Medial Tibial Plateau Fractures Research Articles

Étude comparative biomécanique de l’ostéosynthèse par plaque vissée versus vis dans les fractures du plateau tibial médial de type Schatzker 4

Introduction The objective of this biomechanical study was to compare the respective efficiency of plate-screw fixation and screw fixation in an experimental model of a Schatzker type IV fracture. Hypothesis Screw fixation and plate fixation have a similar load to failure. Materials and methods This study compares the stability of Schatzker type IV medial tibial plateau fractures fixed with either three 6.5 mm cancellous bone screws with a 16 mm threaded segment or with six-holed buttress T plate-screw system. A Schatzker type IV fracture was modeled on an artificial bone model. In a first group of 10 fracture models, following the anatomical reduction, fractures were stabilized with screws with washers. In the second group of 10 fracture models, fractures were stabilized with T plate. After fixation, ascending axial compression was applied on bone models (Instron machine). Results Load bearing capacity was 1397.6 ± 194.4 in group I and 2153.2 ± 204.4 in group II. The difference between two groups were statistically significant ( p < 0.001). Discussion According to this result, experimental load bearing of bone models indicates that plate-screw fixation system has a significantly higher stabilization capacity than fixation with three screws alone. Our hypothesis was not confirmed. In order to maintain anatomical repositioning, the plate-screw system is a more stable fixation method than the screw in medial tibial plateau fractures of Schatzker type IV.

Biomechanical comparison of plate-screw and screw fixation in medial tibial plateau fractures (Schatzker 4). A model study

The objective of this biomechanical study was to compare the respective efficiency of plate-screw fixation and screw fixation in an experimental model of a Schatzker type 4 fracture. screw fixation and plate fixation have a similar load to failure. This study compares the stability of Schatzker type 4 medial tibial plateau fractures fixed with either 36.5mm cancellous bone screw with a 16 mm threaded segment or with six-holed buttress T-plate-screw system. A Schatzker type 4 fracture was modeled on an artificial bone model. In a first group of 10 fracture models, following the anatomical reduction, fractures were stabilized with screws with washers. In the second group, of 10 fracture models, fractures were stabilized with T-plate. After fixation ascending axial compression was applied on bone models (Instron machine). Load bearing capacity was 1397.6+/-194.4N in the Group 1 and 2153.2+/-204.4N in the Group 2. The difference between the two groups was statistically significant (p<0.001). According to this result, experimental load bearing of bone models indicate that plate-screw fixation system has a significantly higher stabilization capacity than fixation with three screws alone. Our hypothesis was not confirmed. In order to maintain anatomical repositioning, plate-screw system is a more stable fixation method than the screw in medial tibial plateau fractures Schatzker 4 LEVEL OF EVIDENCE: 1.

Use of a Midline Anterior Incision for Isolated Medial Tibial Plateau Fractures

A technique using an anterior midline incision with a medial parapatellar arthrotomy and a medial full-thickness skin flap for the open reduction and internal fixation of isolated medial tibial plateau fractures is presented. The approach is advocated as an alternative to a posteromedial approach when medial tibial plateau fractures are present alone. The anterior approach is simple and familiar for orthopaedic surgeons. It offers good visualization, simplifies reduction, and provides a functional scar if future procedures are necessary.

Biomechanical characteristics of fixations parallel to the plateau and vertical to the fracture line in the early management of fractures of tibial plateau in rabbits

Objective To evaluate the biomechanical characteristics of fixations parallel to the tibial plateau and vertical to the fracture line in the early management of fractures of tibial plateau in rabbits. Methods Models of oblique split fractures of the medial tibial plateau were created in 30 New Zealand rabbits of 13 months. One fibial plateau was fixed with 3 lag screws （2. 0 mm） parallel to the articular surface while the contralateral plateau was stabilized with 3 lag screws （2. 0 mm） vertical to the fracture line. The specimens were harvested at 0, 1, 2, 4, and 8 weeks after operation respectively and tested in a biomechanical testing machine. The maximum load of anti-compression at the medial tibial plateau and the maximum work at the maximum load, as well as the load and work as the articular surface displaced downwards for 2mm, were recorded. Results The biomechanical comparison of the 2 methods at the same time points showed that there were no significant differences at 0, 1 and 8 weeks but significant differences at 2 and 4 weeks. The biomechanical comparison of the same method at different time points showed that the biomechanical measures decreased at the early period after operation, then increased and finally kept steady at 4 or 8 weeks. Con- clusions The stability of tibial plateau fractures in rabbits decreases at the early post-operation and gradually increases to the normal level. It takes less time for the fixation parallel to the tibial plateau to increase the biomechanical stability to the normal level than the fixation vertical to the fracture line. The parallel fixation can provide more biomechanical advantage in stabilization of the fractures than the vertical one. Key words: Tibial fracture; Knee joint; Biomechanics

