Rasmussen Score Research Articles

Surgical Treatment of Lateral Tibial Plateau Fractures Involving the Posterolateral Column.

ObjectiveTo summarize the indications and the clinical effects of a transfibular neck osteotomy approach and a combined anterolateral and posterolateral approach in the treatment of fractures of the lateral tibial plateau involving the posterolateral column.MethodsEleven patients with lateral tibial plateau fractures were included in the present study. The fractures were Schatzker type II or lateral platform fractures involving posterolateral column. The anterolateral combined posterolateral approach (lateral + posterolateral locking plate fixation) was applied in 7 patients and 4 patients underwent transfibular neck osteotomy (lateral + posterolateral locking plate fixation + 1/4 tubular plate edge fixation, fibular osteotomy with Kirschner wire tension band fixation, and hollow nail fixation for upper tibiofibular joint). All cases were followed up for 12–24 months, with an average follow‐up of 17.5 ± 5.0 months. At the last followup, the Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation. The knee joint function was evaluated using the knee function evaluation criteria of the Hospital for Special Surgery (HSS). The Lachman test and the pivot‐shift test were used to evaluate the anterior and posterior and rotational stability of the knee joint. The range of knee motion was recorded.ResultsBone healing was achieved in all patients with fractures treated with a transfibular neck osteotomy approach and a combined anterolateral and posterolateral approach. At the last follow‐up, both the Lachman test and the pivot‐shift test results were negative. All patients had complete knee extension. For the combined anterolateral and posterolateral approach, the knee flexion angle was 110°–130°, with an average of 122.86° ± 7.56°. For the transfibular neck osteotomy approach, the knee flexion angle was 115°–130°, with an average of 120.00° ± 7.07°. For the patients in which the combined anterolateral and posterolateral approach was used, the Rasmussen score was 12–18 points, with an average of 16.00 ± 2.56 points. The results were excellent in 4 cases and good in 3 cases; therefore, 100% of results were excellent or good. For patients in which the transfibular neck osteotomy approach was used, the Rasmussen score was 10–18 points, with an average of 15.25 ± 3.77 points. The results were excellent in 2 cases, good in 1 case, and acceptable in 1 case; therefore, 75% of results were excellent or good. The HSS score for the combined anterolateral and posterolateral approach was 76–98 points, with an average of 88.43 ± 7.55 points. The results were excellent in 5 cases and good in 2 cases; therefore, 100% of results were excellent or good. The HSS score for the transfibular neck osteotomy approach was 74–96 points, with an average of 87.25 ± 9.43 points. The results were excellent in 3 cases and good in 1 case; therefore, 100% of results were excellent or good. There were no significant differences in operation time, surgical blood loss, fracture healing time, postoperative imaging score, and knee function evaluation between the two approaches. One patient who underwent transfibular neck osteotomy had a 3‐mm step that gradually appeared, but no significant abnormalities were found in the width of the platform and the lower limb force line. One patient in whom the combined anterolateral and posterolateral approach was used showed numbness in the common peroneal nerve. No common peroneal nerve injury occurred through the transfibular neck osteotomy approach.ConclusionsThe anterolateral combined posterolateral approach and the transfibular neck osteotomy approach are effective in the surgical treatment of lateral tibial plateau fractures involving the posterolateral column. However, the transfibular neck osteotomy approach is more suitable for the posterolateral plateau articular surface damaged with bone separation and displacement, deep collapse, cases involving a large range of the posterolateral column, especially fractures of the lateral tibial plateau in the upper tibiofibular syndesmosis area of the line connecting the anterior and posterior margin of the fibular head to the midpoint of the plateau.

Comparison of a modified technique with conventional tension-band using Cable Grip System for comminuted patella fractures

IntroductionTreatment of comminuted patella fractures with tension band has resulted in impaired functional outcomes because the relationship between tension band and the tendons is always underestimated. We developed a modified enlacement (ME) technique to better place the tension-band under the quadriceps and patellar tendons and close to the patella. The study aimed to compare the ME with conventional enlacement (CE) technique regarding recovery of knee function. Patients and methods51 patients with comminuted patella fractures operated between January 2012 and December 2016 were reviewed retrospectively. 22 patients in the ME group (9 males and 13 females) with a mean age of 51.3 years, 29 patients in the CE group (16 males and 13 females) with a mean age of 47.1 years. ROM was measured at postoperative intervals of 1, 2, 4, 12, and 48 weeks; Knee function was evaluated using the Rasmussen scores at 4, 12, and 48 weeks postoperative. ResultsThere was no difference (P = 0.082) regarding the fracture healing time between the two groups. Patients with the ME technique had clinically and statistically significantly higher ROM recovery throughout the study period (P < 0.001) with an earlier recovery. The Rasmussen scores also demonstrated significant improvements in patients with ME technique than CE group at all time-points (P < 0.05). Three patients in the CE group had migration of K-wires, with no migration observed in the ME group. ConclusionThe ME technique enables improved clinical outcomes and functional performance for the treatment of comminuted patella fractures.

Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment

ObjectiveThe aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment. MethodsOur revision strategy was as follows: First, we determined the presence of any infection. Second, we determined whether the patient required total knee arthroplasty (TKA). Third, based on the characteristics of the tibial plateau fracture malunion, patients underwent one of the following surgical methods to achieve reduction: original fracture line osteotomy, tibial tubercle + original fracture line osteotomy, fibula head + original fracture line osteotomy, and metaphyseal open window reduction rod technique. The results was assessed with healing time, Rasmussen score, knee range of motion and complication rates. ResultsA total of 25 patients 16 men and 9 women; Mean age: 47.4 years (range: 35–63 years) underwent tibial plateau fracture revision operation. The time interval between the two surgeries was 2–24 months. The follow-up time was 12–30 months, and the operation time was 120–300 min. All patients received bone union at the last follow-up. The healing time was 3–6 months. The postoperative Rasmussen score was 19–29 (mean 23.8) compared with 14.4 points before the operation (p < 0.05). The postoperative knee joint activity was 60–110° (mean 95.0°), compared with 57.8° before the operation (p < 0.05). Six patients still had a 2-mm collapse on the articular surface, and 4 patients still had slight valgus (<5°). Except for 2 TKA cases, fracture reduction was excellent in 15 cases and good in 8 cases, with a good rate of 100%. Superficial wound infections occurred in 3 patients. ConclusionBecause revision of tibial plateau fracture malunion caused by failure of initial treatment is difficult, it is necessary to create a detailed surgical plan before the operation. Satisfactory clinical effects can be obtained if the correct revision strategy is used. The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion. Level of EvidenceLevel IV, Therapeutic Study.

Reoperation strategy of malunited tibial plateau fracture

Objective To explore the revision strategy of the malunited tibial plateau fracture and to analysis the main points of four common revision operations and the clinical effect. Methods From January 2012 to December 2016, 18 patients (5 males and 13 females) aged 35-60 years (average 49.7 years) underwent tibial plateau revision surgery in our hospital were collected. The time from the second revision operation to the first operation was 2-24 months (average 10.4 months). Our revision strategies were as follows: Firstly, to determine whether there is an infection or not. If there was infection, we changed the original internal fixation to external fixator to control infection. Secondly, todetermine whether the patient could suffer re-reduction and internal fixation. If the patient was older (>65 years old) or with severe local bone defect, total knee arthroplasty should be performed. Thirdly, patients were divided into four operation modes according to the tibial plateau fracture malunion type: 1. the original fracture line osteotomy; 2. the tibial tubercle + original fracture line osteotomy; 3. tibial metaphyseal window-rod reduction; 4. the osteotomy of fibula head and original fracture line osteotomy. Results All patients were followed up for 12-30 months (average 16.8 months), and the operation time was 120-300 min (average 185 min). 2 cases were infected before operation and the original internal fixation were removed to instead of external fixator;1 patient underwent total knee arthroplasty; 3 cases were treated with metaphyseal open window-rod reduction and internal fixation; 6 cases were operated with the original fracture line osteotomy and internal fixation; 4 cases were treated with tibial tubercle osteotomy+original fracture line osteotomy and internal fixation; 2 patients underwent fibular head osteotomy+ original fracture line osteotomy and internal fixation. All patients achieved bony union at the last follow-up. The healing time was 3-6 months (mean 3.6 months). The postoperative knee Rasmussen score was 19-29 (average 22.9), compared with average 14.4 points before operation (t=-10.169, P=0.001). The postoperative range of motion of knee joint was 60-110 degrees (mean 94.5 degrees), compared with average 55 degrees before operation (t=-5.773, P=0.001). The post-operative VAS pain score was average 1.1 points, compared with average 4.2 points before operation (t=8.960, P=0.001). Fracture reduction was excellent in 12 cases and good in 5 cases, with the excellent and good rate of 100%. 3 patients still had 2mm collapse on the articular surface, while 3 patients still had mild valgus (less than 5 degrees). There were 2 cases of superficial infection of the wound surface after operation. Conclusion It was difficult to revise the malunion of tibial plateau fracture and it was necessary to make a detailed operation plan before the operation. Satisfactory clinical effects could be obtained for the patients by correct revision strategy. The key to success was the proper revision strategy which was adopted according to the different characteristics of the tibial plateau fracture malunion of the patients. Key words: Tibial fracture; Intra-articular fractures; Osteotomy; Joint deformities, acquired; Reoperation

