Schatzker Type Research Articles

Incidence and Radiological Predictors of Concomitant Meniscal and Cruciate Ligament Injuries in Operative Tibial Plateau Fractures: A Prospective Diagnostic Study

The aim of this prospective study was to determine the incidence of meniscal and cruciate ligament injuries in operative tibial plateau fractures detected using knee arthroscopy, and to identify the radiological predictors observed on CT images. From January 2016 to February 2017, a total of 102 closed tibial plateau fractures were enrolled in this prospective protocol. Each patient underwent arthroscopic examination following the tibial plateau internal fixation. Univariate analysis and multivariable logistic regression were used to assess the association between imaging parameters and soft-tissue injuries. The menisci were traumatically injured in 52.9% of subjects (54 of 102) and the cruciate ligaments injured in 22.5% (23 of 102). Significantly higher injury rates for bucket-handle meniscal tears were observed in Schatzker type VI fractures (P = 0.04). Greater risk of lateral meniscus injury was observed in patients with >6.3 mm of lateral joint depression. Greater risk of ACL injury when the volumetric lateral joint depression was ≤209.5 mm2 and/or with >5.7 mm lateral joint widening. Associated meniscal and ligament injuries were commonly seen among operative tibial plateau fractures. Preoperative CT measurements might help predict a higher risk of meniscus and ACL injury, providing guidance to the surgeon to look for and to be prepared to treat such injuries.

Staged Treatment of Bicondylar Tibial Plateau Fracture (Schatzker Type V or VI) Using Temporary External Fixator: Correlation between Clinical and Radiological Outcomes.

PurposeThis study is to investigate clinical and radiological results of staged treatment using a temporary external fixator in bicondylar tibial plateau fractures (TPFs) and to evaluate correlation between prognostic factors and postoperative clinical outcomes.Materials and MethodsTwenty-four bicondylar TPF patients were selected. All patients were operated by a temporary external fixator first and then open reduction and internal fixation with dual plating. Clinical and radiological outcomes were evaluated.ResultsThe mean American Knee Society score (AKSS) was 85.3. The mean Western Ontario and McMaster Universities Osteoarthritis index was 11.2. The mean range of motion (ROM) was 123.4°. The mean medial tibial plateau angle (mTPA) was 88.3°, and the mean proximal posterior tibial angle (PPTA) was 8.4°. Compared with the uninjured limb, the mean difference of mTPA was 1.5° and that of PPTA was 4.0°. The difference of PPTA and the AKSS demonstrated negative correlation (p=0.007). Patients with normal mTPA showed better ROM than those with abnormal mTPA (p=0.041).ConclusionsStaged treatment using a temporary external fixator in bicondylar TPFs showed good clinical and radiological outcomes. Surgeons should evaluate the reduction status intraoperatively by fluoroscopy and also refer to the uninjured limb radiologically.

Arthroscopic-assisted balloon tibioplasty versus open reduction internal fixation (ORIF) for treatment of Schatzker II–IV tibial plateau fractures: study protocol of a randomised controlled trial

IntroductionArthroscopic-assisted balloon tibioplasty is an emerging technology that has shown advantages in recovering depression of the articular surface. However, studies evaluating clinical outcomes between arthroscopic-assisted balloon tibioplasty and traditional open...

Single medial approach for the treatment of Schatzker IV tibial plateau fractures

