 43 (30.2%) type V. The average knee flexion at 3 months was 105.7±8.49 degrees and at 6 months 120.6±8.61 degrees. After evaluation, it was observed that at 6 months, 3 patients had extension lag (7%) out total 43 patients. Most of the patients had average IKDC score of 80.2±7.91% at 3 months which increased to average 86.92±8.05% at 6 months.Achieving and maintaining anatomical reduction becomes easy with advanced design of these plates, which helps in early mobilization and hence obtaining good functional and radiological outcomes of tibial plateau fractures.

Arthroscopic-Assisted and Minimally Invasive Plate Osteosynthesis of Tibial Plateau Fractures

Background: Tibial plateau fractures are relatively rare fractures and have always been a challenge for orthopedic surgeons. These fractures may result in significant limitations postoperatively if not treated properly. The role of arthroscopic-assisted fixation of tibial plateau fractures has been advocated in many pieces of literature in the world during the last decades. Several studies have been published regarding arthroscopically assisted internal fixation of tibial plateau fractures. As it is an intra-articular lesion, surgical management is often challenging. We have very little data regarding these issues. The aim of this study was to assess the clinical and radiological outcome after arthroscopic-assisted minimally invasive plate fixation of tibial plateau fractures. Methods: This was a descriptive observational study which was conducted in a single Specialized Hospital, Dhaka, Bangladesh during the period from January 2015 to December 2019. Totally 38 patients with tibial plateau fractures (Schatzker type I-VI) were enrolled in the study. Radiography and 3D computed tomography were used to assess the fracture patterns. Arthroscopic-assisted minimally invasive plate fixation was done in all fractures under the image intensifier. An immediate postoperative radiograph was done and then repeated at 6 weeks as well as 3, 6, and 12 months after surgery. All data were processed, analyzed, and disseminated by MS Office and SPSS version as per need. Rasmunssen clinical and radiological assessment criteria were used for evaluation. Results: In our study, in analyzing the Rasmunssen clinical outcome we found, the highest number of participants got an “excellent” outcome, which was present in more than 70% (n = 27). Besides these, 21.05% (n = 8) participants got “good” and the rest 7.89% (n = 3) participants got “fair” outcomes. On the other hand, in analyzing the Rasmunssen radiological outcome we found, the highest number of participants got an “excellent” outcome which was more than 50% (n = 22). Besides these, 26.32% (n = 10) participants got “good”, 13.16% (n = 5) participants got “fair” and the rest 2.63% (n = 1) participants got “poor” outcomes. Conclusion: According to the findings of this study we can conclude that arthroscopic-assisted minimally invasive plate fixation of tibial plateau fractures may have a key role in the management of such fractures and is the treatment of choice for associated intra-articular pathology. Clinical and radiological evaluations of the patients were excellent in the large majority of the patients, and poor evaluation was non-existant at clinical evaluation. Radialogical evaluation was unsatisfactory for only a small number of patients. J Curr Surg. 2021;11(4):82-86 doi: https://doi.org/10.14740/jcs448

Standard versus customised locking plates for fixation of schatzker ii tibial plateau fractures

Aim3D-printed implants could improve the capture of fracture fragments for improved stability of tibial plateau fracture fixation. The aim of this study was to compare the biomechanical strength of fixation constructs using standard and customised 3D-printed proximal tibial locking plates for fixation of tibial plateau fractures. MethodsThis is a biomechanical study utilising six pairs of cadaveric tibiae. Fractures were created in an identical fashion using an osteotome and mallet, and fixed using either a standard, commercially-available proximal tibia locking plate or a customised 3D-printed plate. Design and production of the customised plates followed a “3D printing at point-of-care” model. Customised stainless steel 316 L plates were produced within a local additive manufacturing laboratory based upon pre-operative CT scans. Determination of implant choice within each cadaver pair was performed via simple randomisation. Following fracture fixation, the tibiae were skeletalised and biomechanically tested using a customised loading jig and a size-matched femoral knee prosthesis. The constructs were loaded cyclically from 100 N to approximately three times the cadaveric body-weight at 5 Hz for 10 000 cycles. Every 1000 cycles, the test was paused and the tibia was physically checked for failure. If failure had not occurred by the end of the testing cycle, the construct was loaded to failure and the load at which the construct failed was noted. ResultsFixation constructs using the 3D-printed plates performed comparably to those using the standard plates. There was no significant difference in the degree of fracture fragment displacement in both constructs. Overall longitudinal construct stiffness and load to failure was higher in the 3D-plates group but this did not reach statistical significance. ConclusionProduction of customised plates for proximal tibia fractures at point-of-care is feasible, however fixation constructs with these plates did not provide any biomechanical advantage over standard plates in terms of axial loading stiffness.

Outcomes of Tibial Plateau Fracture Surgical Fixation: a Comparative Study between Younger and Older Age Groups.

Tibial plateau fractures account for approximately 8% of the fractures of the elderly. Low bone quality that is more common in the elderly is one of the major challenges in fixing fractures and may be a barrier to achieving satisfactory outcomes after a surgical fracture treatment. Accordingly, surgical fixation of tibial plateau fractures was controversial in the elderly. This study aimed to investigate and compare the clinical outcomes of surgical fixation in patients over and under 60 years of age. This study was conducted as a retrospective cohort study of data that were prospectively collected. In total, 48 patients who underwent surgery with open reduction and internal fixation before August 2019 were recruited and followed up at least one year after surgery. Demographic characteristics, the range of motion of the knees, visual analog scale (VAS) score of pain intensity, and the Oxford Knee Score (OKS) were obtained in this study. Furthermore, Short Form-36 (SF-36) questionnaire was used to evaluate patient satisfaction. In total, 19 and 29 patients were over and under 60 years of age, respectively. According to Schatzker's classification, the most common type of fracture was type VI. The range of motion in the knees did not differ significantly between the two groups (P>0.05). Moreover, OKS and the VAS of pain intensity were not significantly different in both groups (P>0.05). In addition, SF-36 scores were not significantly different between elderly patients and the age-matched general population. However, younger patients had lower scores in the physical function and vitality scales of SF-36, compared to the age-matched general population. Based on the results of the present study, it can be stated that increasing age did not affect the surgical outcomes of patients with tibial plateau fractures.