A STUDY OF OPERATIVE OUTCOMES OF AO TYPE B &amp; C FRACTURES OF TIBIAL PLATEAU

Background: Anatomical restoration and stable rigid fixation of tibial plateau fractures with various fixation modalities among young population due to higher functional demand which is always challenging for operative surgeons. The main purpose of this study to see operative and functional outcomes among patients having intra-articular tibial plateau fractures. Material and Methods: Twenty-two patients were prospectively studied to see functional outcomes by using Modified Rasmussen Criteria. There were fifteen males and seven female patients. Patients included were more than fifteen years of age group. Study group were classified according to AO/ OTA classification. All patients had undergone internal fixation with suitable approach as earliest after anesthetic clearance. Results: Mean age of duration was 38 years with follow up varies between six months to one year. Fall from height (36.26%) was the major etiological factor and next being motor vehicle (31.8%) road traffic accidents. According to AO/OTA classification eighteen (81.83%) patients having type B fractures while four (18.18%) patients having type C fractures. Results were assessed by using Modified Rasmussen Criteria. Among them,twelve (54.5%) patients having excellent results, seven (31.8%) patients having good results, two (9.09%) patients having fair results and one (4.6%) patient having poor results. None of the patients showed complications like non-union or any neurovascular damage. Conclusion: Surgical modalities of fixation for tibial plateau fracture must needed to achieve anatomical articulation and stable rigid fixation with locking plates to restore articular congruency and with early knee mobilisation to get better functional outcomes. Keywords: AO TYPE B & C, Tibial plateau, Internal fixation , Rasmussen Score

The “Apple-Bite-Fracture”: ACL rupture combined with posterolateral tibia plateau fracture

Aims and Objectives: Anterior cruciate ligament (ACL) ruptures are often concomitated by posterolateral bone bruise in the MRI. This is caused by a ventral subluxation of the tibia and impact of the femur in the posterolateral tibia plateau. In some cases, this impact causes a fracture of the posterolateral tibia plateau, the so-called Apple-Bite-Fracture. The increased posterior slope can cause additional instability and has to be considered as a risk factor for ACL failure. In this study we investigated the short term clinical outcomes of patients with this combined injury. Materials and Methods: Retrospective study of 14 patients (mean age 46 ± 12,3) (8 male, 6 female) with a mean follow up of 23,75 months. Different treatment strategies were analyzed. The clinical evaluation included visual analog score (VAS) increasing from 0-10 for Pain, IKDC Score, Rasmussen score as well as a clinical evaluation. Results: First analysis of the treatment options revealed a non-uniformed therapy strategy. In three patients the ACL tear was treated nonsurgical. In 11 patients the ACL tear was addressed surgical: six times the ACL was reconstructed with hamstring tendon graft, two times the ACL was sutured. Two patients treated with a non-reconstructive technique to promote healing (“healing response”). In one patient a tibial eminence fracture was fixated with a screw. The fracture of the posterolateral tibia plateau was in nine cases minimally invasive reduced and fixated with a screw osteosynthesis in jail technique. Two patients needed posterior buttress plate. Three times the large bone defect has been augmented with autologous bone graft from the pelvis. The postoperative clinical testing did not reveal any persisting knee instabilities. All patient had a non-limited ROM. No significant differences in ROM in comparison to the contralateral knee was seen. One patient reported persisting knee pain (VAS 3). All other patients reported no pain (VAS 0). Subjective IKDC score was 78,18 (71,3 - 83,9; ± 5,68). Clinical Rasmussen scores ranged from 27 to 30 (mean 27, ± 3,0). Rasmussen radiological results ranged from 16 to 18, mean 16,67 (± 1,15). Conclusion: Despite a very small patient number and leck of statistical power the new patient-spedific mini-metal implant seems to be a good options fort he treatment of middle-aged patients who already underwent frustane cartilage surgery. In these relatively rare caes early unicompartimental arthroplasty can be prevented. Further clinical studies with larger patient collectives have to prove the effectiveness of this new technique.

Failure analysis of primary surgery and therapeutic strategy of revision surgery for complex tibial plateau fractures

PurposeTo analyze the cause of failure of the primary surgery for complex tibial plateau fractures and to define the therapeutic strategy of the revision surgery for the same.MethodsTwenty-one cases with failure of primary surgery for complex tibial plateau fractures were treated in our hospital from January 2012 to September 2016. There were 13 males and 8 females with an average age of 39.4 years (ranged between 27 and 58 years). Patients presented with different types of complex tibial plateau fractures like Schatzker type V (n=9), VI (n=12), type 41.C1 (n=9), type 41.C2 (n=6), and type 41.C3 (n=6). The therapeutic strategy for revision surgery in individual patients was decided following careful analysis and accurate assessment of the causes of failure of the primary surgery. All the patients were followed-up with Rasmussen radiographic scores and Hospital for Special Surgery (HSS) knee scores.ResultsAll 21 patients underwent clinical and radiological examination after a mean follow-up time of 32.6 months. The average time of fracture healing was 4.5 months (ranged between 3 and 6 months). During the last follow-up, the mean range of motion of knee extension was 2.3° and knee flexion was 123.8°. The mean radiological Rasmussen score was 15.6 points, with an overall success rate of 85.7%. The average HSS knee score was 84.3 points, with an overall success rate of 80.9%.ConclusionThe common reasons for the failure of primary surgery of complex tibial plateau fractures were inadequate experience of the surgeon, inaccurate diagnosis and management, improper selection of implants, and poor surgical techniques. The key factors to succeed revision surgery were adequate preoperative evaluation, accurate intraoperative procedures, and proper postoperative rehabilitation.Level of evidenceLevel IV, case series, treatment study