A case of compression fracture of medial tibial plateau and medial femoral condyle combined with posterior cruciate ligament and posterolateral corner injury

We report a case of compression fracture of anterior margin of medial tibial plateau and medial femoral condyle combined with the posterior cruciate ligament and posterolateral corner disruption. A thirty-seven-year old male had undergone the left knee injury 6 months before. The physical examination revealed positive posterior drawer test and tibial dial test, which evidenced the posterior cruciate ligament and posterolateral corner insufficiency. The plain lateral knee radiographs showed a marginal fracture of the anteromedial tibial plateau and a dimpling on the adjacent part of the medial femoral condyle. On arthroscopy, there were no gross tear of the cruciates, but the posterolateral capsule disclosed stigmata of stretching injury with multiple petechiae and scarring. The compression fracture on the anteromedial side and the stretching injury on the posterolateral side altogether support the mechanism of hyperextension pivoting on the anteromedial side of the knee joint. A small bony lesion around the knee joint should be inspected rigorously with an assumed mechanism of injury for it may herald major ligamentous injury.

Biomechanical comparison of two screw fixations in treatment of tibial plateau fractures ZHANG

Objective To compare the biomechanical stabilities of 2 fixations for oblique split fractures of tibial plateau. Methods Oblique split fractures of the medial tibial plateau were simulated by osteotomy in 6 pairs of fresh tibia of adult swine. One fracture of each pair was fixed with 3 lag screws parallel to the articular surface whereas the contralateral site was stabilized with 3 lag screws vertical to the fracture line. The maximum anti. Compression load, the maximum power consumption at the maximum load.the load and power consumption at the 2 mm subsidence of articular surface were measured and recorded. Results There were no significant differences between the 2 groups in the maximum anti-compression load. The maximum power consumption at the maximum load, the load and power consumption at the 2 mm subsidence of articular surface. Conclusion Vertical fixation may not provide a biomechanical advanrage over the parallel fixation in stabilizing oblique split fractures of tibia plateau. Key words: Tibial fracture; Knee joint; Biomechanics; Experimental study

Medial Buttress Versus Lateral Locked Plating in a Cadaver Medial Tibial Plateau Fracture Model

To compare the mechanical stability of a medial tibial plateau fracture model secured with a lateral locking periarticular plate versus a medial buttress plate in cyclic testing and load to failure. Medial tibial plateau fractures were created in 6 matched pairs of fresh cadaveric tibias. In each pair of tibias, 1 side was randomly selected to be fixed with a lateral locking plate on 1 side and the contralateral limb to be fixed with a medial buttress plate. The fixated tibias then underwent cyclic testing followed by single-cycle failure compressive loading. Displacement of the medial tibial plateau was measured in both cyclic and failure testing. Statistical analyses revealed relevant trends in fixation strength during cyclic testing, but neither the mean maximum displacement during nor mean residual displacement after cyclic testing were statistically different between the 2 fixation techniques. Statistically significant differences were observed for the mean forces to failure however. The medial buttress plate construct provided greater fixation strength with its failure force of 4136 +/- 1469 N compared with the lateral locking plate mean failure force of 2895 +/- 1237 N (P < 0.05). In the setting of a vertically oriented fracture in a medial tibial plateau without comminution, the medial buttress plate provides significantly greater stability in static loading, and a trend toward improved stability with cyclic loading. Clinical correlation is necessary to substantiate these findings.

