Management Of Tibial Plateau Fractures Research Articles

Tibial Plateau Fracture: Anatomy, Diagnosis and Management.

Tibial plateau fractures are peri-articular knee fractures of the proximal tibia. The presentation is dependent on the mechanism of injury. The tibial plateau is the bony platform of the distal half of the knee joint, and is made up of a medial and lateral condyle separated by the intercondylar eminence. The presentation of tibial plateau fractures can vary greatly as a result of the bimodal mechanism of injury and patient characteristics. The patient should be assessed for life- and limb-threatening injuries in accordance with British Orthopaedic Association Standards of Trauma guidelines. Imaging is undertaken to understand configuration of the fracture, which is classified by the Schatzker classification. Definitive management of the fracture depends on the severity, ranging from conservative to surgical management. Surgery is required for more severe tibial plateau fractures to restore articular congruity, mechanical alignment, ligamentous stability and to permit early mobilisation. Medium-term functional outcome after tibial plateau fractures is generally excellent when anatomy and stability is restored. At least half of patients return to their original level of physical activity. Surgical management of tibial plateau fractures is not without complication. Risk factors include postoperative arthritis, bicondylar and comminuted fractures, meniscal removal, instability, malalignment and articular incongruity. Tibial plateau fractures account for 1% of all fractures, and typically occur either as a fragility fracture or secondary to a high-energy impact. These latter injuries are associated with extensive soft tissue injury, life- and limb-threatening complications and long-term sequelae. While outcomes are generally good, severe injuries are at higher risk of infection and post-traumatic arthritis requiring knee arthroplasty. This article considers the anatomy, diagnosis and evidence-based management strategies for tibial plateau fracture.

A study on functional outcome of osteosynthesis for fracture proximal tibia

Background: The ultimate objective in the management of tibial plateau fracture is to ensure anatomic reduction, restore the axial alignment and maintain a stable fixation such a way to prevent the secondary displacement of fracture fragment. The various type of managing the tibial plateau fractures apart from conservative management are open reduction and internal fixation, closed reduction and percutaneous fixation and hybrid type of external fixation. Aim: To evaluate the functional outcome of osteosynthesis of tibial plateau fractures using different surgical techniques after a minimum period of 6 months by using Rasmussen scoring system. Methodology: All patients with proximal tibial fracture in the age group between 20 and 60 years were included as our study subjects. A total of 38 patients were taken as our study subjects. The tibial fractures were classified based on schatzker type of fracture classification. Fracture reduction was done under C-arm guidance by closed methods using ligamentotaxis. After confirming the reduction under C-arm guidance fixation of the fracture was done with locking plate. Functional outcome assessment of knee joint was done after six months post-operatively by using Rasmuseen score, which includes pain perception, walking capacity, extension at knee joint, range of movements and stability.Results: Majority of the patients who had undergone closed reduction with cancellous screw procedure or open reduction and internal fixation with buttress plate and bone graft had the functional outcome between excellent and good whereas patients who had underwent dual plating had a fair to poor outcome and this difference was found to be statistically significant. Pain and knee stiffness were reported in very few patients at the end of 6 months.Conclusion: In the management of tibial plateau fractures, open reduction with internal fixation using plate screws with lesser soft tissue dissection would lead to excellent functional outcome.

