Schatzker Type Research Articles

Surgical fixation methods for tibial plateau fractures.

Tibial plateau fractures, which are intra-articular injuries of the knee joint, are often difficult to treat and have a high complication rate, including early-onset osteoarthritis. The most common treatment for complex tibial plateau fractures is surgical fixation. Additionally, orthopaedic surgeons often use bone defect fillers to address bone defects caused by the injury. Currently, there is no consensus on the best method of fixation and on whether bone defect fillers are necessary. To assess the benefits and harms of different surgical interventions and bone defect fillers for treating tibial plateau fractures. We searched CENTRAL, MEDLINE, Embase, and trial registries up to March 2023. We also searched conference proceedings and the grey literature. We included randomised controlled trials (RCTs) and quasi-RCTs comparing surgical interventions for treating tibial plateau fractures and different types of filler for bone defects. Two review authors independently screened search results, selected studies, extracted data, and assessed risk of bias. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (CIs). Our primary outcomes (and the specific measures we considered most relevant) were generic quality of life (general health score in the 36-item Short-Form Health Survey (SF-36)), patient-reported lower limb function (Hospital for Special Surgery (HSS) score), and adverse events (frequency of unplanned reoperation). We used GRADE to assess the certainty of evidence. We included 15 trials in the review, with a total of 948 adult participants. Nine trials compared different types of fixation, and six trials evaluated different types of bone graft substitutes. All 15 trials were small and at high risk of bias. We considered most available evidence to be of very low certainty, meaning we have very little confidence in the results. Only limited pooling was possible. One trial compared circular fixation combined with insertion of percutaneous screws (hybrid fixation) versus standard open reduction and internal fixation (ORIF) in 82 people with open or closed Schatzker types V or VI tibial plateau fractures. At 24 months' follow-up, hybrid fixation compared with ORIF may have little or no effect on SF-36 general health score (MD 6 points higher, 95% CI 7.7 points lower to 19.7 points higher; 66 participants), patient-reported lower limb function according to the HSS score (MD 7 points higher, 95% CI 2.4 points lower to 16.4 points higher; 66 participants), or frequency of unplanned reoperation (RR 0.78, 95% CI 0.45 to 1.32; 83 fractures (82 participants)). However, the evidence for all three outcomes is very uncertain. Three trials (with 242 participants) compared single-plating ORIF versus double-plating ORIF. There may be little to know difference in patient-reported lower limb function (HSS score) at 24 months' follow-up in people who undergo single-plating ORIF compared with those who undergo double-plating ORIF (MD 0.2 points higher, 95% CI 2.12 points lower to 2.52 points higher; 1 study, 84 participants), but the evidence is very uncertain. There were no data for quality of life or unplanned reoperation at 24 months' follow-up. Six trials (including 368 participants) compared bone substitute versus autologous bone graft (autograft) for managing bone defects. No trials reported SF-36 general health score, HSS score, or frequency of unplanned reoperation at 24 months' follow-up. There is insufficient evidence to ascertain the best method of fixation or the best method of addressing bone defects during surgery in people with tibial plateau fractures. Further well-designed RCTs with larger sample sizes are warranted.

Lack of standardisation in the management of complex tibial plateau fractures: a multicentre experience.

In recent years, the trauma mechanisms and fracture types in tibial plateau fractures (TPF) have changed. At the same time, treatment strategies have expanded with the establishment of new classification systems, extension of diagnostics and surgical strategies. Evidence-based recommendations for treatment strategies are rare. The aim of this study is to assess the extent of standardization in the treatment of complex TPF. For the study, specialists in trauma surgery/orthopaedics were presented thin-slice CT data sets of three complex TPFs including 3D reconstructions. A standardized questionnaire on fracture morphology and planned treatment strategy was then completed. A total of 23 surgeons from 7 hospitals (Trauma center levels I-III) were included. All three fractures were most frequently classified as Schatzker type V (fracture I: 52.2%, II: 56.5%, III: 60%). Averaged over all three fractures, 55% of the respondents chose the same patient positioning. The combination of a posteromedial and anterolateral approach was the most frequently chosen approach at 42.7%. Double plating was favored for the surgical treatment of all fractures (70.7%). Preoperative MRI, extended approaches and intraoperative fraturoscopy were significantly more common in level I trauma centres. There are major differences in the management of complex TPF. 360° treatment is carried out in all departments regardless of the level of care, but without further standardization in terms of preoperative imaging, classification, initial treatment, approach, fixation and intraoperative imaging. There are major differences within the departments with different level of care.

