Ipsilateral Tibial Plateau Research Articles

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.

Masquelet Technique for Hindfoot Fusion of Gustilo IIIA Open Ankle Dislocation with Complete Talar Extrusion and Loss

Category:Hindfoot, Trauma, AnkleIntroduction/Purpose:Complete talar extrusion is a rare injury resulting from high-energy trauma, with dissociation of the talus from surrounding bony and soft-tissue structures. Complications after complete talar extrusion include infection, osteonecrosis, posttraumatic osteoarthritis, and leg-length discrepancy. There is a lack of consensus on the optimal treatment algorithm for complete talar extrusion, due in part to high complication rates associated with injury and treatment. Thus, we report a staged treatment method utilizing the Masquelet Technique with temporary cement spacer, followed by bone grafting with use of femoral shaft autograft and bulk cancellous allograft.Methods:44-year-old male status post high-speed motorcycle collision presented with left ankle Gustilo IIIC open fracture dislocation with complete talar extrusion and loss, concomitant ipsilateral tibial plateau fracture and metatarsal shaft fractures. Twelve weeks post-injury, after multiple staged debridements, external fixation and extensive wound vac treatments, removal of the left leg multi-planar external fixator was performed with left distal tibial, fibular, navicular and calcaneal articular and subchondral bone debridement in preparation for Masquelet procedure and pantalar fusion. Open reduction and realignment of left ankle and foot with intramedullary fixation with hindfoot fusion nail was performed, with placement of antibiotic cement spacer for development of secondary reactive periosteal membrane. After nine weeks, intramedullary bone reaming aspiration tool was utilized for removal of left femur intramedullary bone marrow for autograft. Hindfoot pantalar fusion was performed using ipsilateral femoral shaft autograft and bulk cancellous allograft in place of antibiotic spacer.Results:Patient went on successfully to fusion and had one transfixation screw removed during the course of his recovery. Patient was also treated using a long leg ankle foot orthosis brace as a stress shielding device during heavy labor. Patient returned back to work and heavy labor as a landscaper and has had no residual pain. At 24 months postoperative, patient achieved an AOFAS ankle-hindfoot score of 83/100 (good).Conclusion:To our knowledge, this is the first case of complete talar extrusion treated with a Masquelet procedure with ipsilateral femoral shaft autograft and bulk cancellous allograft. While chronic pain is reported in as many as 75% of patients post- complete talar extrusion, and infection rates as high as 88%, our patient reports no residual pain and did not experience a postoperative infection. This technique represents a reasonable approach and warrants consideration for the treatment of this rare, complex injury.

MRI diagnosis in multiligamentous injuries of knee with associated dislocations and neurovasacular sequelae: a retrospective analysis of injury patterns

BackgroundSimultaneous injury of two or more knee ligaments with concurrent tears involving the anterior cruciate and medial collateral ligaments is considered to be associated with femorotibial knee dislocations (KD). The purpose of this study is to characterize multiligamentous knee injury patterns associated with dislocations on MRI and to describe the incidence of their sequelae such as tibial plateau fractures, peroneal nerve injuries, and posterolateral corner (PLC) injuries.Participants and methodsAfter obtaining institutional ethical committee approval, we retrospectively identified 108 multiligamentous knee injuries in 100 patients who met with trauma and were treated at our tertiary care center between April 2014 and December 2018. Descriptive statistics were reported using numbers and percentages for categorical variables in cases of multiligamentous injuries, ipsilateral tibial plateau fractures, ipsilateral femoral fractures, peroneal nerve injury, arterial injury, compartment syndrome, and PLC injuries.ResultsThe most common (39.8%) injury pattern was a combined disruption of the anterior cruciate ligament, posterior cruciate ligament, and PLC. Schenck KD III-M was the most common injury type in KD, constituting 16.7%. Medial-sided injuries were the most common injury patterns seen with KD. There was a significant risk of peroneal nerve injury with lateral-sided injuries.ConclusionKD, though rare, may have devastating clinical sequelae such as compartment syndrome if not recognized and treated. Therefore, it is necessary to recognize imaging findings of femorotibial joint dislocations and associated injuries to the adjacent neurovascular bundles.