Objective Try to treat the Schatzker Ⅳ tibial plateau fractures with a single medial approach. Methods A single medial longitudinal incision was used to treat 16 cases of Schatzker type Ⅳ tibial plateau fractures admitted to hospital from January 2013 to January 2016 which diagnosed by computed tomography (CT). The range of peeling up to the anterior edge of the tibia, the back side skipping over the posterior bone crest to expose the Posterior surface, persisting the joint capsule and the medial collateral ligament, and the far end reached 3-5 cm beyond the fracture line. As the lower limbs in the situation of external rotation with hip and knee flexion, open the medial fracture, using a strutting forceps to brace the bone block, made out he collapsing cartilage and subchondral bone which belong to de back column, Using the detacher to lift the subchondral bone together with the cartilage surface, lift up to the lateral side until it can’t be raised again, fixed them with 2-3 Kirschner-pins of 1.5 mm-diameter. And then used a large C type Matta forceps to clamp the fracture line for recovering the width of tibial platform. A Tomofix plate was used to fix the fracture in the position of posterior bone crest. The intercondylar eminence fracture of the anterior cruciate ligament was fixed under direct vision, and the supporting plate was placed in the posterior medial wall to fix the posterior medial small fracture. The standard X-ray films of bilateral knee joint were taken and compared after the operation. The knee joint activity was measured at 1 year follow-up after 1 years. The healing of subchondral fracture and no secondary collapse were performed by plain scan, and the function of the knee joint was evaluated by Lysholm scoring system. Results 15 cases were followed up for more than 1 years. All the X-ray showed fracture healing at half a year. CT confirmed that the fracture healed completely at the time of reexamination. The condylar crest avulsion fracture healed well, there was no secondary cartilage surface collapse, no obvious osteoarthritis, the average knee joint activity was 118°, and the average of Lysholm score was 87. Conclusion Combined approach is an effective method for the treatment of complex tibial plateau fractures, but for Schatzker Ⅳ fractures, a good reduction can be achieved with a single medial approach combined with some proper tools. Key words: Tibial plateau fractures; Medial approach; Schatzker Ⅳ

Biomechanical study of nickel-titanium three-dimensional memory alloy mesh and autologous bone in treatment of canine tibial plateau collapse fracture

To evaluate the biomechanical effect of a nickel-titanium (Ni-Ti) three-dimensional memory alloy mesh in treating a canine tibial plateau collapse fracture model and to lay a foundation for further experiments in vivo. Sixteen tibial plateau specimens of 8 adult Beagle dogs were harvested. Twelve specimens were taken to prepare canine tibial plateau collapse fracture models (Schatzker type Ⅲ) and randomly divided into groups A, B, and C, with 4 specimens in each group. Four normal tibia specimens were used as blank control group (group D). In groups A and B, the bone defects were repaired with Ni-Ti three-dimensional shape memory alloy mesh combined with autologous bone and simple autologous bone respectively, and fixed with the lateral plate and screw. In group C, the bone defect was directly fixed with the lateral plate and screw. By using a biomechanical tester, a progressive load (0-1 700 N) was loaded vertically above the femoral condyle. The maximum failure load was recorded and the stiffness was calculated according to the load-displacement curve. The maximum failure loads in groups A, B, C, and D were (1 624.72±7.02), (1 506.57±3.37), (1 102.00±1.83), and (1 767.64±24.56) N, respectively; and the stiffnesses were (129.72±20.83), (96.54±27.05), (74.96±17.70), and (169.01±35.62) N/mm, respectively. The maximum failure load and stiffness in group A were significantly higher than those in groups B and C, but which were significantly lower than those in group D ( P<0.05). Ni-Ti three-dimensional memory alloy mesh combined with autologous bone can repair the Schatzker type Ⅲ tibial plateau collapse fracture, which has better biomechanical properties than simple autologous bone grafting.

Treatment of Lateral Tibial Condylar Fractures Using Bioactive, Bioresorbable Forged Composites of Raw Particulate Unsintered Hydroxyapatite/Poly-L-Lactide Screws.

Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) devices possess high mechanical strength, bioactivity, and radio-opacity. The aim of this study was to assess the efficacy of F-u-HA/PLLA screws in the treatment of lateral tibial condylar fractures. From January 2005 to December 2010, a total of 7 patients with displaced closed lateral tibial condylar fractures (Schatzker type II) were treated using F-u-HA/PLLA screws. Open reduction and internal fixation was performed using 2 or 3 F-u-HA/PLLA screws. After surgery, weight bearing was not allowed for 6 weeks. Range of motion exercise was initiated after removal of the plaster splint. Radiographs were evaluated for fracture healing, joint depression, and the radioopacity of F-u-HA/PLLA screws. Clinical outcomes and postoperative complications were also assessed. Average follow-up was 44 months. All fractures were successfully healed. Average values for joint depression were 4.7 mm (range, 2-9 mm) preoperatively, 0.4 mm (range, 0-1 mm) postoperatively, and 0.4 mm (range, 0-1 mm) at final follow-up. Whole shadows of F-u-HA/PLLA screws were observed during the follow-up period. Breakage of screws, osteolysis, and a radiolucent zone around the screws were not observed at final follow-up. Average knee flexion and extension were 134° (range, 110° to 150°) and -1° (range, -10° to 0°), respectively. No patient had wound infection, late aseptic tissue response, or foreign body reaction postoperatively. None of the patients reported pain at final follow-up. These results suggest that F-u-HA/PLLA screws could be an alternative option for the treatment of lateral tibial condylar fractures. [Orthopedics. 2018; 41(3):e365-e368.].

