Reduction Of Tibial Plateau Fractures Research Articles

Maintenance of joint reduction and allograft incorporation in treating tibial plateau fractures. Retrospective case series using cortico-cancellous, non-irradiated, bone allograft

BackgroundRestoring joint congruence and maintaining reduction until healing is imperative in treating tibial plateau fractures (TPF). The main objective of this study was to evaluate the feasibility of augmentation with impacted bone allograft (IBA) to prevent loss of reduction in tibial plateau fractures during healing and to evaluate its incorporation. MethodsWe retrospectively analyzed all patients with an acute, closed tibial plateau fracture (Schatzker II, III, IV) treated between 2010 and 2019 with open reduction and internal fixation (ORIF) and impacted bone allograft (IBA), with a minimum follow-up of 24 months. We evaluated the postoperative radiographs by drawing a line along the tibial axis and another perpendicular to the healthy plateau to measure the reduction and subsequent behavior. The incorporation of the allograft was evaluated by radiological analysis assessing its integration, non-union, resorption, or sclerosis. We used the clinical-radiological Rasmussen system and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to objectify the outcomes. Results78 TPFs were included, with a median age of 51.5 (40.7–62.2) years and a median follow-up of 66 (24–89) months. Two (2.5 %) patients presented loss of joint reduction (subsidence) during the follow-up regarding the achieved in the surgery. Seventy-six (94.7 %) patients presented integration, two (2.5 %) resorption, and one (1.3 %) sclerosis. Seventy-two (92.3 %) patients presented excellent and good results in the Rasmussen radiological score, and 72 (92.3 %) patients presented excellent or good clinical scores. The mean WOMAC at two years postoperatively was 15 ± 6.5. ConclusionOur results demonstrate that allograft is an adjuvant in maintaining a reduction in type II, III, and IV Schatzker's tibial plateau fractures. Low rates of loss of reduction during follow-up can be expected with its use.

Osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in treatment of tibial plateau fractures involving posterolateral column collapse

To investigate the effectiveness of osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in the treatment of tibial plateau fractures involving posterolateral column collapse. A clinical data of 23 patients with tibial plateau fractures involving posterolateral column collapse, who had undergone osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation between January 2015 and June 2021, was retrospectively analyzed. There were 14 males and 9 females with an average age of 42.6 years ranging from 26 to 62 years. The causes of injury included traffic accident in 16 cases, falling from height in 5 cases, and other injuries in 2 cases. According to Schatzker classification, there were 15 cases of type Ⅴ and 8 cases of type Ⅵ. The time from injury to operation was 4-8 days with an average of 5.9 days. The operation time, intraoperative blood loss, fracture healing time, and complications were recorded. The depth of articular surface collapse of posterolateral column and posterior inclination angle (PSA) of the tibial plateau were compared before operation and at 2 days and 6 months after operation; fracture reduction of tibial plateau fracture was evaluated by Rasmussen anatomic score. The recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score at 2 days and 6 months after operation. All 23 patients were completed the operation successfully. The operation time was 120-195 minutes, with an average of 152.8 minutes; the intraoperative blood loss was 50-175 mL, with an average of 109.5 mL. All patients were followed up 12-24 months, with an average of 16.7 months. One patient had superficial wound infection after operation, and the incision healed after dressing change; primary healing of incision of other patients was obtained. The fracture healing time was 12-18 weeks, with an average of 13.7 weeks. No failure of internal fixation, varus and valgus deformity of the knee joint, and instability of the knee joint was found at last follow-up. One patient developed joint stiffness and the range of motion of the knee joint was 10°-100°; the range of motion of the knee joint of other patients was 0°-125°. At 2 days and 6 months after operation, the depth of articular surface collapse of posterolateral column, PSA, and Rasmussen anatomic scores significantly improved when compared with those before operation ( P<0.05). There was no significant difference between the two postoperative time points ( P>0.05). The HSS score at 6 months after operation was significantly higher than that at 2 days after operation ( P<0.05). For tibial plateau fractures involving posterolateral column collapse, reduction and internal fixation through osteotomy of non-core weight-bearing area of the lateral tibial plateau has the advantages of fully expose the posterolateral column fragment, good articular surface reduction, sufficient bone grafting, and fewer postoperative complications. It is beneficial to restore knee joint function and can be widely used in clinic.

