Schatzker Type Research Articles

Treatment of complicated tibial plateau fractures: strategy and development

Tibial plateau fracture, one of the most common fractures, includes simple and complicated fractures. Inappropriate treatment could result in pain and deformity, which has a bad effect on patient life. With the development of the surgical technique, a lot of methods could be selected when an orthopedist deals with these fractures. X-ray, one of the most common assistant examination, is the preferred method for tibial plateau fracture and could diagnose most of these fractures. Due to high resolution, CT scan could find these micro-fractures which X-ray cannot find and it could supplement the Schatzker type. MRI could find ligament, meniscus and arthrodial cartilage injury. Surgical approach includes anterolateral approach, medial approach, posteromedial approach, post approach, anterior approach. Anterolateral approach could be used for most of tibial plateau fractures. Posteromedial approach is used for medial plateau fracture involving post plateau fracture or post plateau fracture alone. Common plate, locking plate, dual plate and external fixation are commonly used fixation method. Dual plate is often used for complicated tibial plateau fracture. However, how to make accurate diagnosis and choose appropriate fixation is crucial for patients. We will summarize the application of X-ray, CT scan and MRI in diagnosis of tibial plateau fracture. Commonly used approaches to the proximal tibia, which together allow for the treatment of any proximal tibia fracture, will be described in this article.

Canulated Screw Fixation for Tibial Plateau Fracture in Adults

<p><strong>Objective:</strong><strong>Â Â </strong>To determine percutaneous screw fixation (PSF) as fair treatment option for Schatzker type I, closed tibial plateau fracture in adults.</p><p><strong>Patients and Methods:</strong><strong>Â Â </strong>30 male and female adults between the ages of 20 and 40 were included. Only displaced Schatzkar type I closed tibial plateau fractures without any associated injury or complication were included. Type II, III, IV, V and VI, fractures with infection, patients with other severe injuries and neurovascular compromise fractures were excluded. Patients were followed weekly for one month, every alternate week for four months, thereafter monthly for up to six months to assess range of motion, deformity, union or any other complication.</p><p><strong>Results:</strong><strong>Â Â </strong>Mean healing was 11.6 weeks. Mean hospital stay was 8.4 days. The overall clinical results were excellent in 20 (66.6%), good in 8 (26.6%), fair in 2 (6.6%) cases.<strong></strong></p><p><strong>Conclusion:</strong><strong>Â Â </strong>Percutaneous screw fixation provided</p><p>better results in close displaced type I Schatzker tibial plateau fracture in adults. It is minimally invasive and achieved articular anatomical reduction, rigid fixation and early mobilization.</p>

Complicaciones en fracturas de platillos tibiales de alta energía

The approach and management of high energy tibial plateau fractures is a challenge for every surgeon. Soft tissue injuries and joint comminution due to the energy involved are associated with a higher rate of complications and morbidity. ObjectivesTo evaluate the rate of complications in high energy tibial plateau fractures. Materials and methodA retrospective imaging-clinical study of Schatzker type V and IV high-energy tibial plateau fractures, treated with an external fixation and delayed osteosynthesis, was conducted between 2007 and 2013. Statistical analysis was performed using STATA 12.0. ResultsA total of 52 fractures were treated during the study period, of which 39 met the criteria for selection. The mean age of the patients was 42.4 years, with a follow-up time of 41.8 months.The complications include, neuropraxia, 5%, Schatzker V infection (20%), 16.2%, and Vl (80%), 12.1% (P=.759). There was no relationship between infection and age (P=.6056), mechanism involved (P=.131), time between accidents and the installation of an external fixator (P=.0556), or the time used for external fixation (P=.53). DiscussionHigh-energy tibial plateau fractures are associated with significant soft tissue injuries. Immediate reduction and osteosynthesis are determining factors for high rates of complications, while using transient external fixation should decrease them. A midline anterior approach has shown increased complications, while a double approach could improve this situation. ConclusionThe approach to high energy tibial plateau fractures must consider the use of a temporary external fixation for an adequate control of the fracture and the soft tissue for a definitive surgical treatment.