Fixation augmentation using calcium-phosphate bone substitute improves outcomes of complex tibial plateau fractures. A matched, cohort study.

Injectable cements have been developed to improve fixation's stability and thus obtain early return to adequate joint function. We aimed to compare post-operative radiographic and clinical outcomes of patients suffering from a complex tibial plateau fracture (TPF) fixed with calcium-phosphate bone substitutes (CPBS) augmentation to a matched group of patients with identical fracture pattern, treated with the same fixation's type, but augmented with bone grafting. After local ethic committee approval, we retrospectively identified in a prospectively collected database, patients with complex comminuted metaphyseal and epiphysial bicondylar TPF (Schatzker type VI) admitted in our emergency department between January 2011 and December 2013. From those, 23 patients (14 males, 9 females) were treated with CPBS (Quickset-CP®, Graftys, Aix-en-Provence, France) fixation augmentation. Patients' mean age were 44.4years. We then created a control group using a 1:1 matching process on gender, age, fracture pattern, and method of fixation. Patients were evaluated prospectively at 3, 6, and then every sixmonths using radiographic (AP/ML views) and clinical criteria (knee osteoarthritis outcomes score (KOOS) and EuroQOL-5D). Articular step-off and variation of articular step-off were significantly lower in the CPBS groups (mean step-off 1.4 ± 1.9 (0.5-6.5mm) and mean step-off Δ = 0.3 ± 0.4 (0.5-2.2mm)) than in the control group (mean step-off 3.6 ± 2.1 (1-7.5mm) and mean step-off Δ = 2.2 ± 2 (0.5-7mm) p < 0.01). At last follow-up, patients of the control group presented a higher rate of step-off > 2mm and step-off Δ > 2mm (respectively, 56 and 35%) than patients of the CPBS group (26 and 9%). Odd ratio of, respectively, 3.6 (95% CI (1.08-12.7) and p = 0.03) and 5.6 (95% CI (1.04-30.1) and p = 0.03).At mean follow-up of 29months, KOOS pain subscore was significantly better in patients of the CPBS group (85.3 ± 12.1) than in control patients (74.2 ± 10.4 and p = 0.03). The present study demonstrates that calcium-phosphate bone substitute used as synthesis augmentation improves mid-term radiological outcomes of patients suffering from complex tibial plateau fracture. Series reporting outcomes from a larger number of patients and longer follow-up must confirm clinical benefits and safety of this method.

Functional outcome of tibial plateau fractures, Schatzker type V and VI treated surgically with plate osteosynthesis

Functional outcome of tibial plateau fractures, Schatzker type V and VI treated surgically with plate osteosynthesis

Management of tibial condylar fractures in adults: A prospective study

Tibial condylar fractures are specially challenging to the Orthopaedic surgeons because of their variation, complexity, and injuries associated with it. Proximal tibia gives attachment to the various elements of knee stabilizers and is an integral part of the knee mechanism. So, alteration of its anatomy caused by injury result in functional impairment of knee. A study has been carried out to know the mode of injury, fracture pattern, outcome of various modalities of treatment, complications encountered and associated with management of tibial condylar fractures in adults. Study consists of 35 patients with tibial condylar fractures. Out of 35 patients, 12 patients were managed by conservative methods and remaining 23 Patients were managed by surgical methods. Conservative treatment included closed reduction and above knee cast application and surgical management included CRIF with CCS or ORIF with BP with or without bone grafts. Functional evaluation of the knee was done, based on the modified HohI and Luck evaluation methods. Incidence of osteoarthritis was assessed based on the most recent radiograph of tile patient’s weight bearing. The management of tibial plateau fracture has always been a subject of debate because of their variety and complexity. It is concluded that surgery is the treatment of choice for displaced fractures belonging to Schatzker type I and II. Schatzker’s type III fractures can be managed conservatively if the depression is less than 2 mm. Schatzker’s type IV and V can be managed by open reduction and internal fixation with Buttress plate and bone grafting especially in young individuals who require perfect anatomical reconstruction of the articular surface, stable fixation and early mobilization. Conservative method is a valid and useful alternative for undisplaced Schatzker type I fractures.