Nanoscopy and an extended lateral approach can improve the management of latero-central segments in tibial plateau fractures: a cadaveric study

IntroductionThe objective of this investigation was to compare different techniques to improve visualization and reduction in tibial plateau fractures involving the central lateral segments.MethodsMatched pairs of pre-fractured cadaveric tibial plateau fractures that include the central lateral segments were treated by either an anterolateral approach (supine) or PL approach (prone). Reduction was stepwise extended by additional fracturoscopy (FS), nanoscopy (NS) and lastly by epicondyle osteotomy (ECO). Reduction was analyzed by 3D scan and visualization of the lateral plateau was quantified.ResultsTen specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were analyzed. Fracture steps involving the antero-latero-central (ALC) segment were insufficiently reduced after fluoroscopy using both approaches (AL 2.2 ± 1.2 mm vs PL 2.2 ± 1.0 mm, p 0.95). Additional NS and ECO achieved optimized fracture reduction in the ALC segment (NS AL 1.6 ± 1.3 mm vs PL 0.8 ± 0.9 mm, p 0.32). NS provided visualization of the entire lateral plateau (PL 102.9% ± 7.4, AL 108.8 ± 19.2%), while fracturoscopy only allowed visualization of the ALL segment and partially of PLL and ALC segments (PL 22.0 ± 23.4%, AL 29.7 ± 18.3%).ConclusionOptimized reduction of tibial head fractures with involvement of latero-central segments requires additional video-assisted reduction or extended approaches. Nanoscopy helps visualizing of the entire lateral plateau, when compared to fracturoscopy and may become a valuable reduction aid.

Application of a new universal locking anatomical plate in treatment of tibial plateau posterolateral column fractures

To investigate the effectiveness of a new tibial plateau posterolateral column universal locking anatomical plate (hereinafter referred to as "new universal locking anatomical plate") in the treatment of tibial plateau posterolateral column fractures. Between October 2020 and December 2021, 14 patients with tibial plateau posterolateral column fracture were treated with a new universal locking anatomical plate. There were 7 males and 7 females with an average age of 59 years ranging from 29 to 75 years. There were 5 cases on the left side and 9 cases on the right side. The causes of injury included falling from height in 5 cases, traffic accident in 7 cases, and other injuries in 2 cases. The time from injury to operation ranged from 3 to 10 days, with an average of 6 days. According to Schatzker classification, there were 4 cases of type Ⅱ, 8 cases of type Ⅴ, and 2 cases of type Ⅵ. All fractures involved the posterolateral tibial plateau. Three column classification: two columns (anterolateral column+posterior column) in 4 cases, three columns in 10 cases. The operation time, intraoperative blood loss, fracture healing, and complications were recorded. The reduction of tibial plateau fracture was evaluated by Rasmussen radiographic score, and the recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score. All 14 cases completed the operation successfully. The operation time was 95-180 minutes, with an average of 154 minutes, and the intraoperative blood loss was 100-480 mL, with an average of 260 mL. All patients were followed up 6-19 months, with an average of 12.5 months. All fractures healed, and the healing time was 15-24 weeks, with an average of 18.7 weeks. During the follow-up, there was 1 case of common peroneal nerve palsy and 1 case of traumatic osteoarthritis. There was no other complication such as vascular injury, incision infection, deep venous thrombosis of lower limbs, heterotopic ossification, bone nonunion, and failure of internal fixation. The reduction of tibial plateau fractures was good immediately after operation, and the Rasmussen radiological score was 10-18, with an average of 15.7; 3 cases were excellent, 10 cases were good, and 1 case was fair, with an excellent and good rate of 92.9%. The scores and grades of HSS at 3 months after operation and at last follow-up significantly improved when compared with those before operation ( P<0.05). There was no significant difference between 3 months after operation and last follow-up ( P>0.05). For the fractures involving the posterolateral column of the tibial plateau, the new universal locking anatomical plate can provide strong fixation, satisfactory postoperative fracture reduction, and good recovery of knee function.

Relative Sagittal Alignment of the Medial and Lateral Articular Surfaces of the Tibial Plateau Using Radiographic Parameters: A Radiographic Cadaveric Study.

