Management Of Tibial Plateau Fractures Research Articles

Fixation of Tibial Plateau Fractures Type 5,6 by Ilizarov Apparatus: A Systematic Review of Outcomes and Complications

Abstract Background Complex proximal tibial fractures especially tibial plateau are one of the most challenging problems in fracture surgery. Treatment of complex tibial plateau fractures remains difficult. The soft tissue component to the injury necessitates careful timing of surgical fixation in order to minimize wound complications. Objective To compare the 2 Methods of fixation in management of Tibial plateau fractures (Schatzker type V & VI) as regards many aspects including but not limited to; superficial infection, deep infection, osteoarthritis, Functional & Radiological outcome, compartemental syndrome& postoperative stiffness. Patients and Methods Search results was conducted to systematic review management software and manually screened for eligibility to be included. Comparing Ring fixator and ORIF in outcomes and complications for treatment of high-energy fractures (Schatzker type V&VI) of the proximal tibia. Results The results showed that Ilizarov had a higher proportion of cases with excellent functional results compared to ORIF (57.1% vs 24.3%). In addition, the proportion of cases with poor functional results was lower in the Ilizarov group compared to the ORIF group (6.1% vs 25.7%). This revealed a significant difference between the two surgical techniques (p-value = 0.001), indicating that Ilizarov was associated with better functional outcomes compared to ORIF. These findings suggest that Ilizarov may be a more effective surgical technique for achieving better functional outcomes in patients with limb injuries. However, it is important to note that the included studies had some limitations, such as small sample sizes and potential biases. Further studies with larger sample sizes and more rigorous methodologies are needed to confirm these findings and to provide more conclusive evidence on the comparative effectiveness of Ilizarov and ORIF. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022. Conclusion This meta-analysis reviewed and compared the outcomes of two different surgical techniques, Ilizarov and ORIF, in treating limb injuries. The results showed that there was no statistically significant difference between the two techniques in terms of superficial infection, deep infection, osteoarthritis, compartmental syndrome, and stiffness. However, ORIF had a faster time to radiographic union compared to Ilizarov. In terms of functional outcomes, Ilizarov was associated with better outcomes compared to ORIF. These findings suggest that Ilizarov may be a more effective technique for achieving better functional outcomes in patients with limb injuries. Nonetheless, the limitations of the included studies need to be considered, and further research with more robust methodologies is necessary to confirm these findings.

Comparison of Arthroscopy-Assisted Reduction Internal Fixation versus Open Reduction Internal of Tibial Plateau Fracture Management: A Systematic Review of Case Control Studies

Comparison of Arthroscopy-Assisted Reduction Internal Fixation versus Open Reduction Internal of Tibial Plateau Fracture Management: A Systematic Review of Case Control Studies

Radiographic and Functional Outcome of Depressed Tibial Plateau Fractures Treated with Raft Plate with Bone Graft – A Prospective Study

Tibial plateau fractures are the fractures that involve the articular surface of the tibial condyles. The Schatzker and OA classifications are the most commonly used to classify these fractures. The Schatzker classification system is a widely recognized method used by orthopedic surgeons to categorize tibial plateau fractures into six distinct types. This classification helps in assessing the initial injury, planning the appropriate management strategy, and predicting the prognosis. Each type represents a different pattern of fracture, which can guide treatment decisions and expectations for recovery. These fractures typically result from the external(valgus) or internal(varus) forces on the knee with axial loading. In younger individuals, tibial plateau fractures are most commonly caused by road traffic accidents due to the high-energy impact. However, in elderly patients with osteopenic bone, even a simple fall can lead to these fractures because their bones are more fragile and susceptible to injury. The tibial plateau fractures are intra-articular fractures of the knee joint and are often difficult to treat and have a high complication rate, including early-onset osteoarthritis. Surgery is the preferred modality of treatment for these fractures, along with bone void fillers to address bone defects caused by the injury. At present, there is no consensus on the optimal method of fixation or the void filling to treat such fractures. Techniques of operative management of tibial plateau fractures have become more successful in achieving and maintaining reduction of the fracture. Still, avoiding malalignment of the limb has been shown to be at least as important as articular congruity to long-term joint viability.

