Reduction Of Tibial Plateau Fractures Research Articles

Posterolateral Transfibular Approach to Tibial Plateau Fractures: Technique, Results, and Rationale

We describe a posterolateral transfibular neck approach to the proximal tibia. This approach was developed as an alternative to the anterolateral approach to the tibial plateau for the treatment of two fracture subtypes: depressed and split depressed fractures in which the comminution and depression are located in the posterior half of the lateral tibial condyle. These fractures have proved particularly difficult to reduce and adequately internally fix through an anterior or anterolateral approach. The approach described in this article exposes the posterolateral aspect of the tibial plateau between the posterior margin of the iliotibial band and the posterior cruciate ligament. The approach allows lateral buttressing of the lateral tibial plateau and may be combined with a simultaneous posteromedial and/or anteromedial approach to the tibial plateau. Critically, the proximal tibial soft tissue envelope and its blood supply are preserved. To date, we have used this approach either alone or in combination with a posteromedial approach for the successful reduction of tibial plateau fractures in eight patients. No complications related to this approach were documented, including no symptoms related to the common peroneal nerve, and all fractures and fibular neck osteotomies healed uneventfully.

Arthroscopically Assisted Osteosynthesis for Tibial Plateau Fractures

Options for management of tibial plateau fracture are numerous, and the outcome depends on several factors. With the inherent advantages of arthroscopy, the results of tibial plateau fracture have been greatly improved. Thirty-one patients were treated with arthroscopically assisted reduction for tibial plateau fracture, with an average follow-up period of 3 years. Evaluations were performed with the Hospital for Special Surgery knee score clinically, and with the Ahlbäck scale for osteoarthritis radiographically. Eighty percent of cases were Schatzker type II, III, or IV, and over half (52%) of the patients had concomitant intra-articular lesions. Twenty-nine patients (93.5%) had satisfactory results according to the Hospital for Special Surgery knee score, and only one patient developed degenerative arthritis during the period of follow-up. The arthroscopically assisted reduction of tibial plateau fracture is a safe and promising procedure. The results are comparable to traditional methods of open reduction.

けい骨か部骨折の治療

In order to rehabilitate patients as early as possible after the operative reduction of tibial plateau fractures, we developed and applied a knee brace which was possible to give corrective force in the direction of varus or valgus at the knee joint. As a result, the improvement of therapeutic evaluation for the above mentioned fractures was obtained.

Closed Reduction of Tibial Plateau Fractures

One hundred tibial plateau fractures in 96 patients were treated at three teaching hospitals. Seventy-three fractures were treated by closed reduction and early mobilization of the knee using a cast brace. Twelve fractures in this group also had percutaneous pin fixation under fluoroscopic control. The end results were graded by clinical functional criteria and by roentgenographic criteria. Eighty-nine percent of the patients treated by closed reduction methods had good to excellent functional results with a low complication rate (12%). Observations based on long-term roentgenographic examinations did not correlate with the functional end results. Many patients with less than satisfactory roentgenographic results had good to excellent functional long-term results. The indications for operative stabilization of these fractures should be based on testing for knee stability in full extension, rather than on any arbitrary roentgenographic criteria. For unstable fractures, closed reduction using ligamentotaxis and percutaneous fixation supplemented by cast brace support proved effective and relatively free of complications.

Maintenance of Reduction of Tibial Plateau Fractures with Charnley Compression Device

Maintenance of Reduction of Tibial Plateau Fractures with Charnley Compression Device