To characterize anatomic slope (sagittal alignment) of medial and lateral articular surfaces of the tibial plateau using x-ray and computed tomography (CT). Fluoroscopy was used to acquire "perfect" anteroposterior (AP) images of 8 cadaveric knees by tilting a C-arm through a 30-degree cranial/caudal arc in 0.5-degree increments. Five surgeons independently selected perfect AP images that most accurately profiled medial and lateral articular surfaces. Corresponding angles were used to define tangent subchondral structures on sagittal CT that were considered as dominant bony landmarks in a protocol to determine tibial slope on sagittal CT in 46 additional cadaveric knees. Mean perfect C-arm AP angles were 4.2 degrees ± 2.6 degrees posterior for the medial plateau and 5.0 degrees ± 3.8 degrees posterior for the lateral plateau. It was noted that images acquired within a range of angles (medial range, 1.8 degrees ± 0.7 degrees; lateral range, 3.9 degrees ± 3.8 degrees) rather than a single angle adequately profiled each compartment. Using the CT protocol, mean medial slope (5.2 degrees ± 2.3 degrees posterior; range, 0.9-11.5 degrees) was less than lateral slope (7.5 degrees ± 3.0 degrees posterior; range 0.6-12.5 degrees; P < 0.001) in 54 knees. The difference between medial and lateral slopes in any individual specimen ranged from 3.1 degree more medially to 6.8 degrees more laterally. No differences were noted between right and left knees in paired specimens. On average, tibial slope in the lateral plateau is slightly greater than that in the medial plateau, and variation exists between compartments across patients. Because tibial slope is similar between contralateral limbs, evaluating slope on the uninjured side can provide a template for sagittal plane reduction of tibial plateau fractures.

Features of arthroscopic-assisted reduction of tibial plateau fractures

Introduction. Surgical treatment of tibial condyle fractures have been little studied and it represents difficulties up to now. Aim. The aim of the present work was improvement of results of surgical treatment of tibial condyle fractures. Methods. Surgical treatment of tibial condyle fractures is done on total of 65 patients in the department of Sport trauma of Centre of traumatology and Orthopaedics arthroscopy. Results. Good and satisfactory outcomes were achieved in all the patients received arthroscopy treatment. The use of magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) in the diagnosis of intra-articular fractures of the knee joint, and the analysis of their results contribute to the choice of the optimal surgical treatment. Arthroscopy of intra-articular fractures of the tibial condyles allows for an accurate diagnosis, visual control of the reduction, that is characterized by minimal surgical traumatism, minimal risk of infectious complications, leaves a minimal cosmetic defect, and helps to shorten the length of hospital stay and early rehabilitation of patients. Recommendation. Suggested methods are high effective and can be recommended in practical medicine.

Does Time to Theatre Affect the Ability to Achieve Fracture Reduction in Tibial Plateau Fractures?

Surgical management of displaced tibial plateau fracture (TPF) is often delayed due to accompanying soft tissue injuries sustained at the time of injury. The primary aim of this study was to assess the effect of time to surgery on fracture reduction in cases of TPF. The secondary aim was to assess the effect of preoperative demographics and residual articular step on Lysholm Scores and Knee Injury and Osteoarthritis Outcome Scores (KOOS) following fixation. Patients between 2006 and 2017, managed by a single surgeon, were prospectively enrolled in the study. Reduction of articular step, defined as <2 mm, was assessed by a single blinded examiner. A total of 117 patients were enrolled, 52 with Schatzker II, 4 with Schatzker IV, and 61 with Schatzker VI fractures. Patients were followed up to a mean of 3.9 years. Analysis showed that the ability to achieve fracture reduction was negatively influenced by time to theatre, with the odds of achieving reduction decreasing 17% with each subsequent day post injury (p = 0.002). Furthermore, an increased time to theatre was associated with a reduced Lysholm score at one year (p = 0.01). The ability to achieve fracture reduction did not influence PROMs within the study period. We conclude that delay in surgical fixation negatively affects fracture reduction in TPF and may delay recovery. However, residual articular step does not necessarily influence PROMs over the mid-term.