Treatment of Combined Tibial Plateau and Shaft Fractures

Separate ipsilateral tibial plateau and shaft fractures are rare and complicated injuries. They are associated with high energy mechanisms and may present with significant soft tissue as well as life threatening nonorthopaedic trauma. Meticulous preoperative planning is essential when determining the appropriate fixation construct. Utilization of a single locking plate in a minimally-invasive fashion is a common fixation option. Unfortunately, this fixation method is technically demanding and may not provide the optimal biomechanical environment needed for healing of the plateau and/or shaft fracture leading to nonunion and possible hardware failure. This paper describes fixation techniques for ipsilateral tibial plateau and shaft fractures that combine suprapatellar intramedullary nailing of the shaft with separate plate fixation of the tibial plateau. While also technically demanding, with close attention to preoperative planning, these techniques allow for fracture specific fixation of both the tibial plateau and shaft. In doing so, the ideal implant for each fracture is utilized which optimizes the environment for subsequent fracture healing and return to function.

Case report of treatment of the the tibial shaft fracture and the ipsilateral tibial plateau fracture in a patient with cancer

Case report of treatment of the the tibial shaft fracture and the ipsilateral tibial plateau fracture in a patient with cancer

Analysis of the tibial baseplate coverage and symmetrical tibial prosthesis in primary total knee arthroplasty

Objective: To investigate the tibial baseplate coverage with symmnetrical tibial prosthesis in primary total knee arthroplasty (TKA). Methods: From August 2014 to February 2015, 39 patients (39 knees) with varus knee osteoarthritis were retrospective reviewed in Department of Orthopaedics, Tianjin Xiqing Hospital. Nine males and 30 females; aged 50 to 78 years (67±6 year). 3D tibia models of the knee were built with Mimics 10.01 software, simulated TKA surgeries were performed. The morphology of the proximal tibia was measured, including the mediolateral (ML), anteroposterior (AP) and medial and lateral tibial plateau AP dimensions. 3D models of PFC Sigma tibial prosthesis were imported and the tibial coverage characters were analyzed. Results: The AP and ML dimensions of the tibial resection surface were (45.7± 3.4) mm, (71.7± 4.2) mm respectively, the plateau aspect ration ratio (AP/ML) was 63.8%±3.0%. The medial tibial plateau AP[(46.9± 3.3) mm]was significantly greater than the lateral side[(41.8±3.3) mm, P=0.000], the asymmetric ratio averaged 112.4%±6.9%. The medial tibial plateau, anteromedial, posteromedial, posterolateral unsatisfied coverage ratio were 33.3%, 76.9%, 20.5%, 33.3% respectively. There are 5 cases underhang and 3 cases overhang in the posteromedial side, whereas 1 case underhang and 12 cases overhang posterolateral, the overhang ratio was 30.8%. Posteromedial, posterolateral prosthesis coverage had linear positive correlation to the ipsilateral tibial plateau AP diameter. Conclusions: The medial AP diameter of tibial plateau is significantly lager than the lateral side in varus knee osteoarthritis patients. With symmetrical tibial baseplate placement in TKA, the prosthesis usually lead to medial tibial plateau anterior and posterior underhang and posterolateral overhang.

One-stage minimally invasive surgery for femoral and ipsilateral tibial plateau fractures with a rapid reductor

Objective To investigate the fixation sequence, key points and clinical value of a new minimally invasive surgery for one-stage treatment of femoral and ipsilateral tibial plateau fractures with a rapid reductor. Methods From October 2015 to January 2017, 5 patients with femoral and ipsilateral tibial plateau fractures received surgery at our department. They were 4 men and one woman, aged from 23 to 65 years (mean, 45.5 years). The femoral fractures were type A in 2 cases, type B in 2 cases and type C in one case according to AO/OTA classification. The tibial plateau fractures were type Ⅴ in 2 cases and type Ⅵ in 3 according to Schatzker classification. After the tibial plateau fractures were first fixated, Kirschner wires were inserted via the femoral condyle and distal tibia. A rapid reductor was used to reduce the tibial plateau and dual plates were implanted by percutaneous minimally invasive internal fixation. Then the same set of rapid reductor was used to treat femoral fractures by antegrade femoral nailing. The bone traction was completed via the femoral condyle and anterior superior iliac spine. The operative time, bone union time, knee functional recovery and hospital stay were recorded. Results The 5 patients were followed up for an average of 10 months (from 7 to 17 months). No delayed union, nonunion or malunion happened of either femoral or tibial plateau fractures. The healing time for femoral fractures ranged from 4 to 8 months, averaging 5.5 months; the union time for tibial plateau fractures ranged from 10 to 14 weeks, averaging 12.0 weeks. The knee flexion averaged 110° (from 95° to 130°). The overall functional recovery was rated as excellent in 2 cases and good in 3 according to the Karlstrom & Olerud criteria. The average hospital stay was 18 days(from 13 to 32 days). Conclusion Minimally invasive surgery with a rapid reductor can treat femoral and ipsilateral tibial plateau fractures at one stage, leading to fine functional recovery of the knee and greatly reduced hospital stay in particular. Key words: Femur; Tibia; Fractures fixation, internal; One stage; Minimally invasive