Use of arthroscopy in management of tibial plateau fractures

Introduction Tibial plateau fractures are periarticular injuries of the proximal tibia often associated with soft tissue injury. They account for 1-2% of all fractures. Their impact on the articular surfaces and the development of osteoarthritis make them an interesting research topic in the orthopaedic field. With the development of arthroscopic treatment methods, many are thinking of ways to incorporate less invasive methods in the reduction and fixation of these injuries. Review methods English-language scientific literature found in PubMed and Google Scholar was used for the review. Articles were searched based on keywords. Each article was analyzed for knowledge currency and relevance for use in the review. Description of the State of Knowledge After searching the articles, 35 articles were selected for final analysis. The collected data provided the latest information on treatment of tibial plateau fractures (TPF) using arthroscopic tools with studies diving deep into both the technique and longer-term results. Summary The use of arthroscopy in treatment of tibial plateau fractures grows year by year with more and more clinicians being interested in limiting the soft tissue damage and other adverse effects of ORIF Keywords: Schatzker, arthroscopy, tibial plateau fracture

Optimizing Surgical Management of Tibial Plateau Fractures: A Comparative Study of Minimally Invasive Versus Open Reduction Techniques.

Tibial plateau fractures pose a significant challenge to orthopedic surgeons due to their complex nature and potential for long-term morbidity. Surgical intervention is often necessary to restore anatomical alignment and optimize functional outcomes. This study aimed to evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) compared to open reduction and internal fixation (ORIF) in the management of tibial plateau fractures. The present hospital-based observational study was conducted at Agartala Government Medical College for two years. Seventy adult patients with tibial plateau fractures were included, with surgical interventions performed based on fracture characteristics. Postoperative outcomes, including knee range of movements, functional recovery, and complication rates, were assessed at six months. MIPPO demonstrated superior outcomes compared to ORIF, with a higher proportion of participants achieving knee range of movements > 120 degrees (66.7% versus 36%; p = 0.030), excellent functional outcomes (66.7%versus 36%; p = 0.046), and lower postoperative complication rates (2.2% versus28%; p = 0.001). Fracture union times were significantly shorter in MIPPO (12.49 weeks) when compared to ORIF (14 weeks) (p = 0.009). MIPPO offers advantages over conventional ORIF in terms of functional recovery and complication rateswhile demonstrating comparable fracture union times. These findings advocate for the adoption of MIPPO as a preferred surgical technique for tibial plateau fractures.

Modified gastrocnemius splitting anatomic approach to the tibial plateau. Medium-term evaluation

BackgroundPosterior tibial plateau fractures, including avulsion fractures of the posterior cruciate ligament (PCL) insertion, represent a challenge for the orthopedic trauma surgeon. These injuries have gained a new perspective both diagnostically and therapeutically after the regular use of multiplanar computed tomography. In the herein study, we describe the outcome of patients sustaining a tibial plateau fracture with posterior articular involvement treated by open reduction and internal fixation (ORIF) using our modified gastrocnemius splitting anatomic approach. MethodsThis observational retrospective descriptive study was conducted at Complejo Medico de la Policia Federal Argentina Churruca-Visca. All patients were treated by ORIF by our team through our modified gastrocnemius splitting anatomic approach, and followed-up for a minimum of 12 months. ResultsA total of 18 patients sustaining plateau fracture were treated by this approach. Satisfactory tomographic reduction with articular gap and/or step-off <2 mm was achieved in 16. The mean time to the return to activities of daily living was 192.2 days. ConclusionThe modified gastrocnemius splitting anatomic approach represents a good alternative for the management of tibial plateau fractures involving the posterior quadrants.

873 Fixation and Graft Augmentation of Tibial Plateau Fractures: A Systematic Review and Meta-Analysis

Abstract Aim Modern techniques have challenged the consensus of open reduction and internal fixation (ORIF) with autologous graft augmentation as the gold standard management of tibial plateau fractures. The objective of this review was to assess the outcomes of surgical techniques and graft materials for managing tibial plateau fractures. Method MEDLINE, Embase and CENTRAL searches were conducted alongside trial registers, conference abstracts and OpenGrey from their inception to July 2022. Randomized and quasi-randomized controlled trials comparing fixation techniques or graft materials were included. Bias was assessed using the Risk of Bias 2 (ROB2) framework, and certainty of evidence using the GRADE approach. Primary outcomes included functional and radiographic outcome scores, with secondary outcomes of complications, radiographic parameters, and time to union. Results Eleven studies were included, five assessing surgical techniques and 6 graft materials. ROB2 assessments highlighted some concerns in nine papers and high risk in one. Improved functional outcomes were reported in minimally invasive techniques (mean difference = 3.25, 95% CI -0.17, 6.67) trending towards significance (p = 0.20). Trends towards significantly reduced complications were observed in both minimally invasive (risk ratio 0.58, 95% CI 0.26, 1.30, p = 0.19) and synthetic graft (risk ratio 0.66, 95% CI 0.37, 1.15, p = 0.14) groups. sd definite conclusions regarding the best fixation and graft approach. However, greater efficacy and non-inferiority were demonstrated with minimally invasive techniques and synthetic grafts respectively. It is our judgement that the fixation approach is the most important prognostic factor in these injuries thus future research should be focused accordingly.