Application of Allgöwer-Donati suture in internal fixation of Schatzker type Ⅴand Ⅵ tibial plateau closed fractures

To investigate the effectiveness of Allgöwer-Donati suture in open reduction and internal fixation of Schatzker type Ⅴ and Ⅵ tibial plateau closed fractures. A clinical data of 60 patients with Schatzker type type Ⅴ and Ⅵ tibial plateau closed fractures, who met the selection criteria and admitted between May 2022 and May 2023, was retrospectively analyzed. After open reduction and internal fixation via double incisions, the incisions were closed with conventional mattress suture in 30 cases (control group) and Allgöwer-Donati suture in 30 cases (observation group). There was no significant difference in gender, age, fracture side and type, time from injury to operation, body mass index, and other baseline data between the two groups ( P>0.05). The incidence of incision-related complications after operation, visual analogue scale (VAS) score of incision at 3 days and 1 and 2 weeks after operation, and the short-form 36 health survey scale (SF-36) [physical functioning (PF), role physical (RP), bodily pain (BP), and general health (GH)] at 12 weeks after operation were compared between the two groups. All operations of the two groups successfully completed. All patients were followed up 6-14 months (mean, 12 months). Incision fluid leakage occurred in 1 case of observation group and 7 cases of control group within 1 week after operation, and the incisions healed after symptomatic treatment. The incisions of other patients healed by first intention. The incidence of early incision complications in observation group was significantly lower than that in control group ( P<0.05). No late incision complications was found in the two groups. There was no significant difference in VAS scores at each time point between the two groups ( P>0.05). The VAS score significantly decreased with the increase of time in the two groups, showing significant differences between the different time points ( P<0.05). There was no significant difference in SF-36 scores (PF, RP, BP, and GH) between the two groups at 12 weeks after operation ( P>0.05). Compared with conventional mattress suture, Allgöwer-Donati suture is effective in open reduction and internal fixation via double incisions for Schatzker type Ⅴand Ⅵ tibial plateau closed fractures, which can reduce the incidence of early incision complications.

Is Staged Surgery Always Necessary for Schatzker Type IV-VI Tibial Plateau Fractures? A Comparison Study.

This study aims to compare the outcomes of immediate (followed by closed-incision negative-pressure therapy use) versus delayed ORIF in patients with Schatzker type IV-VI TPFs. A prospective study of patients undergoing ORIF between January 2018 and December 2019 was performed. The inclusion criteria were patients (>18 years) with a closed fracture sent to the emergency room (ER) within 24 h of injury. All the patients underwent preoperative image evaluation. Two senior orthopedic trauma surgeons evaluated the soft tissue condition in the ER by 5P's of the compartment syndrome, judging the timing of the operation of definitive ORIF. Group 1 (n = 16) received delayed ORIF. Group 2 (n = 16) received immediate ORIF and ciNPT use. Patient follow-up occurred after 2 and 6 weeks and 3, 6, and 12 months after surgery. The assessments included the time to definitive fixation, the length of hospital stay, the time to bone union, surgical site complications, and reoperation within 12 months. A universal goniometer was used to measure the postoperative 3 m, 6 m, and 12 m ROM. The patient demographics were similar between the groups (p > 0.05). Group 2 displayed significantly a shorter time to definitive fixation (5.94 ± 2.02 vs. 0.61 ± 0.28, p < 0.0001) and hospital stay (14.90 ± 8/78 vs. 10.30 ± 6.78, p = 0.0016). No significant difference was observed in the time to bone union, surgical site complication incidence, and reoperation rates (p > 0.05). Flexion and flexion-extension knee ROM were demonstrated to be significantly improved in Group 2, 3, 6, and 12 months postoperatively (p < 0.0001). In this study, early ORIF and ciNPT use resulted in a shorter hospital length of stay, a reduced time to early active motion of the knee, and improved knee ROM. These results suggest that early ORIF with ciNPT for Schatzker type IV-VI TPFs is safe and effective in some patients. However, further research to confirm these findings across larger and more diverse populations is needed.

Double reverse traction repositor assisted closed reduction and internal fixation versus open reduction and internal fixation for treatment of lateral tibial plateau fractures among the elderly.