Arthroscopic Assisted Reduction and Internal Fixation of Tibial Plateau Fractures.

BACKGROUND:Tibial plateau fractures present an important entity in orthopaedic fractures. Arthroscopic-assisted reduction and internal fixation is a good alternative to ORIF as it has the advantage of direct visualisation of the articular surface of the plateau, direct assessment of the reduction of the articular surface, and managing any associated intra-articular pathology.AIM:Our study aim is to determine the results of arthroscopic assisted reduction and internal fixation of tibial plateau fractures.METHODS:This study involved 25 patients with tibial plateau fractures presenting to the emergency department of Cairo University Hospitals between the periods of November 2016 and May 2017. The patients were followed up for an average of 14 months (11-18 months). According to Schatzker’s classification, five patients had type I, eleven had type II, and nine patients had type III fractures.RESULTS:The average time to full union in Schatzker type I was 9.1 weeks, in type II was 10.2 weeks, and in type III it was 9.4. The mean clinical Rasmussen score among the 25 patients was 26 (range, 24-30). A group of 19 patients (76%) had excellent results, (4 type I, 8 types II, and 7 types III) 6 patients (24 %) had good results (1 type I, 3 types II, 2 types III). Radiologic results were excellent in (14 cases) 56.0% and good results (11 cases) 44%.CONCLUSION:Arthroscopic assisted reduction and fixation of tibial plateau fractures have the advantages of checking the adequacy of reduction, avoiding the need for detachment of the meniscus, and allowing for accurate diagnosis and management of associated knee injuries. Therefore, we recommend that arthroscopic assisted reduction and fixation of tibial plateau fractures should be used more often.

The Use of Intra-articular Steroid Injection to improve functional outcomes in Tibial Plateau Fractures

Tibial plateau fractures should be properly managed, otherwise, they may end up in serious complications. These complications include limitation of movements, osteoarthritis and may finally result in joint stiffness. From February 2017 to August 2017, a study was conducted including 30 patients with united tibial plateau fractures to evaluate the role of intra-articular corticosteroid injection in improving the clinical outcomes after open reduction and internal fixation. Ten patients had Schatzker type I tibial plateau fractures, 13 patients had Schatzker type II and seven patients had Schatzker type III fractures. Average follow-up was 13.5 months. The average total clinical Rasmussen score was 28.3. It was excellent in 19 cases, and 11 cases had good results.

Management of communited patellar fracture with combined Tension Band Wiring Technique and Encirclage

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objective of the study was to evaluate functional results of combined encirclage wiring and tension band fixation in comminuted patellar fractures.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study of 15 patients treated with this method. All fractures described herein were classified as 45-C3 (based on Orthopaedic Trauma Association classification) and were fixed with encirclage wire and tension band wire proximally looped through the quadriceps tendon and distally through the patellar ligament in a figure-of-eight configuration. Knee function was evaluated using the Rasmussen scores at final follow-up.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 13 patients gained up to 90 degrees of active flexion at the end of the first week. 4 patients had 10–15 degrees of extensor lag at the end of the first week which improved after vigorous physiotherapy and none of them had any residual extensor lag at the subsequent follow-up. Two patients developed superficial infection. All fractures united at the end of 12 weeks. One patient underwent a second surgery; due to implant related complications. Malunion or non-union was not noted in any of the cases. The average Rasmussen scores was 27.9 out of 30 (range, 27–29).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The tension band technique combined with cable encirclage for treatment of communited fractures of patella is a simple and technically less demanding operative technique producing a rigid fixation, stable osteosynthesis and minimal injury to the tendon. It can be done with easily available implants. &lt;/p&gt;

Arthroscopic-Guided Balloon Tibioplasty in Schatzker III Tibial Plateau Fracture.