Application of Percutaneous Screw Fixation and Closed Reduction for Tibial Plateau Fractures in Karachi, Pakistan

Objective: Objective of this study is to assess the application of percutaneous screw fixation and closed reduction for tibial plateau fractures in Karachi, Pakistan.&#x0D; Methods: The study design of this study is case series with sample size of 58 patients calculated by WHO calculator with functional outcome of 80-100%. The duration of the study was about 6 months.Non-probability sequential technique was adopted for data collection.&#x0D; Results: The average patient age was 35.35±6.84 years however male patient were high in numbers (83.8%). Types of fractures (type I, II and IV) and functional outcomes (un-satisfactory and satisfactory) showed 17(29.3%), 33(56.8%) and 12(20.6%) and 4(6.45%) and 58(93.5%). The mean Rasmussen Score was 24.6(4.9%) however significant relationship between age and functional group were observed (p&lt;0.05). The Rasmussen Functional Scoring System and Schatzker classification were also evaluated w.r.t ache, capability of walking normally, extension lag, stability as well as range of motion. Scores ranging from 28 up till 36 stipulate excellent, from 20 to 27 good, considering score of 10 to 20 fair and 6 to 10 poor.&#x0D; Conclusion: The application of Percutaneous screw fixation and closed reduction for tibial plateau fractures in Karachi, Pakistanis less invasive, decrease hospital stays and charges, escalation of early mobilization along with satisfactory outcomes.

The role of Arthroscopy in Mini-Invasive Treatment of Tibial Plateau Fractures

The tibial plateau is one of the most critical load-bearing area in the human body. The aim of this work was To evaluatethe effect of using knee arthroscopy as an assisting tool in achieving anatomic reduction and improving the results of treatment tibial plateau fractures. This prospective study involved 20 patients with fractures of the tibial plateau underwent knee arthroscope.All patients were followed up for at least 6 months. Modified Rasmussen clinical criteria consist of the subjective state of the knee according to the patient, and the objective state of the knee. Osteoarthritis grading according to Resnick and Niwoyama criteria for grading of osteoarthrosis. Mean clinical score was 27.85 (± 2.455) while mean radiological score was 8.3 (± 1.418). Eleven patients (55%) and thirteen patients (65%) had excellent clinical and radiological outcomes respectively. there are statistically non-significant relations between clinical and radiological outcomes and schatzker type. Also, there is statistically non-significant correlation between time till operation and Ramsussen clinical and radiological scores. using knee arthroscope as an assisting tool in reduction of tibial plateau fractures with internal fixation can give satisfactory clinical and radiological results.

Extended approach to the lateral tibial plateau with central meniscal subluxation in fracture repair: feasibility and first clinical and radiographic results

PurposeAnatomic reduction in tibial plateau fractures remains to be demanding. For further visualisation of and approach to the joint surface an extended lateral approach using a lateral femoral epicondyle osteotomy and subluxation of the lateral meniscus was recently described. First clinical and radiographic mid-term results of this technique are presented in this feasibility study.MethodTen complex tibial plateau fractures treated with extended lateral approach and lateral meniscal subluxation were prospectively analysed. Clinical and radiographic results were objectified according to the Rasmussen scores.ResultsAfter a median follow-up of 8.6 (IQR 4.3) months good to excellent clinical and radiographic results were noted. The clinical Rasmussen Score showed a median of 25 (IQR 2.8) and radiographic a median of 17 (IQR 2.0) points.ConclusionGood to excellent clinical and radiological scores were obtained after using an extended lateral approach with lateral femoral epicondyle osteotomy and central meniscus subluxation. No approach specific complications could be observed.

Defining the “mediolateral widening of tibial plateau” as a guide for reduction in tibial plateau fractures: An Indian perspective

PurposeThe primary aim in fixation of the tibial plateau fractures is the restoration of normal anatomy. Evaluation of the widening of the tibial plateau, which has been linked with adverse long term outcomes, still needs precise markers for quantification. The purpose of this study is to analyze the normal limits of tibial plateau widening in the Indian population in relation to the distal femur in a standardized manner to provide important radiological parameters for the same. MethodsWe retrospectively analyzed electronically archived true AP radiographs of uninjured normal knee joints during one year between 2018 and 2019. We measured the mediolateral width of the articular surface and extraarticular extent of the tibial plateau and compared them with the distal femoral articular and extra-articular extents. The measurements were compared between the male and female groups. ResultsTibial plateau articular width was found to be 4% wider in relation to the distal femoral articular surface. The medial articular rim of distal femur matches closely to the medial articular rim of the tibial plateau. The lateral articular rim of distal femur lies medial to the lateral articular rim of tibial plateau with a mean distance of 3.49 mm. ConclusionsOwing to individual variations in bony extents around the knee, the differential extent of tibial plateau relative to distal femur would be a more reliable parameter than absolute measurements. Medially the articular extent of distal femur matches closely with the articular extent of tibial plateau while the lateral extra-articular extent of distal femur matches closely with the lateral tibial articular extent. Gender-based differences do not significantly affect these two parameters.