In elderly tibial plateau fractures (TPFs), the lateral condyles are involved frequently. This study aimed to compare the outcomes of open reduction and internal fixation (ORIF) and double reverse traction repositor (DRTR) assisted closed reduction and internal fixation (CRIF) in elderly patients with lateral TPFs. From January 2015 to July 2020, we retrospectively reviewed 68 patients treated surgically at our trauma center for lateral TPFs (Schatzker type I-III). 31 patients were eventually assigned to the DRTR assisted CRIF group, whereas 37 patients were assigned to the ORIF group. The primary outcomes included surgical details, radiological assessment, follow-up knee function, and complications. The DRTR assisted CRIF group experienced a 43.6mL decrease in intraoperative blood loss (161.3ml vs 204.9ml, p = 0.033), and the operation duration was 32.1min shorter than the ORIF group (83.8min vs 115.9min, p < 0.001). There was no statistically significant difference in terms of widening of the tibia plateau (WTP), depth of articular depression (DAD), medial proximal tibial angle (MPTA) and posterior tibial slope angle (PTSA) immediately after surgery and at the last follow-up. No differences in malreduction (p = 0.566) or reduction loss (p = 0.623) were observed between the groups, and Lysholm and HSS scores were similar between the two groups (83.6 ± 15.8 vs 83.4 ± 5.1, p = 0.934; 89.3 ± 7.8 vs 86.9 ± 6.2, p = 0.172; respectively). However, ORIF was associated with a greater increase in postoperative complications than DRTR assisted CRIF (3.2% vs 27%, p = 0.008). Both types of internal fixation provide good radiological outcomes and knee function in the treatment of lateral TPFs in the elderly. However, DRTR assisted CRIF has the advantage of a shorter duration of surgery, less blood loss, and fewer postoperative complications, and appears to be a better treatment option for elderly patients with lateral TPFs.

A STUDY OF FUNCTIONAL OUTCOME IN THREE COLUMN FIXATION OF COMPLEX TIBIAL PLATEAU FRACTURES

Introduction: The treatment of complex tibial plateau fractures (TPF), especially those caused by high-energy trauma, remains a challenge in many respects. Tibial plateau fractures are one of the commonest periarticular fractures. These fractures include 1% of all fractures and 8% of fractures in elderly. Motor vehicle accidents account for the majority of these fractures in younger individuals with good bone stock, but in elderly individuals these fractures may result from simple fall due to osteopenic bone. Conservative methods may result in malunion and articular congruity cannot be restored. Surgical treatment can regain articular congruity and restore mechanical alignment, and can allow early range of motion. Open reduction and internal fixation techniques had been associated with wound complications. Aim Of The Study: To evaluate functional outcome in patients of complex tibial plateau fractures treated by three column fixation. Materials and Methods: In our institution 20 patients with displaced tibial plateau fractures with posterior column involvement were selected for the study. This is a prospective study done from AUGUST 2023 to APRIL 2024(9 months).Patients were evaluated with X rays (AP and lateral views) and Computed Tomography (axial, coronal, sagittal with 3D reconstruction views). Fractures classified based on 3 column concept classification. Mean follow up period was 6 months .Functional and radiological outcome was assessed using functional knee score , modified rasmussen score and WOMAC score. Inclusion Criteria: 1. Patients admitted with complex tibial plateau fractures involving medial, lateral and posterior column of tibia. 2. Both sexes 3. Age 20-60 yrs. Exclusion Criteria: 1) Bad skin status of the fractured site. 2) Patients with co morbidities not fit for surgery. 3) Patients with neurovascular deficit. 4) Patients not willing for surgery. Results:In our study, 70% of the patients were in active productive age group (30-50 years). 85% of the patients were male. The fractures were left sided in 75% patients. 85% patients in study sustained injury due to road traffic accident. 80% cases in the study were type 5 schatzker type 5 fractures and all the cases included in the study were 3 column fractures. 8 cases out of 20 cases in the study required epidural analgesia instead of a repeat spinal as the duration of the surgery was longer. Conclusion: To conclude,3 column fixation in high energy displaced tibial plateau fractures with three column fractures resulted in Good clinical and radiological outcomes.

The Clinicoradiological Outcome of Arthroscopic-assisted Reduction and Internal Fixation of Tibial Plateau Fractures