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.

A Novel Approach in the Management of Tibial Plateau Fractures with Compartment Syndrome.

Compartment syndrome in tibial plateau fractures presents a formidable challenge for treating orthopedic surgeons. The most common strategy is early fasciotomy and external fixation, followed by a second stage definitive fixation. We conducted a prospective study of tibial plateau fractures of Schatzker Type V and VI with impending compartment syndrome treated by single-stage double incision fasciotomy and dual internal fixation and Vacuum-Assisted Closure (VAC). The study was between May 2014 and February 2019. 21 patients with impending compartment syndrome who underwent single-stage double incision fasciotomy and Open Reduction and Internal Fixation (ORIF) with dual plate were included in the study. The functional and radiological outcome was measured using the modified Rasmussen functional and radiological scoring and The Western Ontario and McMaster Universities Arthritis Index (WOMAC). The mean age of patients was 38.7years (Standard deviation of ± 9.48). The mean follow-up period was 27months (Standard deviation of ± 6.51). The mean functional and radiological modified Rasmussen score was 27.28 (range 21 to 29) & 8 (range 7 to 10), respectively. 4 patients had excellent outcomes, and 17 patients had good results. The mean WOMAC score was 8.04 (Standard deviation of ± 5.35). Five patients had a score of 0, 14 patients had a score of 1-10 and 2 had a score of 11-20. The early double incision fasciotomy and definitive internal fixation with dual plate and VAC as single-stage surgery in patients with impending compartment syndrome help to obtain excellent to good functional outcomes with reduced complications.

Development and clinical application of a new reduction device for the treatment of tibial plateau fracture under arthroscopic monitoring

To develop a reduction device for the arthroscopy-assisted treatment of tibial plateau fracture and explore its clinical efficacy. From May 2018 to September 2019, 21 patients with tibial plateau fracture were treated, including 17 males and 4 females. Their ages ranged from 18 to 55 years old with an average of (38.6±8.7) years old. There were 5 cases of Schatzker typeⅡand 16 cases of Schatzker type Ⅲ. The self-designed reductor combined with arthroscope was used for auxiliary reduction and fixation(minimally invasive percutaneous plate osteosynthesis). The efficacy was analyzed by observing the operation time, blood loss, fracture healing time and knee function(HSS and IKDC scoring criteria). All the 21 patients were followed up for 8 to 24 with an average of(14.0±3.1) months. The operative time ranged from 70 to 95 min with an average of(81.7±7.6)min, incision length ranged from 4 to 7 cm with an average of(5.3±0.9) cm, intraoperative blood loss ranged from 20 to 50 ml with an average of(35.3±5.2) ml, postoperative weight-bearing time ranged from 30 to 50 d with an average of(35.1±9.2) d, fracture healing time ranged from 65 to 90 d with an average of(75.0±4.4) d, and complications were 0 cases, respectively. The fracture was well healed and no screw plate fracture was observed. The knee function scores of HSS and IKDC 18 months after operation were significantly higher than those before operation(P<0.05). The custom-made reduction tool for the arthroscopic management of tibial plateau fracture is reasonable in design and simple in operation. The specific reduction tool could effectively reduce the fracture, and shorten the fixation time with minimally invasive procedure.

Top 50 Cited Papers on Tibial Plateau Fracture Management: A Bibliometric Analysis and Review.