Purpose The study aims to present the results at a mean 28-months follow-up of arthroscopic-guided balloon tibioplasty and to spot some technical tricks and some practice using tools and materials. Methods The study relates to six patients with tibial plateau fractures type Schatzker III with tibial plateau depression more than 4 mm at preoperative computed tomography scan (CT-scan). The follow-up period ranged from 22 to 33 months, with a mean of 28 months. No patients were lost to follow-up. The patients were evaluated clinically using the Rasmussen score system and Lysholm score systems at 6 to 12 and 24 months, postoperatively. Radiographic evaluations (standard X-rays) were done preoperatively at 1, 3, and 12 months postoperatively while a CT-scan with 3D reconstruction was performed preoperatively, at the first day and 6 months, postoperatively. Results The mean Rasmussen clinical score at 6 months postoperatively was 26.3 while at 1-year postoperatively the mean Rasmussen clinical score was 28.33. At 2-year postoperatively the mean Rasmussen clinical score was 28.83. Statistically significant difference was found in 6-months and 2-years results ( p < 0.05). CT-scan achieved the first postoperative day showed the recovery of approximately 70% of the area of the interested tibial plateau, restoring of the joint surface without articular bone free fragments. Conclusion The described surgical procedure, if correctly performed with proper indications (Schatzker III), respect the principles mentioned above and the clinical and radiological results confirm our purpose. Level of Evidence This is a therapeutic case series, level IV study.

The use of bidirectional rapid reductor in minimally invasive treatment of bicondylar tibial plateau fractures: preliminary radiographic and clinical results

BackgroundMinimally invasive treatment of complex tibial plateau fracture represents one of the most challenging problems in orthopedic surgery. We intended to describe the percutaneous surgery involving an originally designed traction device which might facilitate the closed reduction for bicondylar tibial plateau fractures. Further, to assess the clinical outcomes of this minimally invasive technique.MethodsBetween December 2015 and July 2016, Twenty-one patients, mean age 43.71 ± 13.80 years, suffering from a bicondylar tibial plateau fracture (AO/OTA 41-type C) were included. All fractures were firstly reduced by skeletal traction with the aid of bidirectional rapid reductor, and residual depressed fragments were treated with minimally invasive bone tamp reduction. We then evaluated at a minimum follow-up of one year: (1) the rate of complications, (2) the radiographic outcomes (the amount of depression, tibial plateau widening, tibial plateau angle and posterior slope angle) and (3) the clinical outcome (Rasmussen scoring system).ResultsAll patients had their fractures healed without secondary displacement. No instrument-related complications occurred during operation. Post-operatively, superficial infection was found in two patients and donor-site morbidity was found in one patient. We observed a < 5 mm step-off in 100% of patients and a < 5 mm plateau widening in 95.5% of patients. Three patients were considered indicative of malalignment with TPA > 90° or PSA > 15°. At last evaluation, the Rasmussen clinical score was excellent in 11 patients (52.3%), good in 9 (42.9%) and fair in 1 (4.8%), and the radiological score was excellent in seven patients (33.3%), good in 14 (66.7%).ConclusionsThe bidirectional rapid reductor facilitates the minimally invasive treatment of bicondylar tibial plateau fracture. The patients exhibited excellent functional recovery. These results should be validated with a larger group of patients and longer period results.Trial registrationChiCTR-OPC-16008011.

Comparison of extended anterolateral approach in treatment of simple/complex tibial plateau fracture with posterolateral tibial plateau fracture

BackgroundOur hospital has recently used the extended anterolateral approach in posterolateral tibial plateau fracture. We compared the clinical effects of this method in Schatzker type II or type V/VI fractures with posterolateral tibial plateau fracture based on our patients.MethodsThe patients from January 2013 to December 2015 were summarized, and some of them were assisted with arthroscopy. According to Schatzker classification, patients with Schatzker type II fracture were divided into group A; patients with Schatzker type V/VI fracture were divided into group B. The fracture characteristics, operation statistics, and postoperative functional evaluation of each group were compared.ResultsA total of 46 patients were included in the study and were followed up for 23–45 months. There were 24 cases in group A and 22 cases in group B. The operation time and the amount of bleeding were significantly less in group A (P < 0.05). Twelve cases were assisted with arthroscopy including 6 patients in each group. The fracture healing time made no significant difference in the two groups (P > 0.05). All patients experienced no significant influence on daily life. The knee Rasmussen score was 26.8 in group A and 23.5 in group B (P > 0.05), and the knee range motion was 115.5° in group A and 106.6° in group B (P > 0.05). The excellent and good rate of reduction was 91.7% in group A and 81.8% in group B (P > 0.05), but the excellent rate of reduction was 83.3% in group A and 27.3% in group B (P < 0.05). The unfixed rate of posterolateral fracture was 16.7% in group A and 36.4% in group B (P > 0.05). One patient in group B suffered postoperative wound infection.ConclusionsThe extended anterolateral approach could obtain similar satisfactory clinical results in simple/complex tibial plateau fracture with posterolateral tibial plateau fracture. It seemed that easier operation, better posterolateral fracture reduction, and fixation occurred in relative simple fracture from our cases.Trial registrationIt was a retrospective study. This study was consistent with the ethical standards of the Second Affiliated Hospital of Zhejiang University Medical College and was approved by the hospital ethics committee and the trial registration number of our hospital was 20170053.