Complications in the management of closed high-energy proximal tibial plateau fractures

PurposeTo report complications in the management of complex closed proximal tibial fractures. MethodA retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted. ResultsThe overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention. ConclusionProximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

The morphological features of different Schatzker types of tibial plateau fractures: a three-dimensional computed tomography study.

BackgroundTibial plateau fractures are of great challenge to treat with open reduction and internal fixation, because fractures vary from simple to complex, with little or extensive articular involvement. Hence, recognition and comprehension of the fracture features will help orthopedic surgeons understand the injury mechanism better and manage these fractures by planning optimal surgical procedures. This study aimed to evaluate the morphological characteristics of tibial plateau fractures based on the Schatzker classification.MethodsA total of 186 patients with 188 tibial plateau fractures from 2010 to 2014 in our hospital were reviewed using a computed tomography scan and three-dimensional (3D) reconstruction. The main fracture line angles (FLA) of Schatzker types I, II, and IV were measured. For each fracture, depression depth was measured, and the depression zone was also located. Depression zones were overlapped to obtain a frequency diagram.ResultsSchatzker type I and II fractures had three subtypes: single anterolateral fracture, single posterolateral fracture, and complex fracture (the anterolateral and posterolateral parts). Schatzker type IV fractures were also divided into three subtypes: single posteromedial fracture, single anteromedial fracture, and the whole medial fracture. For various Schatzker types and subtypes of fracture, fracture depression clustered and occurred at different locations of the tibial plateau. A significant difference was observed in the depression depth among the different Schatzker types (P < 0.01, Kruskal-Wallis test), especially between Schatzker type III and other types (Nemenyi test). There was no difference in the depression depth among the subtypes of Schatzker type II, whereas the difference was significant between the two subtypes of Schatzker type IV.ConclusionsSchatzker type I, II, and IV fractures could be divided into three corresponding subtypes by FLA. Various Schatzker types of fractures differed in location and depth of depression. A proper operative approach should be made based on the morphological characteristics of individual types of tibial plateau fractures.

Second Place Award Immediate versus delayed operative treatment of low-energy tibial plateau fractures.

Background:Current management of tibial plateau fractures requires careful soft-tissue management. Often a staged approach with temporary external fixation followed by delayed internal fixation is recommended. While proven in high-energy injuries, its relevance in treating low-energy fractures has not been investigated. The goal of the current study was to assess the short-term complication rates in low-energy tibial plateau fractures treated early (<48 hr). As a secondary aim, we investigated whether surgical approach would affect rates of wound complications.Methods:This is a retrospective analysis of patients treated operatively for low-energy tibial plateau fractures at a level-1 urban trauma center between January 1, 2000 and January 1, 2010. Schatzker type 1-3 fractures were considered “low-energy,” despite stated mechanism. Statistical analysis was performed using chi-square and Fischer’s exact tests.Results:We analyzed 49 patients. From these, 29 received early (<48 hr) definitive surgery, while 20 had surgery delayed (>48 hr). The early treatment group had an infection rate of 3.4% and total complication rate of 20.6%. The delayed treatment group had an infection rate of 5.0% and total complication rate of 25%. There was no significant difference with respect to superficial infection (P=1.0), deep infection (P=0.48), or total complications (P=0.74) Additionally, infection rates did not differ between surgical approaches (P=1.0, 1.0).Conclusions:Early surgical fixation (<48 hr) of low-energy tibial plateau fractures can be performed safely. Additionally, a midline approach did not increase soft-tissue complications and could be utilized in a patient with a prior midline incision, or one who will soon require a knee arthroplasty.

Functional Outcomes of Internal Fixation of Complex Tibial Plateau Fractures: A Case Series