The orthopaedic surgeons, especially the young budding surgeons should have a well-balanced knowledge of the past evidence as well the current evidence in the literature for the appropriate as well as optimum management of tibial plateau fractures. Bibliometric analysis of the top-cited papers on tibial plateau fracture management can help know their concurrent interests, deficiencies and conflicting issues regarding their management. This study aimed to identify the 50 most cited research articles in tibial plateau research and analyse their characteristics. We searched the Thompson Reuters Web of Science database for articles relevant to tibial plateau fracture and prepared a list of top 50 cited articles that included original articles and review articles concerning tibial plateau fractures. The included articles were analysed for contributing journals, corresponding author's country, publication year, cumulative citations, annual citations, citation trends over time, level of evidence and a qualitative review. The search strategy resulted in 2263 articles. The top 50 cited articles were published from 1974 to 2014 and belonged to 12 journal sources. There were 47 original articles and 3 review articles. The average citations per article were 126.2, and the annual citations per article were 6.478 per year. The top-cited articles were relevant to the strategies in the management, classification, fracture reduction, articular restoration, types and number of fixation devices, surgical approaches, associated menisco-ligamentous injuries and applicability of bone grafts/substitutes in tibial plateau fractures. The current bibliometric analysis summarises the top-cited evidence concerning tibial plateau fractures and can be a potential resource for reviewing and locating the same. The analysis shows that most top-cited evidence belongs to the year 2000 onwards. Also, recent articles have a higher annual citation rate. A limited number of journals and mostly, western countries have contributed to the top-cited evidence. Whilst the top-cited evidence has touched several aspects of tibial plateau fractures, it is in the form of level IV case series. It needs better prospective evidence to establish sound recommendations. The online version contains supplementary material available at 10.1007/s43465-023-00932-4.

Implementing 3D fluoroscopy in the management of tibial plateau fractures: Shorter hospitalization and decline in revision surgery, but increase in the duration of surgery and radiation exposure

BackgroundIntraoperative 3D fluoroscopy (3DRX) is increasingly used in fracture management instead of conventional fluoroscopy (RX), but its effect on the treatment and outcome of tibial plateau fractures (TFs) is not well known. This study aims to evaluate whether the use of 3DRX in the treatment of tibial plateau fractures reduces the number of revision surgeries. MethodsThis retrospective cohort study includes all patients who underwent surgical treatment for TF in a single center from 2014 to 2018. Patient-, fracture-, and treatment characteristics were compared between the 3DRX and RX subgroups. The primary endpoint was the number of patients requiring revision surgery. Secondary endpoints were surgery duration, hospital length of stay, radiation exposure, postoperative complications, and secondary total knee arthroplasty. ResultsEighty-seven patients were included, of which 36 were treated with 3DRX. Three patients in the RX group required revision surgery, while no revision surgery was performed in the 3DRX group (p = 0.265). The use of 3DRX resulted in significantly more intraoperative adjustments (25% versus 6%; p = 0.024) and an increase in surgery duration (by average of 28 min, p = 0.001), without a significant increase in postoperative wound infections (12% versus 19%; p = 0.374) or fracture-related infections (2% versus 2.8%; p = 0.802). The 3DRX group had an average radiation exposure of 7,985 mGy versus 1,273 mGy in the RX group (p<0.001). The hospital length of stay was 1 day shorter in the 3DRX group (5 days versus 4 days; p = 0.058). ConclusionsImplementing 3DRX in treating TFs improves the assessment of fracture alignment and implant position perioperatively, resulting in more intraoperative corrections and no revision surgeries within 6 weeks postoperatively. However, using 3DRX significantly increases perioperative radiation exposure and surgery duration without a significant rise in postoperative infections and a shorter hospital length of stay.

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

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

Outcome of management of tibial plateau fracture by posterior Lobenhoffer approach: case series.

Displaced Tibiai plateau fractures are complex periarticular injuries. Restoration of the anatomy and internal fixation are key elements for early return to function and better functional outcome. Newer modalities like CT scans has enabled better understanding of these fractures. Posterior approaches were not very common as compared to anteromedial and anterolateral surgical approach. Posterior approach has the advantage of avoiding anterior skin and soft tissues that has been compromised as a result of the fracture; it is also particularly helpful in direct and accurate reduction in certain fracture patterns. This case series highlights the importance of posterior approach to restore the articular surface of complex periarticular proximal Tibial fractures. All displaced tibial plateau fractures with posteromedial fragment were included in the study. Pathological fractures and all open fractures were excluded from this study. Oxford Knee score was done at regular intervals for functional outcome assessment. No wound complications or iatrogenic neurovascular damage were observed with this approach in this series. Anatomical reduction and radiological union was obtained in all patients with excellent functional outcome. We recommend posterior Lobenhoffer approach for fixation in select group of patients with Tibial plateau fractures.

Regional Anesthesia Is Safe and Effective for Low-Energy Tibial Plateau Fractures.