Extended anterolateral approach for thetreatment of tibial plateau fractures with posterolateral bone fragment

Objective To investigate the differences and clinical effects of extended anterolateral approach in the treatment of simple/complex tibial plateau fractures with posterolateral bone fragment. Methods From January 2013 to December 2015, forty-six patients with posterolateral tibial plateau fractures treated in our hospital were included in our research. The posterolateral plateau fractures were reduced and fixed by the extended anterolateral approach. According to Schatzker fracture classification, patients with type II fractures were treated as simple group and patients with type V and type VI fractures were treated as complex group. According to tibial plateau three column classification, patients were divided into single column group, double column group and three column group. The operative time, bleeding volume, fracture healing time, postoperative Rasmussen score, knee mobility, reduction and fixation of fractures and postoperative complications were compared among the groups. Results All 46 patients were followed up for 23-45 months, with an average of 31.9 months. There were 24 cases in simple fracture group and 22 cases in complex fracture group. The mean operation time of simple group was 124±33.8 min, and that of complex group was 175±65.5 min, with significant difference (t=2.302, P=0.025); the mean bleeding volume of simple group was 118±93.5 ml, and that of complex group was 190±149.4 ml, with significant difference (t=1.905, P=0.028). 12 cases were treated with arthroscopy. Bone union was achieved in all patients at the last follow-up, and daily activities were not limited. The average healing time was4.58 months in simple group and 5.54 months in complex group. The excellent rate of fracture reduction was 83.3% in simple group and 27.3% in complex group (χ2=14.679, P=0.000). Posterolateral bone fragment was not completely fixed in 4 cases (16.7%) in simple group and 8 cases (36.4%) in complex group. The average Rasmussen function score was 26.8±2.1 and the range of motion of knee joint was 100°-120° (average 115.5°±6.2°) in simple group; The average Rasmussen function score was 23.5±3.4 points and the range of motion of knee joint was 95°-115° (average 106.3°±7.4°) in complex group, neither with no significant differences. According to the three-column fracture classification system, there were 6 cases in the single-column group, 24 cases in the double-column group and 16 cases in the three-column group. There were significant differences in the operative time (F=5.039, P=0.000), bleeding volume (F=5.215, P=0.000) and the excellent rate of fracture reduction (χ2=7.003, P=0.030) between these three groups. But there was no significant difference in the time of fracture healing, un-fixation rate of posterolateral bone fragment, knee joint Rasmussen score and knee jointactivity. The excellent rate of fracture reduction was 83.3% in arthroscopy assisted cases and 47.1% in arthroscopy un-assisted cases respectively (χ2=4.749, P=0.002). Postoperative wound infection occurred in 1 patient. Conclusion Extended anterolateral approach could provide good reduction and fixation of tibial plateau fractures with posterolateral bone fragment with satisfactory clinical outcomes obtained in both simple and complex fractures. The operation was relatively simple and posterolateral bone fracture could get better reduction and fixation in simple tibial plateau fractures, and arthroscopy treatment was helpful to improve fracture reduction. Key words: Tibial fractures; Arthroscopy; Comparative study; Fracture fixation, internal

Surgical methods and curative effect of tibial plateau fracture with medial large block split

To explore the clinical effects of protecting the internal structure of the knee and internal fixation through two different directions for the treatment of tibial plateau fractures with medial large block split. From January 2010 to January 2016, data of 21 patients of tibial plateau with medial large block split fractures who were treated with protecting the internal structure of the knee and internal fixation through two different directions were retrospectively analyzed, including 17 males and 4 females, with an average age of (39.2±3.2) years old ranging from 27 to 63 years. Anteroposterior and lateral radiographs as well as computed tomography(CT) images were obtained in the course of preoperative. It was made in the operation to protect medial knee structure, combining with internal fixation via two different directions plates(medial and posteromedial). If the posterolateral condyle fracture was involved, a plate was applied through posterolateral approach. Rasmussen score was used for radiological assessment, and HSS knee score was used for efficacy assessment at 1 year after operation. The fracture healing time was judged by X-ray and clinical examinations, additionally, the complications and corresponding outcomes were also recorded. All patients were followed up for 10 to 24 months with an average of(17.2±1.7) months. All fractures were healed, the healing time was 9 to 16 weeks with an average of(11.1±3.2) weeks. The Rasmussen score after surgery was 1 to 18 points with an average of(16.7±1.5) points. Sixteen cases got excellent, 3 good and 2 fair. At the final follow-up, HSS functional scores ranged from 60 to 100 points with an average of (87.3±6.7) points, the result was excellent in 18 cases, good in 2 cases and fair in 1 case. For a split fracture of the medial tibial plateau, the medial incision, full protection of the medial knee structure, and two different directions of supporting plate fixation are feasible, and the short-term effect is satisfactory.