A study of short term outcome of high energy tibia plateau fractures treated with bicondylar proximal tibia plating using modified rassmusen’s score

Objective: This study focuses on short term outcome of bicondylar proximal tibia plating as a treatment of High energy tibia plateau fracture using Modified Rassmusen’s score. Introduction: High energy tibial plateau fractures remain a challenge to the most experienced orthopaedic surgeons, with the bicondylar type (schatzker type V)and the comminuted type(schatzker type VI)fractures being the most difficult to treat. The goals of treatment include satisfactory restoration of mechanical alignment, anatomical reduction of articular surface and stable fixation that allows early range of motion of knee. Methodology: A cohort of 30 patients with high energy tibia plateau fractures, treated with bicondylar proximal tibia plating between Jan 2016 to Dec 2017 were analyzed for minimum of 6 months and final result was analyzed using Modified Rasmussen’s score. Results: 40% patients had excellent and 40% patients had good results. Assessment done using Modified Rassmusen’s score.

Open reduction and internal fixation in a one-stage anterior cruciate ligament reconstruction surgery for the treatment of tibial plateau fractures: A case report and literature review

Treatment of tibial plateau fractures associated with anterior cruciate ligament (ACL) injuries can be challenging. Maintaining the joint surface and axis are two main principles for the management of patients with tibial plateau fractures. Herein, we describe a patient with tibial plateau fracture of Schatzker type VI associated with complete ACL rupture. Although in a two-stage reconstruction surgery for treatment of its rupture seem to be accepted by most orthopaedic surgeons in cases of ACL injuries, we treated our patient with ORIF in a one-stage ACL reconstruction surgery. At the 1-year follow-up, the patient gained full range of motion and was functioning well. We reviewed the literature on performing ORIF in a one-stage ACL reconstruction for the treatment of tibial plateau fractures, which seemed to be a reasonable management approach that supported its use for the treatment of this patient.

Value of quantitative assessment using Multidetector CT in predicting ligamentous and meniscal injuries in acute tibial plateau fractures

PurposeTo assess the ability of MDCT to predict ligamentous and meniscal injuries in acute tibial plateau fractures compared to MR images. Patients and methodsForty patients with acute tibial plateau fracture and 15 control subjects were subjected to MDCT and MR images. Lateral plateau depression (LPD) and lateral plateau widening (LPW) were measured in coronal MDCT images. Meniscal, cruciate, and collateral ligaments injuries were evaluated in MR images. ResultsSoft tissue injuries incidence was not related to Schatzker type (P > 0.05). LBD and LBW were different significantly between patients and control subjects ((P value < 0.001∗). LPD was correlated to meniscal, cruciate, and collateral ligaments injuries (P < 0.05). LPW was correlated to cruciate and collateral ligaments tears (P < 0.05) but not meniscal lesions (P > 0.05). LPD > 6 mm or LPW > 7 mm increased possibility of Soft tissue injuries. Multiple soft tissue injuries were not related to Schatzker types (P > 0.05). LPD and LPW were correlated with number of soft tissue injuries. ConclusionMDCT measurements of LPD and LPW are correlated with incidence and number of ligamentous and meniscal injuries. MDCT can predict ligamentous and meniscal injuries without waiting for MRI in acute tibial plateau fractures.