The purpose of this study was to determine if the use of peripheral nerve blocks in the operative management of tibial plateau fractures is associated with improved outcomes when compared with the use of spinal and general anesthesia. Over a period of 16 years, 132 patients who underwent operative repair for a low-energy tibial plateau fracture and had at least 12 months of follow-up met the inclusion criteria and formed the basis of this study. Patients were grouped into cohorts based on the anesthetic method used during surgery: peripheral nerve block in combination with conscious sedation or general anesthesia (BA), general anesthesia alone (GA), or spinal anesthesia alone (SA). Outcomes were assessed at 3 months, 6 months, and 12 months. Length of stay was greatest in the GA cohort (P<.05), and more patients in the BA cohort were discharged to home (P<.05). Patients in the GA cohort had the highest pain scores at 3 months and 6 months (P<.05). Patients in both the SA and BA cohorts had better Short Musculoskeletal Function Assessment scores at 6 and 12 months when compared with the GA cohort (P<.05). Although knee range of motion did not differ among the three cohorts at 3 months, it did differ at 6 months and 12 months postoperatively, with those who had a preoperative nerve blockade (SA and BA) having the greatest knee range of motion (P<.05). Regional anesthesia was safe and was associated with lower pain scores in the early postoperative period and greater knee range of motion and functional outcome scores in the late postoperative period. [Orthopedics. 2023;46(6):358-364.].

PRE-EXISTING KNEE OSTEOARTHRITIS AND JOINT DEPRESSION ARE ASSOCIATED WITH TOTAL KNEE ARTHROPLASTY REQUIREMENT AFTER TIBIAL PLATEAU FRACTURE IN PATIENTS ≥60 YEARS OF AGE

We aimed to determine the rate of and risk factors for post-traumatic osteoarthritis (PTOA) and total knee arthroplasty (TKA) requirement after operative management of tibial plateau fractures (TPF) in older adults.We conducted a retrospective cohort study of 182 operatively managed TPFs in 180 patients ≥60 years old over a 12-year period with minimum follow up 1 year. Data including patient demographics, clinical frailty scores, mechanism of injury, management, reoperation and mortality were recorded. Radiographs were reviewed for: Schatzker classification; pre-existing knee osteoarthritis (KOA); severe joint depression &gt;15mm; and development of PTOA. Kaplan Meier survival analysis was performed. Regression analysis was used to identify risk factors for radiographic indication for TKA and actual TKA.Forty-seven percent were Schatzker II fractures. Radiographic KOA was present at fracture in 32.6%. Fracture fixation was performed in 95.6% cases and acute TKA in 4.4%. Thirteen patients underwent late TKA (7.5%). At five-years, 11.8% (6.0-16.7 95% CI) had required TKA and 20.9% (14.4-27.4 95% CI) had a radiographic indication for TKA. Severe joint depression and pre-existing KOA were associated with worse survival for endpoints radiographic indication for TKA and actual TKA. Severe joint depression (HR 2.49(1.35-4.61 95% CI), p=0.004), pre-existing KOA (HR 2.23(1.17-4.23), p=0.015) and inflammatory arthropathy (HR 2.4(1.04-5.53), p=0.039) were independently associated with radiographic indication for TKA.In conclusion, severe joint depression and pre-existing arthritis are independent risk factors for both severe PTOA and TKA after TPFs in older adults. These features should be considered as an indication for primary management with acute TKA.

Evaluation of Radiological and Functional Outcome of Intra-articular Proximal Tibia Plateau Fracture Treated with Plating.

Proximal tibial plateau fractures are one of the major problems in orthopaedic surgery and are associated with high complication rates. Intra-articular proximal tibia plateau fractures represent approximately 1% of fractures in adults. Various modalities of proximal tibial plateau fracture management have been considered, ranging from simple external fixators in impending compartment syndrome to periarticular proximal tibia plates and inter-locking nails with poller screws. Purpose of this study is to determine clinical outcomes of proximal tibial plateau fractures treated with plate. We did this study of proximal tibial plateau fracture according to Schatzker's classification treated with proximal tibial periarticular plates in 53 patients prospectively admitted at the author's institute from June 2018 to May 2020 with follow-up period of 6 months. In our study, the average knee score was 89.30 (ranging from 79 to 93) and functional knee score was 97.92 (ranging from 75 to 100). Fifty-one (51) patients (96.23%) showed excellent results and 2 patients (3.77%) showed good results according to Knee Society Score, which suggest that internal fixation of proximal tibia plateau fracture with plating provides better results. Out of 53 patients, 9 patients had post-operative complications. Average radiological union was seen at 14 weeks. Locking compression plate in proximal tibia plateau fractures act as a good biological fixation provide stable fixation, articular reduction and limb alignment even in difficult fracture situations. Fixation of proximal tibia plateau fractures with plate gives excellent to good knee society score, with satisfactory functional and radiological outcome.