OUTCOME OF THE POSTERIOR APPROACH IN MANAGEMENT OF POSTERIOR TIBIAL PLATEAU FRACTURES: CASE SERIES STUDY

Background:. Complex tibial plateau fracture management remains clinically challenging. In recent years, a ‘‘three-column fixation’’ technique was developed to treat the multiplanar complex tibial plateau fractures, which is based on three-dimensional understanding of the fractures. The direct posterior approach to posteromedial fractures of the tibial plateau, with the patient in a prone position, has been used to overcome limitations related to conventional posteromedial approaches. The posterior approach allows for fracture reduction by hyperextension of the knee through axial traction over a surgical bump.Objective: Evaluate the clinical and radiologic efficacy of use of posterior approaches to tibial plateau fractures whether alone or combined with other approaches sequentially or staged for complex tibial plateau fractures with posterior involvement.Patients and methods: this study included twenty seven consecutive patients with tibial plateau fractures involving the posterior column in Orthopaedic Department, Ain Shams University Hospitals-Egypt in the period between August 2016 and August 2018. Cases underwent Lobenhoffer approach for the posteromedial fragment, or posterolateral approach with or without fibula osteotomy for posterolateral fragment fixation. Patients were evaluated radio logically immediately postoperative, at 3, 6, 12, 18 months by serial anteroposterior and lateral x- rays of knee with comparison with preoperative data.Results: The cases were 4 femalesand 23 males, with age range between18-46 years. There was a significant improvement after the surgery regarding the following parameters; pain, extension lag, antero-posterior stability, medio-lateral stability, total range of Flexion, alignment (Varus & Valgus) and Walking distribution. The results showed that 7.4% of the patients had Knee society score (KSS) of 70, 18.5% of the patients had a score of 75, while 29.6% of the patients had a score of 80, only 3.7% of the patients had a score of 85; in addition to 11.1% of the patients had a score of 90, 3.7% of the patients had a score of 95, and 25.9% of the patients had a score of 100.Conclusion: Posterior approaches to tibial plateau fractures whether alone or combined with other approaches was associated with good outcomes along the duration of postoperative follow up and should be advised for management of tibial plateau fractures.

Management of proximal tibial fractures by posteromedial locking compression plate

Management of tibial plateau fractures aims to restore normal knee functionality by near normal anatomical restoration of the articulating surfaces, thereby maintaining the mechanical axis and restoring ligamentous stability. Plate fixation is important when a medial plateau is involved in proximal tibial fractures. The present study was designed to assess the management of medial condylar fractures of proximal tibia treated by posteromedial locking compression plate. A total of 30 cases with Schatzker type IV-VI fractures to the proximal tibia, who followed up for clinic radiological evaluation, between age group 20-60 years were recruited. Clinical examination and radiological investigations were performed to review the fractures. The fractures to the medial condyle of tibia were treated by posteromedial approach. Post-operative care has been initiated with physical therapy in the form of quadriceps exercises. The postoperative follow up was continued at the end of one month, three months and six months and outcomes were recorded by using Lysholm knee score. According to Schatzker type of fractures 46.6% had type IV, 33.3% had type V and 20% had type VI fractures. Majority cases had fractures due to road traffic accidents (70%). Postoperative fracture outcome showed excellent outcome in 78% cases, good results in 16%, fair results in 6% and none of the case had a poor outcome. In postoperative complications, 80% cases were recovered without complications, 10% cases had superficial infection, 7% cases had knee pain, and 3% cases had knee stiffness. The posteromedial approach of tibial fracture management is safe with minimal complications. Fixation of posteromedial tibia permits quick reformation of the patient with outstanding functional outcome with minimal incidence of complication.

Arthroscopic Assisted Reduction and Internal Fixation of Tibial Plateau Fractures

Tibial plateau fractures present an important entity in orthopaedic fractures. They may be associated with other knee injuries such as meniscal tears, cruciate ligaments injuries and collateral ligaments damage. The purpose of this study was to reach the latest advances in the different methods of management of tibial plateau fractures using arthroscope and evaluate the results of arthroscopically assisted reduction and internal fixation of tibial plateau fractures on a series of patients clinicaly and radiologicaly. Our study was a prospective case series study that involved 20 patients with tibial plateau fractures presenting to Benha University Hospitals between the period of September 2017 and November 2019.All fractures were evaluated according to the Schatzker classification and there were 2 type I, 7 type II, 7 type III, 2 type IV and 2 type V. According to the clinical Rasmussen score, 15 patients [75%] had excellent results, [2 type I, 5 types II, 7 types III and 1 type IV], and 5 patients [25%] had good results [ 2 types II, 1 type IV and 2 types V]. Radiologic results were excellent in 14 cases [70 %] and good in 6 cases [30%]. There were no patients who had fair or poor results. ARIF of selected tibial plateau fractures allows anatomic reduction and rigid internal fixation with less morbidity than with ORIF, and has the advantage of superior visualization of the entire joint.