Revision of Schatzker type Ⅵ tibial plateau fracture failure focus on the recovery of lower limb alignment

Objective: To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills. Methods: Twenty-two cases of tibial plateau Schatzker Ⅵ fracture internal fixation failure revision from January 2012 to January 2017 in Department of Orthopedics, Shanghai 10(th) Hospital.One year follow-up after initial surgery to make sure of failure.Three-dimensional CT scan, radiography, infection index, gait analysis, knee joint ROM, femur tibia angle, tibial plateau tibial shaft angle and posterior slope if tibial plateau were observed. The medial approach and bi-planer osteotoma were used.Autogenous iliac bone graft, postoperative fast recovery channel were used.Follow-up point included preoperative and postoperative 7 days, 6 weeks, 3 months, and 6 months.Obvervational index included double lower limbs radiography, knee society score(KSS), complications such as infection, skin necrosis, joint main passive activity, double lower limbs alignment the last follow-up SF-36 scale.Rate was compared by χ(2) test, measurement data using paired sample t test.Correlation was analyzed by Pearson correlation regression testing. Results: Twenty-two patients received follow-up.KSS, more than 21 cases were benign, with good gait.One case was poor, with claudication gait.Not skin necrosis, no deep infection cases, 1 case get blisters 2 days postoperatively, and disappear after 5 days with detumescence and cold therapy.Whether restoring force line affect the KSS significantly(χ(2)=22.000, P=0.000). Knee joint ROM, SF-36 score, KSS and lower limb alignment were improved significantly. In different individual the articular surface and anatomical angle recovered greatly but the posterior slope angle was quite difference which has no correlation with KSS and SF-36 scale(P>0.01). Conclusions: Revision of Schatzker type Ⅵ tibial plateau fracture failure should focus on the recovery of lower limb alignment.moderate overcorrect bone cutting and joint surface height can bring benefits to the postoperative knee function.Revision surgery patients have greater psychological pressure, more early psychological intervention is necessary.

Treatment of Schatzker IV tibial plateau fractures with arthroscopy combined with MIPPO technique

To discusses the clinical effects of arthroscopy combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in treating Schatzker IV tibial plateau fractures. From January 2012 to January 2016, 19 patients with Schatzker type IV tibial plateau fractures were treated with arthroscopy combined with minimally invasive technique including 12 males and 7 females with an average age of 46.5 years old ranging from 19 to 78 years old. Patients were suffering knee pain, swelling, flexion and extension limited, and other symptoms preoperative. Patients were followed up and assessed by Rasmussen knee function score. No infection, traumatic arthritis, and knee joint valgus occurred after operation. Nineteen cases were followed up for 12 to 24 months with an average of 18.6 months. Fracture healing time was 3 to 5 months with an average of 3.8 months. The knee pain and limited mobility improved significantly. The range of autonomic movement of joints was from 90 to 136 degrees. According to Rasmussen functional score criteria, the total score was 27.00±2.49, the result was excellent in 16 cases, good in 2 cases, fair in 1 case. Arthroscopic treatment for Schatzker type IV tibial plateau fractures combined with MIPPO can simultaneously treat internal structural injuries such as meniscus and other knee joints, with less trauma, fewer complications, and faster joint function recovery, but we must strictly grasp surgical indications and avoid expanding injuries.

Comparison of medial and lateral locking plates for Schatzker type VI fractures of tibial plateau: a finite element analysis

Objective To compare the biomechanical characteristics of medial and lateral locking plates for Schatzker type Ⅵ fractures of tibial plateau by finite element analysis. Methods A 38 year-old male volunteer was enrolled for CT scan of his lower limbs. His CT images of the left tibial plateau were used for 3D reconstruction of a model of Schatzker type Ⅵ fracture by NX 9.0 software. After the boundary conditions were set, a 500 N load was applied to the tibial plateau to simulate the stress on a single leg when an adult weighing 60 kg walked. The displacement and stress on plate and screws were analyzed by Abaqus software. Results The ultimate stress on the model fixated with a medial locking plate was 81.7 MPa, located at the proximal tibiofibular joint surface. The ultimate stress on the model fixated with a lateral locking plate was 487.4 MPa, located at the junction of plate and screws. The ultimate stress on the fibula was much larger in the model fixated with a medial locking plate than in the model fixated with a lateral locking plate. The ultimate displacement was smaller and more homogeneous in the model fixated with a medial locking plate (1.15 mm) than in the model fixated with a lateral locking plate (3.44 mm) . Conclusion The Schatzker type Ⅵ fractures of tibial plateau should be fixated with a medial locking plate because it has more biomechanical advantages than a lateral locking plate. Key words: Tibia; Fractures fixation, internal; Bone plates; Finite element analysis