Abstract Background: The fractures of the tibial plateau are intraarticular fractures accounting for 1% of all fractures. Surgical management of such fractures is often challenging because they require anatomical reduction and stable fixation, which will allow for early rehabilitation. Arthroscopy has evolved nowadays and arthroscopically assisted reduction and fixation is a good option among the available surgical options. Materials and Methods: This prospective study included 50 cases of tibial plateau fractures managed surgically by arthroscopic-assisted reduction and fixation starting from August 2019 to December 2022. Results: The patients were 39 years old on average and were mostly men (58%). The right knee was the most usually injured (53%), and the most common cause of injury (41.5%) was a fall from a height. The majority of these fractures (44.5%) belonged to Schatzker type 2, followed by type 1 (37%) and type 3 (18.5%). The average time to complete weight-bearing for a Schatzker type I fracture was 10 weeks, 11.5 weeks for a type II fracture, and 13.5 weeks for a type III fracture. The average time to union for Schatzker type I was 13 weeks, 15.5 weeks for type II, and 16 weeks for type III. The mean clinical and radiological scores using the modified Rasmussen criteria were 26.3 and 7.3, respectively. Conclusions: A good surgical outcome of tibial plateau fracture is acquired when anatomic articular surface reconstruction with the elevation of depressed bone fragment is combined with rigid stable fixation, which permits early rehabilitation. Arthroscopy helps in achieving these goals by providing a good visualization of the articular surfaces, adequate fracture reduction, and anatomical restoration of the joint surface and aids in thorough joint lavage to remove the intraarticular debris.

Tibial plateau fractures are associated with poor functional outcomes and a low conversion rate to total knee arthroplasty.

The aim of this study was to analyse the functional outcome and the conversion rate to total knee arthroplasty (TKA) after surgically treated tibial plateau fractures (TPF). All patients undergoing surgical treatment of TPF at a single institution between January 2003 and December 2019 were retrospectively reviewed. The Knee injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale (TAS) were collected. The conversion rate to TKA was examined 2, 5, 7 and 10 years after surgical treatment of TPF. Ninety-four patients, with a mean follow-up of 110.6 months (±60.0), were included in the functional outcome assessment. Mean KOOS scores were 75.4 for symptoms, 80.6 for pain, 84.3 for activities of daily living (ADL), 59.5 for sports and 61.3 for QOL. All subscales were significantly lower on the injured side compared with the contralateral leg. Lower KOOS was observed in patients with hardware removal and Schatzker type 5 and 6 injuries. Median TAS was postinjury (4) significantly lower than preinjury (5) (p < 0.001). The conversion rate to TKA was 6.3%, 10.9%, 11.7% and 12.2% after 2,5,7 and 10 years of follow-up, respectively. Patients undergoing TKA were older than patients with no conversion to TKA (2 years follow-up 53.8 vs. 64.5 years, p = 0.026). TPFs decrease the function of the knee when compared with the contralateral side and to the preoperative condition. Bicondylar fractures are associated with worse functional outcomes. A conversion rate to TKA of 12.2% was found at 10 years follow-up. Level III.

Treatment of Schatzker Type VI Tibia Fractures Using Circular External Fixation: State of the Art, Surgical Technique and Results.

Schatzker type VI tibia fractures are usually associated with infection and surgical wound-related problems. Circular external fixation (CEF) has been shown to minimize such complications. We pose a retrospective study of patients with Schatzker type VI fractures treated with CEF. Twenty-two (22) patients were included (11M/11F) with a mean age of 60.1 ± 14.9 years. According to the AO/OTA classification, two fractures (9.1%) were A2, three (13.6%) were A3, and seventeen (77.3%) were C3. Three (13.6%) of them were open. The tissue damage observed in the nineteen (86.4%) closed fractures was classified according to Tscherne (four grade I, twelve grade II, and three grade III). The mean ex-fix time was 24.1 ± 5.1 weeks. None of the patients experienced deep infections, nonunion, or malunion. The mean ROM was 111.4 ± 17.8 degrees. Although stability was achieved in all cases, 50% of them suffered osteoarthritic degeneration. Four knees required TKR at a mean of 8.77 ± 5.58 years from trauma. The mean HHS knee score was 84.2 ± 10.3 points (excellent in fifteen (68.2%) cases, good in four (18.2%), and acceptable in three (13.6%)). The mean Rasmussen radiological score was 13.3 ± 3.5 (excellent in three (13.6%) cases, good in fifteen (68.2%), and acceptable in four (18.2%)). The mean SF-12 score was 35.1 ± 10.4 points on the physical scale and 53.0 ± 10.6 points on the mental scale. CEF has shown itself to be a valid treatment for patients with Schatzker type VI fractures, particularly for those where the fracture is comminuted, severely displaced, open, or associated with severe soft tissue damage.