Tibial plateau fracture: does fracture classification influence the choice of surgical approach? A retrospective multicenter analysis.

The role of classification systems for the choice of surgical approach and the management of tibial plateau fractures remains unclear. The purpose of this study was to investigate the potential of classification systems to choose the appropriate operative approach. Current surgical management strategies were investigated in a large multicenter assessment. In this study, we retrospectively analyzed all patients with tibial plateau fractures that have received surgical treatment in one of the five Level I trauma facilities between 2012 and 2015. Fractures were classified in each center by a senior orthopedic surgeon using the AO/OTA and the Luo classification. Demographics, trauma mechanism, as well as the surgical approach were recorded. 538 patients (46.1% male, 53.9% female) were included. The anterolateral approach was used most frequently with 54.8% of all single approaches; 76.2% of all combined approaches used anterolateral as part of the approach. Combined approaches were used in 22.5% of the cases; a combination of the anterolateral and medial (10%), anterolateral, and posteromedial approach (5.8%) were used most frequently. The lowest number was found for the posterolateral (1.3%) and the combined approaches dorsal/anterolateral and medial/dorsal (1.7%, 1.1%). The AO/OTA classification showed a peak for 41.B2 (21.9%) and B3 (35.5%) fractures. Regarding the Luo classification, the dorsal column was involved in 45.7%. In contrast, only 14.7% of the surgical approaches used were able to address the dorsal tibial plateau potentially. The use of dorsal approach seems to be of minor importance than expected in daily clinical practice in this multicenter study. It was not possible to specify whether the AO/OTA or the Luo classification can reliably predict the choice of surgical approach. The operative treatment strategy of tibial plateau fractures seems to rather rely on the surgeons' experience, education, and preferences.

Functional outcome of tibial plateau fracture managed conservatively

<p class="abstract"><strong>Background:</strong> Tibial plateau fractures involve the articular surface of the proximal tibia. They account for approximately 1% of adult fractures. A number of articles have been published regarding tibial plateau fracture management. Interestingly excellent results have been published concluding not all fractures of the tibial plateau require surgery and not all displaced intra-articular fractures need to be reduced surgically. In this method we used conservative method to restore normal joint anatomy, joint stability, and functional motion and avoid complications.</p><p class="abstract"><strong>Methods:</strong> This study design is prospective study including forty randomly selected cases of diagnosed tibial plateau fracture presented in Orthopaedic department of tertiary referral centre over 18 months period and treated with conservative method. The patients then were followed up and evaluation of outcome was analyzed as per modified Rasmussen clinical criteria and radiological criteria at six months.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, tibial plateau fracture was seen more in patients of age group 31-40 (35%). Mean age being 41.25 years. There were 28 (70%) male and 12 (30%) female. Road traffic accident comprises the majority of cases (75%). Regarding radiological outcome, 41.5% had excellent result, 34.3% had good result, 8.5% had fair result and 15.7% had poor result. 84% had acceptable outcome. The Rasmussen’s functional outcome at final follow up was 46% patients had excellent result, 30% had good result, 12% had fair result and 12% had poor result. 88% had acceptable clinical outcome.</p><p class="abstract"><strong>Conclusions:</strong> Conservative management of tibial plateau is still a reliable, inexpensive and alternative treatment option with favourable functional outcome.</p>

Arthroscopy-assisted tibial plateau fracture surgery - Minimum 2 years follow up results