The interest of FE simulation for the reduction of tibial plateau fracture using balloon inflation

For several years, in traumatic surgery, surgical techniques have evolved towards minimally invasive methods. Recently Vendeuvre et al. (2013) developed a novel method for tibial plateau fracture t...

Aspect Regarding Plastic Deformations in Tibial Plateau Fractures

Our purpose was to study tibial plateau fractures considering the rise of their incidence, their potential immediate seriousness or late complications and their complexity. We realized a clinical-statistical study concerning the incidence of tibial plateau fractures taking in account critaeria like age, sex, mechanism of injury, fracture type and correlations between these. The study involves 126 patients, 98 (77.77%) being treated surgically and 28 (22.22%) conservatory between 2008-2016 in the I-st Clinic of Orthopaedics and Traumatology Timisoara. Approximately 2/3 of cases are of Schatzker type I, II and III. Type VI Schatzker occured in 5.78% of all, the mechanism of injury being split almost equal between road accidents and falls from height. Road accidents prevale as a causing circumstance of tibial plateau fractures. 2/3 of the tibial plateau fractures associate with other significant regional lesions. Bone lesions are not rarely underestimated by plain radiographs. Therefore evacuation of haemarthrosis (showing lipohaemarthrosis) and high performance imaging (CT, MRI) are often needed. In comparison to other fracture sites, imperfect reduction of tibial plateau fractures results more frequently in long term sequellae. Being frequently complex, comminuted fractures with associated regional lesions tibial plateau fractures raise the complexity of the medical act from establishing a complete diagnosis to the final therapeutic measures. For a correct and complete preoperatory diagnosis frequently high performance imaging is needed. Tibial plateau fractures significantly affect patients, the healthcare and social-economic system, the healing and rehabilitation.

The distal femur is a reliable guide for tibial plateau fracture reduction: a study of measurements on 3D CT scans in 84 healthy knees

BackgroundLimited data have been published regarding the typical coronal dimensions of the femur and tibia and how they relate to each other. This can be used to aid in judging optimal operative reduction of tibial plateau fractures. The purpose of the present study was to quantify the width of tibial plateau in relation to the distal femur.MethodsWe reviewed 3D computed tomography (CT) scans taken between 2013 and 2016 of 42 patients (84 knees). We measured positions of the lateral tibial condyle with respect to the lateral femoral condyle (dLC) and the medial tibial condyle with respect to the medial femoral condyle (dMC) in the coronal plane. Positions of the articular edges of the lateral and medial tibia were also measured with respect to the femur (dLA and dMA).ResultsThe mean (± standard deviation) measurements were as follows: dLC, − 0.1 ± 1.9 mm; dMC, − 4.7 ± 4.1 mm; dLA, 0.9 ± 1.0 mm; and dMA, 0.1 ± 1.5 mm. The mean (± standard deviation) ratio of tibial to femoral condylar width was 0.91 ± 0.03, and the ratio of tibial to femoral articular width was 1.01 ± 0.04.ConclusionsThe articular width of the tibia laterally and medially was slightly wider than the femoral articular width. These small differences and deviations indicate that the femur might be used as a reference to judge tibial plateau width reduction.

Effectiveness analysis of surgical treatment of Schatzker type Ⅳ tibial plateau fractures