Functional Outcome of Surgical Management of Tibial Plateau Fractures: A Prospective Observational Study

Background: Because of intra-articular nature, tibial plateau fractures are significant and difficult to manage. Low and high-energy tibial plateau fractures usually result from axial loading in combination with valgus stress forces, present a variety of soft tissue and bony injuries that can produce permanent disabilities. Although there are various modalities for fixation of these fractures with satisfactory results, but there is no general consensus as to which modality is the best in terms of functional outcome and proving the superiority of one over the other. Aim of the Study: The study aimed to evaluate the functional outcome of surgical management of tibial plateau fractures. Methods: It was a prospective observational study conducted in the Trauma Center, Bangabandhu Sheikh Mujib Medical College (BSMMC) &amp; Hospital, Faridpur, Bangladesh during the period from January 2021 to December 2021. In total 85 more than 20 years old patients of both sexes with tibial plateau fractures attended to the mentioned hospital during the first six months of the study were selected as the study population. Obeying the inclusion criteria of this study, only simple fractures of tibial plateau presenting in patients requiring open or closed reduction as well as internal fixation to restore the articular anatomy were finalized for this study. Result: In this study, according to the Schatzker classification and outcomes as per the recommendation of Rasmussen et al., 89% (n=76) patients got acceptable outcomes whereas the rest 11% (n=9) did not get satisfactory results. For majority (55%) of the patients, the union time was found &lt;12 weeks whereas in 2% cases (n=2) incidence of non-union was observed. Besides these, in general grading of patient’s outcome as per patient’s satisfaction, 56% patients got excellent results. Conclusion: In this study we found satisfactory outcomes in majority of the patients but in case of more than 10% cases outcomes were not acceptable. .............

Editor's Spotlight/Take 5: Functional Outcome After Nonoperative Management of Tibial Plateau Fractures in Skeletally Mature Patients: What Sizes of Gaps and Stepoffs Can be Accepted?

1Editor-in-Chief, Clinical Orthopaedics and Related Research®, Park Ridge, IL, USA S. S. Leopold ✉, Clinical Orthopaedics and Related Research®, 300 S. Northwest Highway, Suite 203, Park Ridge, IL 60068, USA, Email: [email protected] A note from the Editor-In-Chief: In “Editor’s Spotlight,” one of our editors provides brief commentary on a paper we believe is especially important and worthy of general interest. Following the explanation of our choice, we present “Take 5,” in which the editor goes behind the discovery with a one-on-one interview with an author of the article featured in “Editor’s Spotlight.” We welcome reader feedback on all of our columns and articles; please send your comments to[email protected]. The author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR® or the Association of Bone and Joint Surgeons®. This comment refers to the article available at: DOI: 10.1097/CORR.0000000000002266.

External fixator pin placement during initial management of tibial plateau fractures: are there parameters to minimize pin-plate overlap?

External fixator pin site overlap with definitive fixation implants (pin-plate overlap) has been identified as a risk factor for surgical site infection in tibial plateau fractures. Despite this, pin-plate overlap occurs in 24-38% of patients. This study sought to identify radiographic characteristics associated with pin-plate overlap to help minimize occurrences. 283 patients at two Level I trauma centers were retrospectively reviewed. Radiographic measurements were recorded including fracture length, distance from fracture to proximal tibial pin site, and pin site distance-to-fracture (PSF) ratio. 70 (24.7%) cases of pin-plate overlap were identified. Pin-plate overlap was associated with increased fracture length (81.5 ± 32.1mm vs 56.9 ± 26.1mm, p < 0.001) and decreased distance from fracture to proximal tibial pin site (84.5 ± 37.1mm vs 126.9 ± 35.8mm). Pins placed greater than 100mm and 150mm from the fracture eliminated 36/70 (51%) and 67/70 (96%) pin-plate overlaps, respectively. Pins placed with a PSF ratio greater than 1.5 and 2.0 eliminated 47/70 (67%), and 57/70 (81%) of pin-plate overlaps, respectively. Longer fractures, pins closer to the fracture, and decreased PSF ratio were associated with overlap. Placing proximal tibial pins more than 100mm from the fracture eliminated most pin-plate overlaps.