BackgroundAccurate anatomical reduction plays a crucial role in the surgical management of tibial plateau fractures. Arthroscopic visualization of the articular surface can allow for a precise reduction. ObjectivesTo evaluate the outcome of arthroscopy-assisted reduction and internal fixation for tibial plateau fractures, Schatzker Type III to VI. MethodsThirty-five patients with tibial plateau fractures treated by arthroscopy-assisted fixation were enrolled in this prospective study. According to the Schatzker classification, the fractures types were as follows: type III (n=15); type IV (n=6); type V (n=8); type VI (n=6). The mean age was 36 years (range 24–58 years). The mean follow-up period was 38 months (range, 26–72 months). During surgery, initial arthroscopic evaluation was done, followed by provisional reduction using fluoroscopy. Subsequently, a final arthroscopic confirmation was done before definitive fixation. Bone grafting was done in all except 6 patients. Clinical and radiologic outcomes were scored by the Knee society score and Rasmussen system. ResultsThe Knee society functional score and Knee society knee score assessed at 6 months, 1 year and 2 years. Final follow up results showed good to excellent outcome in three out of four patients. With increasing severity of injury (from Schatzker types III to VI), the functional score deteriorated. The Rasmussen’s Radiological Score at 24 months showed good to excellent scores in 86% individuals. The association between the condylar widening and functional score was found to be significant (p value < 0.05). The radiological and functional scoring was found to have a percentage agreement of 24%. Persistence of condylar widening had a less favorable functional outcome. Postoperative wound breakdown and infection are among major complications. ConclusionsArthroscopic assisted fracture fixation for complex tibial plateau fractures with associated soft-tissue injuries is a safe and effective procedure that provides good functional outcomes.

Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures

Background: Proximal tibia is one of the most critical weights bearing part of the human body. Fractures of the plateau affect knee alignment, stability, and motion. The present study was conducted to decide whether pre-operative CT scan significantly changes the line of action and plan of surgery, against simple digital radiographs, in managing fractures of the upper tibial condyles and hence should it be an essential investigation for treatment in proximal tibial fractures.Materials & Methods: The present cross-sectional, prospective study was conducted on 42 cases (males- 37, females-5) of traumatic fractures of the proximal tibia. First opinion was taken on the basis of the X-ray alone and second opinion was taken after showing the CT scans.Results: There were 16 (38.09%) patients in age group of < / = 30 years, 17 (40.48%) patients in age group of 30-45 years, 8 (19.05%) patients in age group of 45-60 years and only 1 (2.38%) patient is the age group of 60-75 years. There were 02 (04.76%) patients diagnosed to have no fracture based on X-ray, 14 (33.33%) patients diagnosed as Schatzker’s type-1, 02 (04.76%) patients diagnosed as Schatzker’s type-2, 05 (11.91%) patients diagnosed as Schatzker’s type-4, 13 (30.95%) patients diagnosed as Schatzker’s type-5 and 06 (14.29%) patients diagnosed as Schatzker’s type-6 based on X-ray alone. A total 12 cases were included in Schatzker’s type 1. Management of 01 case was drastically changed, that of 03 cases had subtle changes and that of 08 cases remained unchanged. Plan of 01 case out of 04 included in Schatzker’s type 2 was changed drastically, 02 underwent subtle changes while that of 01 was unchanged. Only 01 case was included in Schatzker’s type 3. Its management underwent subtle change. 02 cases were diagnosed as type 4. Treatment of 01 underwent subtle change while that of 01 remained unchanged. Plan of 02 cases out of 06 included in type 6 were drastically changed. 04 had no changes.Conclusion: CT scan contributes significantly in management of proximal tibia fractures especially in Schatzker’s type 1 and type 4. It reveals articular depressions and fracture fragments that are often obscured on X-rays. It helps surgeons to prevent dreadful postoperative complications.

A New Approach to Surgical Management of Tibial Plateau Fractures.

Tibial plateau fractures (TPFs) are challenging, requiring complex open reduction and internal fixation (ORIF) and are often associated with complications including surgical site infections (SSIs). In 2007, we introduced a novel management protocol to treat TPFs which consisted of an angiosome- or perforator-sparing (APS) anterolateral approach followed by unrestricted weight bearing and range of motion. The primary aim of this retrospective study was to investigate complication rates and patient outcomes associated with our new management protocol. In total, 79 TPFs treated between 2004 and 2007 through a classic anterolateral surgical approach formed the “Classic Group”; while 66 TPFS treated between 2007 and 2013 formed the “APS Group”. Fracture reduction, maintenance of reduction and patient-reported outcomes were assessed. There was a clinically important improvement in the infection incidence with the APS (1.5%) versus the Classic technique (7.6%) (1/66 versus 2/79 for superficial infections; 0/66 versus 4/79 for deep infections). Despite a more aggressive rehabilitation, there was no difference in the fracture reduction over time or the functional outcomes between both groups (p > 0.05). The APS anterolateral approach improved the rate of SSIs after TPFs without compromising fracture reduction and stabilisation. We continue to use this new management approach and early unrestricted weight bearing when treating amenable TPFs.