Investigation of Multiligamentous Knee Injury Patterns With Associated Injuries Presenting at a Level I Trauma Center

To characterize multiligamentous knee injury patterns and describe associated morbidities. Retrospective. Level I trauma center. One hundred two patients (106 knees) with multiligamentous knee injuries and/or dislocations from 2000 through 2008. Subgroup of 82 knees with appropriate magnetic resonance images available assessed for ligamentous injury patterns. Data obtained from medical records for 106 knees. Presence of arterial injuries, nerve injuries, associated fracture patterns, and whole-body morbidities. The most common (43%) injury pattern was a combined disruption of the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner. Twenty-five percent of knees had associated ipsilateral tibial plateau fractures, and 19% had associated ipsilateral femoral fractures. Peroneal nerve injury occurred in 25% of knees, arterial injury in 21%, and compartment syndrome in 16%. An intra-abdominal injury was present in 13% of patients, a severe closed head injury in 10%, and a symptomatic pulmonary embolism in 5%. Nearly half the multiligamentous knee injuries involved the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner; one-fourth had associated ipsilateral tibial plateau fractures. The incidence of peroneal nerve injury (25%) was higher than previously reported (20%), whereas the incidence of arterial injury (21%) was comparable to previous reports (19%). Posterolateral corner injuries were more prevalent than previously reported and were highly associated with peroneal nerve injury. We found a substantial incidence of associated morbidities of the whole body. Multiligamentous knee injuries are a marker of concomitant trauma and should be closely evaluated at presentation and during the hospital course to allow for early intervention for life- or limb-threatening comorbidities.

An unusual combination of floating knee and trifocal articular tibial fracture

Fractures of the ipsilateral femur and tibia are a devastating injury complex, usually as the consequence of high-energy traumatisme. We present a case of 42-year-old man, who sustained a simultaneous fracture of the femoral shaft and trifocal tibia. Our management consisted of treating both the femoral and the tibial fractures surgically, by intramedullary nailing and a percutaneous screw fixation of tibial and malleolar fracture. He was evaluated at 4 years of follow-up. With careful attention to some technical points, femoral fracture, ipsilateral tibial plateau, shaft and malleolar fractures can be managed successfully by combining two familiar techniques commonly employed for each injury in isolation.

Operative Treatment of Ipsilateral Noncontiguous Unicondylar Tibial Plateau and Shaft Fractures: Combining Plates and Nails

Unicondylar plateau fractures with ipsilateral noncontiguous tibial shaft fractures are rare injuries; over a 10-year period, we identified only 50 of these combined injuries in our series of 1586 tibial fractures. Modern locking plates and percutaneous techniques have been increasingly indicated for this injury pattern though this technique can compromise optimal fixation of the plateau and/or shaft fractures. For a number of years, we have combined intramedullary nails and plates for the treatment of these fractures with excellent results. With careful attention to some technical points, ipsilateral tibial plateau and shaft fractures can be managed successfully by combining 2 familiar techniques commonly employed for each injury in isolation.

Reconstruction of the pelvic ring following tumor resection.

Two patients with chondrosarcoma of the periacetabular region were treated by local resection and reconstruction of the pelvic ring and hip, implanting a Charnley-Mueller total hip replacement and reconstituting the pelvic ring with cement reinforced by Küntscher rods and heavy Kirschner wires. The first patient, in whom adequate resection was accomplished, was well five years later and was able to walk with a mild lurch and without a cane except when walking long distances on rough ground. Despite a fall causing a fracture of the ipsilateral tibial plateau at two years and a fatigue fracture of the ipsilateral ischium which healed at 4.5 years, the implant had remained intact. In the other patient, for whom hemipelvectomy was advised but who refused it, the resection was not adequate and although he was able to walk with a cane for short distances postoperatively, he died of metastases at two years. Based on these two cases, it would appear that reconstruction of the pelvic ring and hip may be feasible in a few very carefully selected cases of periacetabular tumors.