Analysis of failed surgical treatments of the medial tibial plateau fractures

目的 分析胫骨内侧平台骨折手术治疗失败的原因,并为内侧平台骨折提出具体分型,以指导治疗,减少并发症.方法对1998年6月～2004年9月间手术治疗失败的17例胫骨内侧平台骨折进行回顾性分析,对骨折类型、固定方法、骨折复位质量及术后康复等因素进行综合评估,分析造成手术失败的可能原因;同时根据内侧平台骨折的影像学资料及临床特点进行具体分型.结果17例失败患者伴有严重的膝关节功能障碍,HSS膝关节功能评分平均为41分(24～54分).手术治疗失败原因:手术方法不当4例,固定方法选择不当11例,术后康复治疗错误2例.结论骨折复位不良、固定方法选择不当、对软组织情况及肢体力线缺乏足够的认识与重视及术后错误的康复治疗均是胫骨内侧平台骨折手术失败的原因,根据具体的骨折类型及软组织条件制订适当的治疗计划是手术成功的关键。

Medial Tibial Plateau Fracture Complicating Unicompartmental Knee Arthroplasty

We describe a new cause of a medial tibial plateau fracture complicating the early postoperative rehabilitation following unicompartmental knee arthroplasty. The patient was successfully treated by open reduction and internal fixation by buttress plating the fracture and retaining the prosthesis. The treatment option used proved to be successful, although careful patient selection for unicompartmental knee arthroplasty should be recommended to decrease the risk of this complication.

Screening for extermity arterial injury with the arterial injury with the arterial pressure index

Certain extremity injuries presenting to the ED or Trauma Unit warrant increased suspicion for underlying arterial trauma. Such injuries include knee dislocations, displaced medial tibial plateau fractures and other displaced bicondylar fractures around the knee, open or segmental distal femoral shaft fractures, floating joints, gunshot wounds in proximity to neurovascular structures, or mangled extremities. Once the diagnosis of arterial trauma is made, a multi-disciplinary approach is warranted. The diagnostic strategies for vascular injury have undergone an evolution over the past 2 decades. One and a half percent to 4.6% of patients hospitalized with blunt extremity trauma have associated vascular compromise [Bunt TJ, Malone JM, Moody M, et al. Am J Surg 1990;160(2):226-8; Reid JD, Weigelt JA, Thal ER, et al. Arch Surg 1988;123(8):942-6; Applebaum R, Yellin AE, Weaver FA, et al. Am J Surg 1990;160(2):221-4; discussion 224-5; Dennis JW, Frykberg ER, Veldenz HC, et al. J Trauma 1998;44(2):243-52; discussion 242-3]. An efficient and effective evidence-based approach to diagnosing vascular injury is necessary, as the difficulty in diagnosis, the multiplicity of diagnostic strategies, the limited time frame in which to initiate appropriate treatment, the limb threatening complications of a missed diagnosis, and the increased awareness of health care expenditures make this entity an intimidating diagnostic challenge [Johansen K, Lynch K, Paun M, et al. J Trauma 1991;31(4):515-9; discussion 519-22; Lynch K, Johansen K. Ann Surg 1991;214(6):737-41; Walker ML, Poindexter Jr JM, Stovall I. Surg Gynecol Obstet 1990;170(2):97-105; Kendall RW, Taylor DC, Salvian AJ, et al. J Trauma 1993;35(6):875-8]. The purpose of this article is to present an evidence-based algorithm for patients who present with either arterial injury or a high-risk of arterial injury. A diagnostic algorithm will be presented, and the rationale for diagnostic interventions will be discussed in the context of current medical literature.

Comparison of a mobile with a fixed tibial bearing unicompartimental knee prosthesis: a prospective randomized trial using a dedicated outcome score

Between February 1996 and December 1997, forty consecutive patients with medial compartment knee arthritis were assigned randomly into two groups. All underwent a unicompartimental knee replacement. The tibial prosthesis in group A (20 knees) had a fixed bearing and in group B (20 knees) a mobile bearing. The average age was 69. Five in group A and 71 in group B. Pre-operatively, and at an average follow-up of 5.7 years, all the knees were assessed using both a dedicated UKR score specifically developed and adopted by the Italian Orthopaedic Unicompartimental Knee Replacement Users Group (GIUM) and the Knee Society Score. During surgery in group B we experienced a medial tibial plateau fracture fixed intra-operatively. One prosthesis in group A required an early revision to a TKR because of a continuous pain without any evident sign of loosening. There were no meniscal dislocations in group B. No statistically significant difference in outcome was observed between the two groups at the latest follow-up.