Functional and Radiological Evaluation of the Management of Tibial Plateau Fractures

Functional and Radiological Evaluation of the Management of Tibial Plateau Fractures

Intraoperative 3D imaging leads to substantial revision rate in management of tibial plateau fractures in 559 cases

IntroductionThe aim of this study was to evaluate the intraoperative revision rate and reasons for revision following 3D imaging in the management of dislocated articular tibial plateau fractures based on a large patient sample.MethodsThis retrospective cohort study included all patients who underwent open reduction and internal fixation due type B or C tibial plateau fracture according to the AO/OTA classification between August 2001 and December 2017 using intraoperative cone beam CT (3D imaging) for the analysis of fracture reduction and implant placement.The findings of the 3D scan were categorized regarding the amount and type of revision. Furthermore, demographic data was examined.ResultsFive hundred and fifty-nine consecutive fractures were included in the study. Evaluation of the image data records revealed an intraoperative revision due to the usage of 3D imaging in 148 out of 559 cases (26.5%). The most common reasons for an intraoperative revision were insufficient fracture reduction (114 cases) and screw length (21 cases).ConclusionThis study reveals indications for a limited analysis of fracture reduction and implant placement during the operative treatment of dislocated articular tibial plateau fractures using conventional fluoroscopy. In view of the high revision rate during open reduction and internal fixation of tibial plateau fractures due to 3D imaging the usage of intraoperative cone beam, CT may be considered. If this is not possible, a postoperative computed tomography may therefore be reasonable.

Role of computerized tomography in management of complex high energy tibial plateau fractures

Introduction: Tibial Plateau fractures are some of the commonest fractures that occur and comprise 1% of all fractures. Plain X - ray radiography has been routinely employed over the period of years to diagnose and treat tibial plateau fractures. Careful preoperative planning using CT scans has shown better radiological outcomes postoperatively. Aims and Objectives: To evaluate the role of CT scans in the management of tibial plateau fractures. Materials and Methods: 30 cases of tibial plateau fractures admitted and treated at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram between May 2016 to September 2018 were taken into the study and evaluated using Rasmussen's knee scoring for functional outcome and 18 cases had CT scan of knee preoperatively whereas 12 cases had plain X rays. Results: Two cases who had preoperative isolated X rays without CT scans had superficial surgical site skin infection and one among them required subsequent bone grafting and additional lateral plating Most patients who had isolated X rays for preoperative evaluation had comparable functional outcome with the patients who had preoperative CT scan although intraoperative time duration was relatively more compared to the patients who had preoperative CT scans. Conclusion: Although three dimensional CT scans of the proximal tibia provide accurate delineation of the fracture configuration, and may even reveal what plain X rays fail to show, they are not as mandatory so as to affect the functional outcome following fracture fixation provided the surgeon expects and is prepared to deal with the newly discovered intraoperative fracture configuration.

Safety and Complications Associated With MRI-Conditional External Fixators in Patients With Tibial Plateau Fractures: A Case Series

To address the safety of obtaining magnetic resonance imaging (MRI) in patients with temporary knee-spanning external fixators placed for tibial plateau fractures. Institutional Review Board-approved retrospective review. Level 1 trauma center. Records were reviewed on patients with knee-spanning external fixators applied during staged management of tibial plateau fractures from 2009 to 2015 and who also had an MRI performed. Complications associated with the MRI; secondary outcomes were pain scores, narcotic requirements, and fracture healing. A total of 56 patients with 57 fractures were included, and 55 scans (96.5%) were completed without complication. Two scans (3.5%) were stopped prematurely for patient-reported pain and subjective warmth of the external fixator. For all 57 studies, pain scores and narcotic usage were unchanged, and all fractures healed without complication. Knee-spanning external fixator placement does not preclude MRI for patients with tibial plateau fractures. MRIs can be safely performed on patients with external fixators if patients are educated before imaging. Even in the small percentage of patients who experienced discomfort, there were no long-term complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Primary and Secondary Total Knee Arthroplasty for Tibial Plateau Fractures.