Arthroscopic-assisted inflatable bone tamp reduction for treatment of posterolateral tibial plateau fractures

AimOur study aimed to assess the safety and efficacy of an innovative arthroscopic-assisted inflatable tamp reduction technique for the treatment of posterolateral tibial plateau fractures. Patients and methodsTwenty-six patients with posterolateral tibial plateau fractures were treated with arthroscopy through inflation reduction technique were enrolled. Arthroscopy was used to observe the reduction of articular surface to avoid over-reduction or de-reduction. An arthroscopic assessment of anatomic joint reduction completed the procedure. Inflatable bone tamp was used to reduce the fractures and calcium phosphate cement was used as bone substitute to augment the repairs. ResultsUnder arthroscopy, the reduction was observed to be excellent without any residual deformity in all the cases. Cement overflow into the soft tissues or the knee joint was not observed. During the follow-up period, no obvious articular surface subsidence (>5 mm) was observed and no evidence of posttraumatic osteoarthritis could be detected. Radiographs under full weight bearing revealed neither loss of reduction nor any valgus deviation. Three months after surgery, the graft was almost completely replaced by new bone. The functional evaluation following the Rasmussen score yielded excellent results. ConclusionsThis study provided a novel technique for the reduction of depressed and split-depressed pasterolateral tibial plateau fractures. Arthroscopic-assisted inflatable bone tamp reduction is an effective method for the treatment of posterolateral tibial plateau fractures.

Percutaneous Reduction and Internal Fixation for Monocondylar Fractures of Tibial Plateau: A Systematic Review.

Instead of extensive dissection of soft tissue around the fracture site, percutaneous techniques have unique advantages in managing displaced fragments, including preservation of soft tissues, less blood loss, lower risk of complications, and earlier functional rehabilitation. However, there are few systematic reviews on the effects of percutaneous reduction and internal fixation (PRIF) for tibial plateau fractures. A systematic search of Cochrane, EMBASE, and MEDLINE databases was performed for all publicly available data in March 2017 regarding the use of PRIF in treating monocondylar tibial plateau fractures. Basic information of included articles, surgical information, clinical outcomes, and concomitant soft tissue injuries were collected for analysis. Finally, a total of 20 articles including 561 patients were retrieved. Traffic accident was the most common cause of injury. Percutaneous techniques using bone tamp reduction were described in all studies. The majority (≥85%) of patients were classified as excellent or good according to clinical and radiological Rasmussen scores. The overall complication rate was 6.6%, with loss of reduction the most frequent complication with an incidence of 2.4%. This systematic review indicated that PRIF was an optimal alternative that physicians should consider for the treatment of monocondylar tibial plateau fractures.

Is "Early Total Care" a Safe and Effective Alternative to "Staged Protocol" for the Treatment of Schatzker IV-VI Tibial Plateau Fractures in Patients Older Than 50 Years?

To compare "Early Total Care" (ETC) with "Staged Protocol" (SP) for the treatment of Schatzker IV-VI tibial plateau fractures in patients older than 50 years regarding safety and effectiveness. Retrospective cohort study. An academic level 1 US trauma center. Eighty-one patients older than 50 years with Schatzker grade IV-VI tibial plateau fractures were included. Fifty-three patients were treated under SP with immediate external fixation followed by definitive internal fixation. Twenty-eight patients were treated under ETC with immediate internal fixation. Comparison of perioperative findings, time to bony and clinical union, soft-tissue and bony complications, radiological outcome, and secondary procedures. The 2 groups were comparable without significant difference regarding age, sex, side of involvement, body mass index, smoking status, American Society of Anesthesiologist classification, associated injuries, comorbidities, follow-up duration, and fracture classification. No statistically significant difference was found regarding the perioperative complications, quality of reduction, time to union, Rasmussen score at union or at the final follow-up, soft-tissue/bony complications, and the rate of the secondary procedures. ETC seems to be a safe, efficacious, and effective alternative to the SP for the treatment of some Schatzker IV-VI fractures in patients older than 50 years. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of three surgical approaches for fractures of anterolateral and posterolateral columns of tibial plateau