Musculoskeletal-Chronic Left Knee Pain in a High School Athlete Competing in Football and Basketball

0109 HISTORY: A 15 year-old high school basketball and football player presents with complaint of intermittent left knee pain for 3 months. One week prior to presentation, the athlete notes that while running and cutting in football practice he “felt something pop in his left knee during contact drills.” After this episode, the patient describes acute swelling over his left knee, occasional “locking” of the knee, and has had to reduce his activities to non-contact drills due to the increased pain with his left knee. The pain presently is located over “the front, inside part of my knee.” Denies any 'giving out' of the knee when ambulating, and has no difficulty ascending or descending stairs. PHYSICAL EXAM: On examination, atrophy of the left thigh over vastus medialis (left thigh girth 2 cm smaller in diameter). Tenderness over medial femoral condyle and anteromedial aspect of knee. Small joint effusion was noted over the left knee. Normal range of motion, no other areas of point tenderness over patella, patellar tendon, or tibial tubercle, and normal patellar tracking with negative apprehension test. No point tenderness over medial or lateral joint lines. Negative Lachman's, posterior drawer, valgus and varus stress testing. Negative McMurray's test. Wilson's test negative. Tanner stage 4. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of the Knee Stress Fracture of the Knee Medial Meniscal injury Medial Collateral Ligament Sprain Patellar subluxation Tibial Plateau fracture Idiopathic Anterior Knee pain (patellofemoral knee syndrome) TESTS AND RESULTS: Left Knee plain radiographs – Partial loose body defect of lateral part of medial femoral. FINAL/WORKING DIAGNOSIS: Osteochondritis Dissecans of the Left Knee TREATMENT AND OUTCOMES: Restriction of all athletic competition and placed on non-weight bearing status via crutches. Two fragments were fixed into position using Acutrak screws followed by chondroplasty. Athlete was placed into immobilizing brace and advised to follow up on a monthly basis to determine weight bearing status via physical examination and follow up radiographs. Follow up radiographs from his first visit showed good approximation of osteochondral body in situ by Acutrak screws. Due to the osteochondral body in situ, patient will likely be non-weight bearing for 8–12 weeks with avoidance of pivoting. For the first 4 weeks, the patient was advised to start range-of-motion exercises with extension and flexion only. Following this, he will start quadriceps strengthening and rehabilitation of left knee. The athlete will likely return to sports in 3–4 months from surgery with graded progression of activity.

Musculoskeletal-Chronic Left Knee Pain in a High School Athlete Competing in Football and Basketball

0109 HISTORY: A 15 year-old high school basketball and football player presents with complaint of intermittent left knee pain for 3 months. One week prior to presentation, the athlete notes that while running and cutting in football practice he “felt something pop in his left knee during contact drills.” After this episode, the patient describes acute swelling over his left knee, occasional “locking” of the knee, and has had to reduce his activities to non-contact drills due to the increased pain with his left knee. The pain presently is located over “the front, inside part of my knee.” Denies any 'giving out' of the knee when ambulating, and has no difficulty ascending or descending stairs. PHYSICAL EXAM: On examination, atrophy of the left thigh over vastus medialis (left thigh girth 2 cm smaller in diameter). Tenderness over medial femoral condyle and anteromedial aspect of knee. Small joint effusion was noted over the left knee. Normal range of motion, no other areas of point tenderness over patella, patellar tendon, or tibial tubercle, and normal patellar tracking with negative apprehension test. No point tenderness over medial or lateral joint lines. Negative Lachman's, posterior drawer, valgus and varus stress testing. Negative McMurray's test. Wilson's test negative. Tanner stage 4. DIFFERENTIAL DIAGNOSIS: Osteochondritis Dissecans of the Knee Stress Fracture of the Knee Medial Meniscal injury Medial Collateral Ligament Sprain Patellar subluxation Tibial Plateau fracture Idiopathic Anterior Knee pain (patellofemoral knee syndrome) TESTS AND RESULTS: Left Knee plain radiographs – Partial loose body defect of lateral part of medial femoral. FINAL/WORKING DIAGNOSIS: Osteochondritis Dissecans of the Left Knee TREATMENT AND OUTCOMES: Restriction of all athletic competition and placed on non-weight bearing status via crutches. Two fragments were fixed into position using Acutrak screws followed by chondroplasty. Athlete was placed into immobilizing brace and advised to follow up on a monthly basis to determine weight bearing status via physical examination and follow up radiographs. Follow up radiographs from his first visit showed good approximation of osteochondral body in situ by Acutrak screws. Due to the osteochondral body in situ, patient will likely be non-weight bearing for 8–12 weeks with avoidance of pivoting. For the first 4 weeks, the patient was advised to start range-of-motion exercises with extension and flexion only. Following this, he will start quadriceps strengthening and rehabilitation of left knee. The athlete will likely return to sports in 3–4 months from surgery with graded progression of activity.