The surgical management of tibial plateau fractures can be technically demanding. In younger patients, the mainstay is fixation with cartilage preservation. In older patients with osteoporotic bone, this method has higher rates of fixation failure; in addition, it requires prolonged bed rest or protected weight bearing, which are major challenges in this group. In contrast, total knee arthroplasty performed acutely for primary treatment of tibial plateau fractures has potential advantages for elderly patients, such as immediate stability, early mobilization, and positive functional outcomes with decreased rates of reoperation. Additionally, arthroplasty can be technically challenging in younger patients with previous tibial plateau fractures in whom debilitating posttraumatic arthritis develops. In these patients, old wounds, retained metalwork, bony deficiency, and instability can lead to poorer outcomes and higher complication rates than in routine knee arthroplasty. In both cases, we recommend surgery be performed by experienced arthroplasty surgeons with ample access to a range of implants with varying constraints and the option of stems and augments.

Management of tibial condylar fractures in adults: A prospective study

Tibial condylar fractures are specially challenging to the Orthopaedic surgeons because of their variation, complexity, and injuries associated with it. Proximal tibia gives attachment to the various elements of knee stabilizers and is an integral part of the knee mechanism. So, alteration of its anatomy caused by injury result in functional impairment of knee. A study has been carried out to know the mode of injury, fracture pattern, outcome of various modalities of treatment, complications encountered and associated with management of tibial condylar fractures in adults. Study consists of 35 patients with tibial condylar fractures. Out of 35 patients, 12 patients were managed by conservative methods and remaining 23 Patients were managed by surgical methods. Conservative treatment included closed reduction and above knee cast application and surgical management included CRIF with CCS or ORIF with BP with or without bone grafts. Functional evaluation of the knee was done, based on the modified HohI and Luck evaluation methods. Incidence of osteoarthritis was assessed based on the most recent radiograph of tile patient’s weight bearing. The management of tibial plateau fracture has always been a subject of debate because of their variety and complexity. It is concluded that surgery is the treatment of choice for displaced fractures belonging to Schatzker type I and II. Schatzker’s type III fractures can be managed conservatively if the depression is less than 2 mm. Schatzker’s type IV and V can be managed by open reduction and internal fixation with Buttress plate and bone grafting especially in young individuals who require perfect anatomical reconstruction of the articular surface, stable fixation and early mobilization. Conservative method is a valid and useful alternative for undisplaced Schatzker type I fractures.

A prospective study of surgical management of tibial plateau fractures by locking compression plate

Aim: To assess the clinical and functional outcome of surgically treated tibial plateau fractures with internal fixation by locking compression plated at SSIMS-RC, DAVANAGERE during JUNE 2015 TO FEBRUARY 2017. Objectives 1. To re-establish the anatomy of articular surface of upper end of tibia and knee joint perfectly by operative treatment with internal fixation. 2. To assess the radiological union of fractures after internal fixation with locking compression plate. 3. To assess the functional outcome of knee joint Materials and methods: Total number of cases studied were 30. Inclusion criteria: Skeletally mature patients with tibial plateau fractures. Exclusion Criteria: Patients with Gustilo- Anderson Type 3 compound tibial plateau fractures, Children with proximal tibial fractures in whom the growth plate is intact, patients with pathological proximal tibial fractures apart from osteoporosis, Patients managed conservatively for other medical comorbidities, Ipsilateral intraarticular fracture femur and patella. Observation and results: Rassmussens criteria was used for evaluation of results. Out of 30 cases., we are able to achieve 66.66% excellent result and 20% good result( over all 86.66%, acceptable results ) with our standard surgical care. in addition we have 13.33% fair and results interm of functional outcome. Conclusion: From this study we conclude that, surgical management of tibial plateau fractures gives excellent anatomic reduction, accurate axial and articular alignment with rigid internal fixation by locking compression plate and achieves a stable and functional knee joint. Preoperative soft tissue status and associated ligamentous injuries and their repair at right time, significantly changes the final outcome.