To introduce a surgical protocol based on the location and orientation of the apex of the medial condylar fracture line for the treatment of Schatzker type Ⅳ tibial plateau fractures and report the preliminary effectiveness. The clinical data of 18 patients with Schatzker type Ⅳ tibial plateau fractures underwent open reduction and internal fixation between March 2012 and April 2016 were retrospectively analysed. There were 6 males and 12 females, aged 36-74 years (mean, 45 years). The causes of injury included traffic accident in 2 cases, falling in 14 cases, bruise injury in 1 case, and crush injury of heavy object in 1 case. All cases were fresh closed fractures, without injury of nerves and blood vessels. According to sub type of Wahlquist tibial plateau type Ⅳ fracture classification, there were 1 case of type A, 5 cases of type B, and 12 cases of type C. The interval of injury and operation was 6-16 days (mean, 9.5 days). The location of the apex of the medial condylar fracture line was determined the surgical approach. After operation, reduction of tibial plateau fractures was evaluated by the DeCoster score evaluation criteria. The knee joint function was assessed by short Musculoskeletal Function Assessment (SMFA) score and Hospital for Special Surgery (HSS) score. The incisions all healed by first intension after operation without surgery related complications. All the patients obtained satisfactory exposure and reduction during operation. According to DeCoster score evaluation criteria, the results were excellent in 13 cases and fair in 5 cases. All the patients were followed up 12-30 months (mean, 18 months). X-ray films showed that all fractures healed at 10-16 weeks (mean, 12 weeks) after operation. There was no plate displacement, screw loosening, and other complications occurred during follow-up. At last follow-up, the SMFA score was 15-48 (mean, 28.5). The HSS score was 52-94 (mean, 81.1), and the results were excellent in 10 cases, good in 5 cases, fair in 2 cases, and poor in 1 case with an excellent and good rate of 83.3%; the main clinical manifestation was severe traumatic osteoarthritis symptom in 1 case with the fair result. The surgical program should be developed based on the location and orientation of the apex of the medial condylar fracture line. Open reduction and internal fixation for treating Schatzker type Ⅳ fractures can achieve satisfactory effectiveness.

Morphological study of tibial plateau based on three-dimensional computed tomography image and its clinical significance

Objective To investigate the three-dimensional morphological characteristics of tibial plateau based on CT image post-processing technique and analyze its significance in preoperative planning of tibial plateau fractures. Methods Multi-slice spiral CT data of 98 humans (56 males and 42 females) with normal tibial plateau and 30 patients (15 males and 15 females) with tibial plateau fractures were extracted. Morphological measurements of the tibial plateau were achieved by means of a three-dimensional measurement method based on points, lines and surfaces. Differences in three-dimensional parameters between genders in normal tibial plateau and differences between normal tibial plateau and tibial plateau fractures were analyzed. Results Differences of males and females were significant in width of tibial plateau [(73.2±3.7)mm, (65.5±3.7)mm], anteroposterior dimension of medial tibial plateau [(39.8±3.5)mm, (34.8±2.6)mm] and anteroposterior dimension of lateral tibial plateau [(34.0±3.3)mm, (29.8±3 5)mm] (P 0.05). Above parameters in three-dimensional morphological measurements of tibibial plateau fractures varied compared to the normal reference value (P<0.05). Intraclass correlation coefficient (ICC) for intra-observe and inter-observer agreement in normal tibial plateau measurement was excellent. Conclusions Present research provides a series of scientific and objective data for preoperative planning of tibial plateau fractures. Measurements of tibial plateau can assist the evaluation of reduction of tibial plateau fractures. Key words: Anthropometry; Tibia; Imaging, three-dimensional; Tomography, X-ray

How much articular displacement can be detected using fluoroscopy for tibial plateau fractures?

IntroductionWhile there is conflicting evidence regarding the importance of anatomic reduction for tibial plateau fractures, there are currently no studies that analyse our ability to grade reduction based on fluoroscopic imaging. The purpose of this study was to determine the accuracy of fluoroscopy in judging tibial plateau articular reduction. MethodsTen embalmed human cadavers were selected. The lateral plateau was sagitally sectioned, and the joint was reduced under direct visualization. Lateral, anterior-posterior (AP), and joint line fluoroscopic views were obtained. The same fluoroscopic views were obtained with 2mm displacement and 5mm displacement. The images were randomised, and eight orthopaedic traumatologists were asked whether the plateau was reduced. Within each pair of conditions (view and displacement from 0mm to 5mm) sensitivity, specificity, and intraclass correlations (ICC) were evaluated. ResultsThe AP-lateral view with 5mm displacement yielded the highest accuracy for detecting reduction at 90% (95% CI: 83–94%). For the other conditions, accuracy ranged from (37–83%). Sensitivity was highest for the reduced lateral view (79%, 95% CI: 57–91%). Specificity was highest in the AP-lateral view 98% (95% CI: 93–99%) for 5mm step-off. ICC was perfect for the AP-lateral view with 5mm displacement, but otherwise agreement ranged from poor to moderate at ICC=0.09–0.46. Finally, there was no additional benefit to including the joint-line view with the AP and lateral views. ConclusionUsing both AP and lateral views for 5mm displacement had the highest accuracy, specificity, and ICC. Outside of this scenario, agreement was poor to moderate and accuracy was low. Applying this clinically, direct visualization of the articular surface may be necessary to ensure malreduction less than 5mm.