A midterm analysis of Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 240 cases

Background: Tibial plateau fractures are a risk to the functional integrity of the knee. They are the result of axial compressive forces alone or combined with varus or valgus stress on the knee joint. Post-traumatic osteoarthritis occurs after traumatic injury to the joint. The presence of residual incongruity at the time of fracture healing could lead to joint stiffness and long-term morbidity has established the restoration of articular congruity as the key principle on the management of these injuries. Despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage injury. This prospective study evaluates the functional and radiological outcome of surgically managed tibial plateau fractures and incidence of osteoarthritis. Methods: In this study 240 patients with tibial plateau fractures were surgically managed by different modalities. The study was prospective, patients were evaluated by Rasmussen criteria clinically and radiologically and Kellgren & Lawrence grading for development of osteoarthritis at 6 weeks, 3 months, 6 months, then onwards regular OPD follow-up and latest final follow-up. Results: Rasmussen clinical scoring system was applied to our study showed excellent results in around 34% (82) of the patients, 53% (127) had good,9% (22) had fair and 4% (9) had poor results.Out of 240 patients 78 (32.5%) developed OA knee ( including Kellgren and Lawrence grade 1) which is a significant number of patients. With increase in schatzker type & amount of articular depression the number of patients developing Osteo arthritis increased, schatzker Type I 16 % vs schatzker Type VI 54% and no articular depression 9.5% vs > 5mm articular depression 46 %. Conclusion: With increase in schatzker type & amount of articular depression the chance of patient developing Osteoarthritis significantly increases and thus excellent anatomical reduction with restored articular congruity rigid fixation is required to facilitate early knee motion and reduces chance post-traumatic osteoarthritis and thus achieving optimal knee function. Keywords: Tibial Plateau fracture, post-traumatic arthritis, Proximal tibia Fracture.

Effects of expanded anterolateral approach for tibial plateau fractures involved the posterolateral column

Objective: To explore the short-term effects of expanded anterolateral approach in treating fracture involved the posterolateral tibial plateau. Methods: A retrospective analysis of the clinical data from 16 patients undergoing extended anterolateral approach for fracture involved the posterolateral tibial plateau in the First Affiliated Hospital of Wannan Medical College between January 2013 and July 2016 was done. The patients were treated with 3.5 mm proximal "L" type proximal tibial locking compression plate with four locking screws through the nail row technique. The X-rays examinations were carried out immediately after the operation and at 1.5, 3, 6, and 12 months later, to continuously measure the tibial plateau angle (TPA) and posterior slope angle (PA). The Rasmussen radiology score was used to assess the reduction. One year later, the modified Rasmussen knee score was used to assess the recovery of knee function, the Lysholm score was applied to evaluate the cartilage injury, softening and degeneration, and lateral stress test and dial test were carried out to evaluate the stability of the knee. Results: The group consisted of 11 males and 5 females; aged 25 to 71 years, mean (47±12) years; schatzker type Ⅱ 9 cases, type Ⅴ 6 cases and type Ⅵ 1 case. There were 9 cases of type B in Orthopedic Trauma Association (OTA) classification, and 7 cases of type C. X-ray was immediately performed after operation and it showed that 14 cases got anatomic reduction, 2 cases left<2 mm of steps. Rasmussen radiology score was 14 to 18 points, mean (17.0±1.5) points. X-ray examination showed no significant difference in TPA immediately after operation and 1.5, 3, 6, 12 months later (F=0.05, P=0.99), and there was no significant difference in PA among the time points (F=0.02, P=1.00). At one-year of follow-up, the modified Rasmussen knee score ranged from 18 to 29 with an average of (25.0±3.3) points, of which 7 were excellent, 8 were good and 1 was fair. The excellent and good rate was 93.75%. Knee range of motion was 110°-135° with a mean of (122±8)°. Lysholm score was 93±4. Evaluation of lateral stress test and dial test were both negative. Conclusions: The short-term curative effect of expanded anterolateral approach in treating fracture involved the posterolateral tibial plateau with the 3.5 mm proximal "L" type proximal tibial locking compression plate proximal to the locking screw is satisfactory, it provides sufficient exposure and effective fixation, the joint function and stability are satisfying.