Skeletal Traction Followed by Plaster of Paris vs Open Reduction and Internal Fixation – Comparison of the Functional and Radiological Outcome of the Two Treatment Modalities in Schatzker Type V and VI Tibial Fractures

Objective: To compare the functional and radiological outcomes of Schatzker type V and VI tibial fractures for the two currently employed treatment modalities. Methodology: It was a quasi-experimental study conducted at Orthopedics department. Patients were admitted through ER and OPD of Mayo hospital Lahore over a period of 1 year. Total 84 patients were included in the study. Patients were divided into two groups. Patients in Group A were managed with skeletal traction for 2 weeks followed by plaster of Paris back splint applied for next 2 weeks followed by plaster of Paris casting for stabilization of the fracture for another next 4 weeks. Patients in Group B were managed with ORIF by wires, screws or plates. Functional and Radiographic evaluations were performed to assess pain, range of motion weight bearing and fracture union in each follow-up visit Results: In this study functional outcome of patients was significantly better and higher in patients who were treated with ORIF technique Conclusion: ORIF is more effective for treating Schatzker type V and VI tibial fracture in terms of functional and radiological outcome as that skeletal traction followed by plaster of Paris casting.

Tibial Tuberosity Fixation in Complex Proximal Tibia Fractures Using Thin Profile Distal Fibular Plate: A Prospective Study with 12-month Outcomes

Introduction: Proximal tibial plateau fractures are common intra-articular injuries that result from either direct axial compressive trauma or indirect coronal trauma. The standard fixation method is bi-columnar dual plating. In cases with additional tibial tuberosity fractures, a thin-profile distal fibular plate can be used for repair. Aim: To assess the clinical outcomes of a combined posteromedial, anterolateral, and thin distal fibular plating of the tibial tuberosity fractures, and also to assess the radiological outcome in complex proximal tibia Schatzker type 5 and 6 fractures with additional tibial tuberosity fractures. Materials and Methods: This prospective study was carried out at the Orthopaedics Department of Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India from January 2017 to January 2022, on 18 patients with tibial plateau fractures (Schatzker type V or VI) associated with tibial tuberosity avulsion fractures. These fractures were fixed with thin-profile distal fibular plates. The functional outcome of the knee joint was assessed after one year, using the Knee Society score. Descriptive statistics were used to compute means, Standard Deviations, and ranges. Student’s t-tests and One-way Analysis of Variance (ANOVA) were used to compare the means. The p-value of ≤0.05 was considered statistically significant. Results: The average age of the study population was 39.4±5.6 years. Road traffic accidents were the most frequent mode of injury in 14 (77%) individuals. No perioperative complications were noted. The average duration of surgery was 114±10.4 minutes, and the average blood loss was 146±40 mL, throughout the procedure. The Knee Society score at 12 months postoperatively was excellent at 93.6 (range 92 to 98). Radiographic bone union was observed after an average of 12.4 weeks. Conclusion: Multiplanar complicated proximal tibia Schatzker type V and VI fractures with tibial tuberosity avulsion fractures may be effectively treated using a novel technique of thin-profile distal fibular plating. The bi-columnar plates combined with open reduction and internal fixation through two incisions with thin distal fibular plates showed satisfactory results.

Comparison of the clinical results of different approaches in the treatment of Schatzker V and VI tibial plateau fractures

Abstract In order to compare the clinical effects of different access surgical approaches in the treatment of Schatzker type V and VI tibial plateau fractures, a total of 68 patients with Schatzker type V and VI tibial plateau fractures involving the posterior-lateral aspect admitted to our hospital from January 2020 to January 2022 were grouped based on the different surgical access approaches, of which Patients treated with medial combined posterior-lateral approach were recorded as Group A (n=34), and patients treated with posterior medial inverted L incision combined with anterior-lateral approach were recorded as Group B (n=34). The surgical indexes (operation time, intraoperative blood loss) of the two groups were observed and compared, and the clinical efficacy of the patients was evaluated based on the New York Surgical Hospital (HSS) scores and imaging review, as well as the postoperative complications and the quality of life of the patients. Through the experiment, the operation time and intraoperative blood loss index of group A were better than that of group B (P &lt; 0.05); the HSS scores of the two groups were significantly improved with time (P &lt; 0.05), and at the same time, based on the follow-up observation, there was no significant difference between the HSS scores of the two groups of patients in the period of 3, 6, and 12 months of follow-up (P &gt; 0.05); up to the time of the last follow-up visit, the patients of the two groups had received the imaging examination, and no The mean knee range of motion in group A was 126. 32°±5. 48° (0-7°; 114-139°), and the mean knee range of motion in group B was 127.56°±6.78° (0-10°; 113-140°), and there was no statistically significant difference in the knee range of motion between the two groups (t=0.05). Range of motion was not statistically different (t=0.829, P=0.409); the incidence of postoperative complications in Group A was 14.71% (5/34) was slightly higher than the incidence of postoperative complications in Group B was 11.76% (4/34), but this difference was not significant (x2=0.128, P=0.720); the quality of life of patients in the two groups was improved over time (P&lt;0.05) and based on the SF36 scale score at 6 and 12 months of follow-up there was no significant difference in the quality of life between the two groups (P &gt; 0.05). The above results showed that the operation time and intraoperative bleeding of the medial combined posterior-lateral approach were less than that of the posterior medial inverted L incision combined anterior-lateral approach. Still, there was no significant difference between the two in terms of clinical efficacy and safety. The choice of surgical approach should be determined by combining the characteristics of fracture morphology, the objective conditions of instrumentation, and the patient’s individuality.