Anterior part of the medial tibial plateau fracture accompanied by hyperextension injury of the knee

Anterior part of the medial tibial plateau fracture accompanied by hyperextension injury of the knee

Stabilization of proximal tibial fractures with the LIS-System: Early clinical experience in Berlin

The Proximal Tibia Less Invasive Stabilization System (LISS PLT) is an internal fixator for the treatment of proximal tibial fractures according to the principles of "Minimally invasive surgery". From July 1998 to August 2000 22 fractures were treated in our clinic with the new Proximal Tibia LISS and the prospective course of healing was documented. The period of follow-up was 12 months. The inclusion criteria were defined as proximal tibial shaft fractures and intraarticular proximal tibial fractures of all degrees of severity. A total of 15 proximal medial and lateral tibial plateau fractures (AO 41) and 7 metaphyseal fractures were treated (AO 42), seven of these fractures presented with open soft tissue damage. The average age of the patients treated was 42 years. With a follow-up rate of 91% (2 patients lost to follow-up), definite consolidation of the fracture was seen in 19/20 cases. In one patient, the fracture had only been partially bridged and secondary bone grafting was performed. Radiologically, there was one case of a varus malalignment of 6 degrees, in two further cases there were valgus malalignments of 5 degrees and 7 degrees at the time of surgery. The other cases all healed in correct alignment. In one case, the implant became loose on the distal shaft and was stabilized again using bicortical screws. In a case with type IIIB soft tissue damage, a soft tissue infection became manifest, but healed uneventfully after a revision operation with the implant in situ.

Impact load transmission of the knee joint-influence of leg alignment and the role of meniscus and articular cartilage

Objective. The objective of this study was to evaluate load transmission in the cancellous bone of the tibia under static and impact load. Background. Abnormal transmission of loads may result in osteoarthritis and fractures. However, the role of the cancellous bone in these processes is not well understood. Methods. The compressive stresses in the subchondral bone, epiphysis and diaphysis of the tibia of porcine knees were measured under static and impact load using mini-pressure transducers. The tests were performed using a drop-tower type testing machine in neutral, varus and valgus alignments. Tests were repeated after meniscectomy and again after removing the articular cartilage. Results. In the intact knee in all alignments, the highest stress on the medial side was found in the epiphysis, and in the subchondral bone on the lateral side. After meniscectomy, a significant increase was observed in the stress in the subchondral bone on both sides. After the articular cartilage was also removed, the stress in the subchondral bone increased again, but slightly. Conclusion. The importance of the meniscus in load transmission is supported by this study. The contribution of the articular cartilage to load transmission is less than that of the meniscus. Relevance. The patterns of static and dynamic load transmission observed in this study correlate with the sites of insufficiency fractures of the medial tibial plateau and traumatic lateral tibial plateau fractures observed clinically. Examination of the load transmission is key to a more complete understanding of the causes of osteoarthritis and tibial plateau fractures.

Nonunion of Tibial Fracture With Bone Defect

Dr. Turner: A 19-year-old college student was thrown through the rear door of an automobile following a two-car collision. He was admitted to a hospital in a neighboring state and was found to have the following multiple injuries: bilateral fractured pubic rami; bladder and urethral lacerations; bilateral closed femoral-shaft fractures; closed fracture-dislocation of the right ankle; closed fracture of the right medial tibial plateau; right peroneal nerve palsy; open fractures of the left tibia and fibula with gross contamination and loss of approximately five inches of the middle portion of the tibia. Blood supply and sensation were entirely normal in the left foot. After initial management of shock by transfusion with seven units of whole blood, laparotomy was performed to repair the lacerated bladder. He was placed in bilateral balanced suspension with bilateral proximal tibial wires for traction. The left leg wound was debrided and packed open, but became grossly