Arthroscopically Assisted Fixation of the Tibial Plateau Fractures

Objectives: To consolidate the current literature and find the evidence of any advantages of the use of the above mentioned techniques and also to emphasize the need for well-designed studies to evaluate long- and short-term function and risk of posttraumatic osteoarthritis in arthroscopically-assisted treated patients.Background: The role of arthroscopy in the fixation of tibial plateau fractures has been advocated in the literature in the last decades. A number of papers have been published regarding Arthroscopically Assisted Internal Fixation (mainly) and Arthroscopically Assisted External Fixation (significantly smaller amount of papers) of tibial plateau fractures.Materials and Methods: 29 studies including 983 patients were identified via Pubmed search. Most of them are small studies, poorly controlled and with potential bias.Results: Despite the small amount of studies comparing ARIF with ORIF technique and studies with an average follow up longer than 3 years), the advocates of ARIF suggest, that this technique can have a key role in the management of tibial plateau fractures and is the treatment of choice for associated intra-articular pathology. Nevertheless, most of these studies, if not all, are selected, small studies, poorly controlled and with potential bias.Conclusions: There is a need for well-designed studies to evaluate long- and short-term function and risk of posttraumatic osteoarthritis in arthroscopically-assisted treated patients.

Circular external fixation in the management of tibial plateau fractures in patients over the age of 55 years

CITATION: Marais, L. C. & Ferreira, N. 2018. Circular external fixation in the management of tibial plateau fractures in patients over the age of 55 years. SA Orthopaedic Journal, 17(4):35-40, doi:10.17159/2309-8309/2018/v17n1a5.

Tibial plateau fracture management: arthroscopically-assisted versus ORIF procedure – clinical and radiological comparison

IntroductionTibial plateau fractures are articular injuries that may influence final functional outcome of the knee. Although these fractures comprise only 1% of all fractures, the fracture pattern is usually complex and requires anatomical reduction and absolutely stable fixation to achieve satisfactory results. The development of knee osteoarthritis is a common late complication and it can be strongly influenced by additional, underestimated cartilage defects, and meniscal and ligament tears. Materials and methodsBetween January 2012 and February 2015, a total of 78 patients with tibial plateau fractures (Schatzker type I-III) were enrolled in the study. Patients were divided into two groups: one group was treated with arthroscopically-assisted reduction and internal fixation (ARIF) and the other with open reduction and internal fixation (ORIF). The final number of patients was 75; 40 in the ARIF group and 35 in the ORIF group. Radiography and computed tomography were used to assess fracture pattern. An immediate postoperative radiograph was performed, and then repeated at 6 weeks, and 3,6 and 12 months after surgery. Demographic data (age and sex), additional intraarticular injuries, hospital stay and complications were noted, and clinical and radiological Rasmunssen score at 3, 6 and 12 months after surgery were evaluated. ResultsAdditional intraarticular lesions were found in 27 patients; 20 in the ARIF group and 7 in the ORIF group (p = 0.06). There was a statistically significant difference in average duration of hospital stay: 3.10 ± 0.63 days for the ARIF group and 5.51 ± 1.66 days for the ORIF group (p = 0.0001). All fractures healed within 3 months following surgery. The overall complication rate was 12%. There was no statistically significant difference in complication rate between the two groups (p = 0.63). Clinical and radiological scores were excellent in most patients in both groups. There was no statistically significant difference in average clinical and radiological Rasmunssen scores between the two groups. ConclusionsBoth ARIF and ORIF can provide equally good results; however, ARIF seems to offer a more precise evaluation and treatment of associated intraarticular lesions and to reduce the duration of hospital stay.