Significance of prothrombin, activated partial thromboplastin, and thrombin times in early rehabilitation after tibial fracture surgery.

To assess the role of prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) in guiding early rehabilitation following tibial fracture surgery. A retrospective analysis was conducted on 168 patients treated for tibial fractures from May 2020 to May 2022. Patients were divided into good and poor rehabilitation groups based on treatment outcomes. Data on age, gender, BMI, Schatzker classification, operation time, blood loss, PT, APTT, and TT were collected for univariate analysis. ROC curve analysis determined optimal cut-off values, followed by multivariable logistic regression to identify independent risk factors. A nomogram prediction model was then constructed. Independent risk factors for early recovery included age ≥45 years, Schatzker type III, operation time ≥99.5 minutes, APTT≥28.5 seconds, and TT≥13.5 seconds. The nomogram model demonstrated high prediction accuracy with a C-index of 0.980. Prolonged APTT, extended TT, longer operation time, and higher Schatzker classification were identified as independent risk factors influencing early recovery post-surgery. A logistic regression-based prediction model was developed, facilitating the design of personalized rehabilitation training programs to improve patient outcomes.

Complications In The Management Of High-Energy Closed Fractures Of Proximal Tibial Plateau. A Retrospective Study

Objective: To analyze the management of high-energy Schatzker type V and VI tibial plateau fractures which are associated with infectious and noninfectious complications. Methods: This study was carried out in the Department of Orthopedic Surgery, Rawalpindi Medical University from July 1, 2018, to June 30, 2021. This is a retrospective study which is done in three years. Patients had to be between the ages of 18 and 60, have no history of arthritis, have a closed fracture of the proximal tibia (Schatzker type V and VI), or have AO type 41-C1, C2 or C3 involvement of the lower limb. Each patient received treatment using techniques such as internal fixation with locking plates and open reduction which are minimally invasive. Results: This study involved a total of 132 patients.Mean age was 35.15±10.59.115(87%) were men and 17(13%) were women out of 132. A total of 39 out of 132 patients experienced complications (29.54%). Infectious complications (18.93%) were found in (25/132) patients 16 out of 25 patients had superficial infections. Routine dressing changes and antibiotic treatment were carried out in patients who had superficial infections.9 out of 25 patients who had faced a deep-seated infection underwent repeated implant removal, debridements, amputation, and flap covering depending on the reaction of the host. Noninfectious complications had been reported in 14 patients(10.6%). Six patients had hardware-related issues and four of them required a secondary treatment.08 individuals had malalignment, with five of them having it in their immediate postoperative radiographs and three others having it in their late postoperative radiographs. Conclusion: In closed wounds, substantial soft tissue destruction is linked to the fractures of the proximal tibial plateau, particularly Shatzker type V and VI. By selecting the right patients and minimising soft tissue dissection, the problems related to the management of these fractures can be reduced. Keywords: Proximal tibial plateau, Malalignment, Infectious complications, Debridement, Schatzker type V and VI.