Assessment of Functional and Radiological Outcome of Proximal Lateral Condyle Fracture of Tibia (Schatzker Type 1, 2 and 3) Fixed with Locking Compression Plate and Screw

Assessment of Functional and Radiological Outcome of Proximal Lateral Condyle Fracture of Tibia (Schatzker Type 1, 2 and 3) Fixed with Locking Compression Plate and Screw

Ability of the Schatzker classification to predict posteromedial fragmentation in tibial plateau fractures

Background: The Schatzker classification is the most widely accepted system used to classify tibial plateau fractures. The presence of posteromedial fragments in the more severe fracture types is known, but the presence of posteromedial fragmentation in the less severe fracture types is unknown. The ability of the Schatzker classification to predict posteromedial fragmentation was evaluated. Methods: Two hundred patients were reviewed of which only 67 met the inclusion criteria. The X-rays were reviewed by three independent orthopaedic surgeons and classified according to the Schatzker classification. A radiologist reviewed the CT scans and noted the presence or absence of a posteromedial fragment and if present, the largest diameter of the fragment was measured. Results: The mean age of the sample was 44.79 (SD: 14.03) years. Seventy-five per cent of the females (n=33) presented with posteromedial fragmentation compared to 65.20% of the males (n=44) (chi²-test, P=0.399). The incidence of posteromedial fragmentation varied between 15.8 and 26.3% for Schatzker 1 and 2 fractures and 73.7 and 84.2% for Schatzker 3 to 6 (chi2-test, p<0.001) based on the three independent assessments. The mean length of the posteromedial fragmentation ranged from 41.87 to 47.77 mm for Schatzker 1 and 2 fractures, and 44.74 to 46.12 mm for Schatzker 3 to 6 for the three assessors (statistically not significant [T-test, P=0.536, P=0.551 and P=0.652]). Conclusion: The Schatzker classification by itself is not adequate to identify all fractures with posteromedial fragmentation. There is a higher association of posteromedial fragmentation with fracture types 3 to 6. There is a high probability of missing a significantly sized posteromedial fragment in Schatzker type 1 and 2 fractures if a CT scan is not performed which might influence and compromise fracture stability, joint congruency and the ability to rehabilitate optimally. Level of evidence: Level 4

A study on clinical, functional and radiological outcome of high velocity tibial plateau fractures managed by dual plating

BACKGROUND: Dual plating in comminuted bi-condylar tibial plateau fractures remains controversial. More methods of treatment have been described, each has got its own merits and demerits. We performed a prospective study to evaluate the Clinical , functional and Radiological outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a posteromedial approach. MATERIAL AND METHOD: We treated 21 high velocity tibial plateau fractures ( Schatzker type V and VI ) with lateral and medial plates through an anterolateral approach and a posteromedial approach over 2 years period . Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The outcome was evaluated according to the Honkonen Jarvinen criteria on follow up. RESULTS: The incidence of male was more compared to females in the ratio - 3.2 : 1. The nature of injury is high velocity injury as it is explained by all patient sustaining road traffic accident .None had sustained injury as a result of trivial trauma as occurs in elderly with osteoporotic bone.The incidence of fracture in right side was 42.9 % and in left side was 57.1 % which nearly equal.Among 21 cases, the incidence of fracture in age group 40 -50 was 52.4 %.Of 21 fractures , 7 patients ( 33.3 % ) had Type V fracture and 14 patients ( 66.7 %) had Type VI fracture.There were no associated injury in all patients .All patients underwent standard surgical procedure by anterolateral & posteromedial approach .Lateral locking plates were used for lateral plateau and T/L Buttress, Semi tubular, Recon plates were used for medial plateau.Bone Grafting was used for 9 patients ( 42.9%) to fill metaphy seal defect.Time required for union ranged from 11 to 16 weeks with average being 12.9 weeks. CONCLUSION: High velocity tibial plateau fracture have excellent to good clinical, functional and radiological outcome . Early mobilisation of the joint provides good range of motion . Posteromedial plating provides a buttress to posteromedial fragment and thereby prevents varus collapse.The patients with good soft tissue cover should undergo anatomical reduction and rigid fixation immediately without deferring time. This is a short term study and need follow up to predict the further outcome.