Objective To compare the clinical effects of combined anterolateral and posterolateral approach, lateral incision via double intermuscular spatia approach, and posterolateral transfibular approach in the treatment of fractures of anterolateral and posterolateral columns of tibial plateau. Methods A retrospective analysis was done of the 18 patients with fracture of anterolateral and posterolateral columns of tibial plateau who had been treated at our hospital from January 2012 to January 2015. They were 10 men and 8 women, aged from 28 to 58 years (mean, 35.5 years). They were divided into 3 equal groups. Group A was treated with combined anterolateral and posterolateral approach, group B with lateral incision via double intermuscular spatia approach and group C with posterolateral transfibular approach. Operation time, surgical blood loss and complications were recorded. At the final follow-ups, Rasmussen score was used to evaluate the fracture reduction and Hospital for Special Surgery (HSS) knee score to assess functions of the involved knees. Results The 18 patients were followed up for 10 to 18 months (average, 13.3 months). No such early complications as incision infection or deep vein thrombosis occurred. The operation time (89.5 min and 79.3 min, respectively) and surgical blood loss (151.7 mL and 207.8 mL, respectively) for groups A and B were obviously less than those for group C (102.5 min; 260.2 mL); the incision length for group A (10.5 cm) was shorter than that for group B (17.4 cm) and for group C (16.3 cm); group C had more cases of excellent reduction (6) than groups A and B (4 for both). There were no obvious differences between groups A, B and C in the Rasmussen score (16.8, 17.0 and 16.3) or HSS score (86.3, 86.0 and 85.7). One case of delayed incision healing due to partial necrosis occurred in group B. At the final follow-ups in group C, the varus stress test showed 2 cases of laxation of degree Ⅱ and 2 cases of laxation of degree Ⅰ. Conclusions In the treatment of fractures of anterolateral and posterolateral columns of tibial plateau, all the 3 approaches can lead to good exposure, fine reduction, rigid fixation and satisfactory outcomes. Although the combined anterolateral and posterolateral approach and lateral incision via double intermuscular spatia approach can lead to similar exposure ranges and fixation effects, the latter is easier in operation while the former exposes the anterior and posterior spatia more fully, allowing the anterior and posterior plates to be better positioned. The posterolateral transfibular approach can lead to the largest exposure range and more precise reduction, but it has risks of damage to the lateral ligamentous structure, greater invasion, postoperative lateral instability and injury to the common peroneal nerve. Key words: Knee joint; Fracture fixation, internal; Case-control studies; Surgical approach; Classification

The value of three dimensional printing technology assisted surgery in the treatment of complex tibial plateau fractures

Objective To investigate the advantage and application prospect of 3D printing technology in assisting surgery for complex tibial plateau fractures. Methods The complete clinical data of 41 patients (48 knees) were retrospectively analyzed. And these patients were divided into two groups as 3D printing assisted operation group and traditional operation group, according to whether 3D printing technology was applied. Study was carried out to compare the clinical efficacy of surgery assisted by 3D printing technology and traditional surgery in the treatment of complex tibial plateau fractures. The 3D printing assisted operation group included 18 patients (22 knees, 12 males and 6 females), aging from 16 to 68 (mean age 45.5±7.2), and there were 12 cases of Schatzker Ⅴ and 10 Ⅵ. The traditional operation group included 23 patients (26 knees, 15 males and 8 females), aging from 19 to 69 (mean age, 46.2±6.8), and there were 14 cases of Schatzker Ⅴ and 12 Ⅵ. The operation time, intraoperative blood loss, the Rasmussen score and hospital for special surgery knee score (HSS) at 6 weeks post-operation were analyzed and the difference between the two groups was tested. Results All those patients were followed up for 7 to 20 months (mean 15 months). For 3D printing assisted operation group, the mean operation time was 81.4±6.3 min for Schatzker Ⅴ and 90.6±15.4 min for Schatzker Ⅵ; the mean intraoperative blood loss was 200.4±72.3 ml for Schatzker Ⅴ and 280.6±101.6 ml for Schatzker Ⅵ; the result of 6-week Rasmussen score was 14 excellent, 6 good and 2 fair (excellent and good rate 90.9%); the result of 6-week HSS score was 15 excellent, 5 good and 2 fair (excellent and good rate 90.9%). Then for traditional operation group, the mean operation time was 100.4±15.3 min for Schatzker Ⅴ and 111.5±20.2 min for Schatzker Ⅵ; the mean intraoperative blood loss was 450.4±173.3 ml for Schatzker Ⅴ and 500.5±247.2 ml for Schatzker Ⅵ; the result of 6-week Rasmussen score was 14 excellent, 8 good, 2 fair and 2 bad (excellent and good rate 84.6%); the result of 6-week HSS score was 13 excellent, 8 good, 2 fair and 3 bad (excellent and good rate 80.8%). The difference in operation time, intraoperative blood loss had statistical significance between the two groups; but the difference in 6-month post-operation Rasmussen score and HSS score had no statistical significance. Conclusion Compared with traditional surgery, 3D printing technology assisted surgery for complex tibial plateau fracture possesses advantage such as shortened operation time, reduced intraoperative blood loss; but there’s no evidence for improved knee function at 6 weeks post-operation. Key words: Imaging, three-dimensional; Tibia; Fractures, bone