FUNCTIONAL OUTCOME OF FIXATION OF TIBIA SCHATZKER TYPE II AND TYPE III FRACTURES UNDER ARTHROSCOPIC GUIDANCE

The tibial plateau fracture is a common type of orthopaedic fracture. An alternative to open reduction and internal fixation (ORIF) is arthroscopic-assisted reduction and internal fixation, which provides direct visualisation of the articular surface of the plateau, evaluation of the reduction of the articular surface, and management of any intra-articular pathology that may be associated with the reduction of the articular surface. This study aimed to determine the functional outcome of patients who received tibial fixation under arthroscopic supervision for Schatzker's Type II and III tibial fractures. The research was conducted over six months in the Orthopaedic Surgical Department at Jinnah Hospital in Lahore from November 17, 2022, to May 17, 2023. Sixty patients met the inclusion criteria were recruited after obtaining written informed permission. A clinical and historical examination of each patient's knees was conducted, followed by arthroscopy-guided internal reduction and repair of the tibial fracture under general anaesthesia. All patients received a post-operative rehabilitation regimen. At the three-month follow-up, standing AP radiographs were taken to examine the general alignment of the limbs, and Rasmussen score results were recorded. The average age of the patients was 46 years, and 63.3% were men and 36.7% were women. Schatzker grades II and III tibial plateau fractures were present in 53.3% and 46.7% of the patients, respectively. The mean Rasmussen clinical score was 27.33, indicating that 50 out of 60 patients had excellent recovery, nine out of 60 patients had good recovery, and one out of 60 patients had fair recovery. The mean Rasmussen radiological score was 7.36, indicating that 48 out of 60 patients had outstanding recovery, 11 out of 60 patients had good recovery, and one out of 60 patients had fair recovery. In conclusion, arthroscopic-assisted reduction and internal fixation is a good technique for treating young patients with Schatzker grades II-III tibial plateau fractures, and it enables control of co-existing injuries of intra-articular soft tissues, leading to faster recovery and greater patient satisfaction. However, having expertise in trauma and arthroscopic methods is important to carry out the procedure correctly.

Introduction of 3D-classification and its derived surgical sequence of Schatzker type IV tibial plateau fractures

IntroductionSchatzker IV tibial plateau fractures usually have a worse prognosis due to their high variability and the accompanied bony and soft tissue injuries. This study aimed to introduce an injury mechanism-based new classification of Schatzker IV tibial plateau fractures and evaluate its reliability. Additionally, this study aimed to evaluate the outcomes of operative Schatzker IV tibial plateau fractures treated according to the surgical sequences determined by the new classification.Materials and methodsA total of 63 cases of operative Schatzker IV tibial plateau fractures that were treated following the new surgical sequences were enrolled in our study. The CT images of these patients were reviewed and classified twice according to the new 3D classification by 4 independent observers. The reliability of the classification was calculated through kappa analysis. The classification-determined surgical sequence was evaluated by observing the postoperative efficacy during the follow-up.ResultsBoth the intra-observer (the mean k = 0.897, CI 0.806–0.971) and inter-observer (the mean k = 0.883, CI 0.786–0.961) reliability of 3D-classification showed excellent agreement according to Landis and Koch. All the patients were followed up for 6–28 months (average 12.8 months). As for the evaluation of the postoperative efficacy, according to KSS, 53 cases were rated as excellent, 8 cases as good, and 2 cases as fair results.ConclusionsThe new proposed classification showed high intra-observer and inter-observer reliability in our study. The surgical sequence determined by the classification can help surgeons to acquire good reduction and rigid internal fixation. Therefore the new classification of Schatzker IV tibial plateau fractures and the derived surgical sequences are worthy of further popularization and application in clinical trials.

Circular frame fixation of complex tibial plateau fractures in the elderly: Functional and radiological outcomes for Schatzker V and VI type fractures

Tibial plateau fracture fixation in the elderly poses a unique challenge due to poor bone stock, comminution and co-morbidities. There is limited evidence available in older patients sustaining multiple column Schatzker type V and VI injuries. In our institutions these injuries have traditionally been managed with circular frame fixation, often augmented with cross knee frame extension, internal screw fixation +/- bone graft substitutes. This study has reviewed the over 60-year-old cohort to better understand this complex injury. MethodsElectronic fracture databases were queried for ‘tibial plateau fracture’ and ‘Ilizarov frame’ between July 2009 and 2019. Inclusion criteria; age >60 years; CT identified multiple column (Schatzker V or VI) injuries; Ilizarov fixation; adequate follow-up data. Patient demographics, fixation technique, time to frame removal, residual radiological tibial deformity, joint incongruity, significant peri‑operative complications and progression to salvage TKA were reported. Results35 patients >60 years were treated with Ilizarov frame techniques for multiple column injuries. 84 % were female. Average age was 68 (62–81) with a follow-up of 6.6 years (2.3–11.3). 33 of the 35 patients investigated for osteoporosis had evidence of decreased bone mass (94 %). 94 % were Schatzker VI injuries. 22 cases required cross knee extension with a frame duration 155 days (range 103–317). Those without had a frame duration 128 days (range 93–212). 20 cases had a combined internal/external fixation technique and 9 cases required allograft or bone substitute. There was one case of non-union requiring salvage to constrained TKA. Three cases (9 %) of metalwork removal, two for prominent metalwork and one for deep infection. There were no VTE events and there was 0 % mortality in the two post-operative years. Oxford knee scores and SF-12 scores demonstrate that minimal residual deformities in the coronal and sagittal planes following frame removal are tolerated well within this age group. This study demonstrates Ilizarov techniques are highly successful at permitting early weight bearing and achieving union with associated low morbidity rates in an older population.