The novel use of an external fixator connecting rod and synthetic bone substitute to achieve anatomic reduction of depressed tibial plateau fracture fragments.

Elevation of depressed articular fragments is crucial for anatomic reduction of tibial plateau fractures. We describe a technique of elevating the depressed fragment using a cortical window, an external fixator connecting rod (Fig 1) and injectable bone substitute. Figure 1 External fixator rod A cortical window is made under image guidance using a 2.5mm drill to make four holes in a square configuration. A narrow osteotome is used to connect three sides. The connecting rod is inserted into the cortical window and used as a punch to elevate the articular fragment under image guidance (Fig 2). Injectable bone substitute is then used to fill the defect created (Fig 3). Figure 2 Elevation of articular fragment with the connecting rod Figure 3 Injectable bone substitute used to fill defect

Risk analysis in tibial plateau fractures: association between severity, treatment and clinical outcome

Our retrospective study analyzes efficacy of treatment techniques we used for the reduction of tibial plateau fracture. A sample of 67 individuals is evaluated, 50 males and 17 females, and treated for a tibial plateau fracture from December 2003 to June 2008. The mean age is 46 (range 22-72). 35 patients were treated with cannulated screws alone, 21 were treated with plates alone, and 11 were treated with both plates and bone substitutes. All patients were clinically and radiographically followed up for an average time of 36.4 months (SD = 17.4; range 24-72). Data about patients sourced from the analysis of SF36, WOMAC and the Rasmussen score. Patients were divided into 4 groups and 2 subgroups, according to the synthesis method used and the severity of the fracture. The control group includes the patients diagnosed with a low-energy fracture treated with screws alone. The median of the total score of Rasmussen functional grading system resulted to be equal to 26; compared with the control group, there is strong relationship between the use of plates alone and the risk of obtaining a clinically less effective result (O.R. = 5.48; p = 0.003) even more when comparing Schatzker type IV, V, and VI (O.R. = 13; p = 0.0073). Radiographic evaluation shows less efficacy of bone substitute to reduce articular step-off. With regard to the SF36, patients treated with plate alone have been awarded the lowest score. The treatment of the most severe fractures of tibial plateau by means of internal fixation with plates can be improved with the use of bone substitutes.

Reliability of locked plating in tibial plateau fractures with a medial component

Tibial plateau fractures are notoriously difficult to manage, particularly when there is a medial or posteromedial component. We report a retrospective analysis of our experience with consecutive tibial plateau fractures including a medial component that were managed using a single lateral locking plate. Tibial plateau fractures with a medial component can be effectively managed using a single lateral locking plate. From January 2005 to December 2008, 20 patients (ten women and ten men, mean age 47 years) were managed for tibial plateau fractures having a medial component, including five Schatzker IV, five Schatzker V, and ten Schatzker VI. One patient had an open fracture. A single lateral anatomically contoured locking compression plate (LCP™) was used with or without additional isolated screws. Mobilization was started immediately after the procedure, and non-weight-bearing was maintained for at least 6 weeks. All patients were followed until healing. A final evaluation was available for 13 patients after a mean of 39.1 months (12-72); five patients were lost to follow-up and two died. Early revision was needed in one patient for 20° malreduction within the fracture site. We recorded one case each of deep vein thrombosis, superficial infection, knee stiffness, and spontaneously regressive common fibular nerve dysfunction. At final evaluation (n=13), mean range of motion was 0°/2°/130° with a mean Lysholm score of 94.1 (73-100) and a mean HSS score of 93.6 (74-99). All previously employed patients returned to work at the same level after a mean of 4.5 months. Mean healing time (n=20) was 10 weeks (6-12). Initially, articular step-offs greater than 2mm were noted in five patients. At healing, no further displacements or aggravation of articular step-offs were recorded. The reductions remained stable over time. At final evaluation (n=13), mean tibiofemoral mechanical angle was 179.7° (176-184) and no patients had evidence of osteoarthritis. The radiological and clinical outcomes in our patients were satisfactory. A single lateral locked plate ensured stable reduction of tibial plateau fractures with a medial component. Biomechanical studies of these fractures have provided conflicting data on the stability of reduction using single plate systems. However, previously reported clinical outcomes are similar to those found in our study and support the effectiveness of favouring the use of single locking plate fixation. Level IV, noncomparative retrospective study.