Does the Schatzker III Tibial Plateau Fracture Exist?

The Schatzker classification system for tibial plateau fractures is one of the most commonly used systems. However, there has been controversy if a Schatzker III type fracture truly exists by their original definition. We aimed to correlate the radiographic and CT images of type III fractures, describe the additional propagating fracture patterns and determine if these fractures do exist by their original description. This multicenter retrospective cohort observational study included patients with tibial plateau fractures across five trauma centers over 9years were identified. All X-rays and CT scans were assessed. Two independent fellowship trained, Orthopaedic trauma surgeons reviewed all knee X-rays and classified them according to the Schatzker system. The CTs were subsequently reviewed and the fractures were reclassified based on CT findings. 569 Tibial plateau fractures in 566 patients were analyzed. All X-ray classified Schatzker III fractures were reclassified to a Schatzker II type after review of CT scans by both assessors independently as there were always at least two or more fracture lines propagating from the depressed fragment to the lateral cortex in all cases. The interobserver variability as assessed by the kappa correlation coefficient (κ) for X-rays and CT-based classifications were κ = 0.274 and κ = 0.906, respectively. The majority of cases had two lateral cortical breaks (83.8%). In addition, the depression occurred mostly in the anterolateral and posterolateral positions (60.3%) of the lateral tibial plateau. This study did not support the existence of true Schatzker Type III fractures.

Assessment of Mean American Knee Society Scorefor Complex Plateau Fractures with Llizarov External Fixation

Objective: To determine clinical outcomes based on the AKSS (American Knee Society Score) in patients with complex tibial plateau fractures treated using Ilizarov external fixation. Methodology: This descriptive case series study was conducted at the Department of Orthopaedics, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from November 2020 to November 2021. The study included patients aged 20 to 55 of both genders with Schatzker type V or VI tibial plateau fractures who underwent Ilizarov external fixation and surgery within one week of the injury. Informed consent was obtained from all patients before undergoing Ilizarov external fixation. Pin tract infections were monitored weekly, and radiological assessments were performed monthly. The decision to remove the fixator was based on evidence of bone healing from two different angles, along with a successful stress test after removing the rods between the first two rings. After the fixator was removed, patients wore a removable brace for 3 to 5 weeks to protect their limbs during weight-bearing. Six weeks after external fixation, patients were assessed for pain levels, knee and ankle range of motion, limb alignment, and functional status according to the AKSS. Data were collected and analyzed using SPSS version 20. Results: The mean age of the patients was 32.4±8.7 years. Out of all the patients, 66.5% were male, and 33.5% were female. The AKSS score averaged 82.5±11.2, the mean duration of surgery was 41.5±9.3, and the mean range of motion (ROM) was 22.1±4.8. Clinical outcomes were classified as excellent in 47 (27.2%) patients, good in 57 (32.9%), while 48 (27.8%) and 21 (12.1%) had fair and poor clinical outcomes, respectively. Conclusion: The Ilizarov external fixation technique appears to be a reasonably effective method for treating complex tibial plateau fractures.

Case Report: Standard rehabilitation protocol for complex tibial plateau fracture associated with fibular head fracture managed with plate osteosynthesis

Schatzker fracture belongs to the tibial plateau fracture. This fracture is frequently characterized by excessive trauma, such as a fall from a terrific height or an automobile collision. They are identified by a vertical break in the tibial plateau, which disturbs the joint surface and surrounding tissues. A schatzker type six fracture is a complex fracture that is difficult to manage conservatively and typically requires surgery to reestablish articular realignment and integrity. The purpose of this study is to examine the rehabilitation method and actual outcomes of a 41-year-old male patient who had a tibial plateau fracture as well as a fibular head fracture. This case study shows the need for a comprehensive rehabilitation program in assisting individuals with this specific fracture pattern to achieve their maximum functional potential. The patient undertook a rehabilitation program that comprised several therapy interventions such as range-of-motion training, enhancing power, balance and proprioceptive training, gait re-training, and pain control measures. To assess the patient's progress, objective measurements such as goniometry, muscular strength by manual muscle testing, functional outcome ratings, and patient-reported outcomes were employed. As demonstrated by the case study, a comprehensive treatment approach is required to properly treat tibial plateau fractures in conjunction with fibular head fractures. The patient achieved a considerable and favorable affiliation with the therapy techniques and the outcome measures rating.