Aim: To study the functional outcomes of internal fixation in complex tibial plateau fractures. Materials and Methods: 51 patients presenting with complex tibial plateau fractures were treated between January,2013 to January,2016 with various modes of internal fixation depending on the fracture type. Subsequently the patients were followed up at 2,6,12,18 and 24 weeks and then at intervals of three months. Early mobilization was encouraged, and weight bearing was allowed on the basis of callus formation. The functional results were evaluated using the criteria of The Knee Society Clinical Rating System. Results: 18 patients of Schatzker type VI fractures were treated, out of which 9 were treated using only lateral plates, 7 were treated using lateral plates and additional cancellous screws, and 2 were treated using bicondylar plating. 15 patients of Schatzker type V were treated, out of which 10 were treated using lateral lock plates and cancellous screw medially, 4 were treated using only lateral lock plates and 1 was treated with bicondylar plating. Remaining 18 patients of Schatzker type II,III,IV were treated using either only screws or lateral lock plates, buttress plates and screws with or without bone graft. The mean follow up was 1 year (range 10 months to 34 months). All patients were followed up, and their functional outcome was recorded. Conclusions: Good results were obtained with internal fixation. There was good range of motion at the knee joint and excellent functional results.

Arthroscopic-Assisted Fixation of Tibial Plateau Fractures: Patient-Reported Postoperative Activity Levels.

Tibial plateau fractures may result in significant limitations postoperatively. Studies have described outcomes of arthroscopic-assisted percutaneous fixation (AAPF) of these injuries but have rarely reported postoperative activity levels. Between 2009 and 2013, patients who sustained a lateral split, split depression, or pure depression type tibial plateau fracture (Schatzker types I-III fractures) and underwent outpatient AAPF were eligible for the study. Outcomes were assessed using Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm score, and Marx activity score. Twenty-five consecutive patients were eligible for the study, and 22 (88%) were included in the final analysis, with average follow-up of 2.5 years (range, 1-5.2 years). Thirteen women and 9 men with an average age of 48.3 years (range, 23-65 years) comprised the study population. Average number of screws used for fixation was 2 (range, 1-4). The average depression was 8 mm preoperatively and 0.9 mm (range, 0-3 mm) postoperatively. Four patients (18%) had complications: 2 with hardware removal and 2 with postoperative deep venous thrombosis. Average postoperative Marx activity score was 5.7. Average postoperative KOOS Symptoms, Sports, and Quality of Life scores were 88 (range, 68-100), 85 (range, 45-100), and 77 (range, 50-100), respectively. Average IKDC and Lysholm scores were 81 (range, 55-97) and 87 (range, 54-100), respectively. The AAPF surgical technique, which was performed in an outpatient setting, facilitated excellent postoperative range of motion, outcomes, and activity scores with minimal complications. [Orthopedics. 2016; 39(3):e486-e491.].

Risk factors for infection after operative fixation of Tibial plateau fractures

IntroductionTibial plateau fractures are challenging to treat due to the high incidence of postoperative infections. Treating physicians should be aware of risk factors for postoperative infection in patients who undergo operative fixation. Patients and methodsA retrospective review was undertaken to identify all patients with tibial plateau fractures over a 10 year period (2003–2012) who underwent open reduction internal fixation. A total of 532 patients were identified who met the inclusion criteria. Several patient and clinical characteristics were recorded, and those variables with a significant association (p<0.05) with postoperative infection after a univariate analysis were further analyzed using a multivariate analysis. ResultsFifty-nine (11.1%) of the 532 patients developed a deep infection. The average length of follow-up for patients was 19.5 months. Methicillin-resistant Staphylococcus aureus was the most common species, and it was isolated in 26 (44.1%) patients. Open fractures, the presence of compartment syndrome, and a Schatzker type IV−VI were found to be independent risk factors for deep infection. ConclusionsThe rate of deep infection remains high after operative fixation of tibial plateau fractures. Patients with risk factors for infection should be counseled on the possibility of reoperation, and surgeons should consider MRSA prophylaxis in those patients who are at higher risk.

Evaluation of functional outcome of tibial plateau fractures managed by different surgical modalities

&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Background: &lt;/span&gt;&lt;/strong&gt;Tibial plateau makes up one of the most important weight bearing surface. Its fractures are commonly faced entity encompassing a wide spectrum of injuries of variable fracture morphology. Due to in-crease in incidence of high velocity trauma and higher functional demands of patients, surgery is warranted in most of the cases. Although, there is advancement in fracture fixation methods, apt treatment of tibial plateau fractures still remains controversial.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Methods:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; In our series, we analyzed the functional outcomes of 58 of surgically treated tibial plateau fractures. Fractures were classified with Schatzker’s classification. Various fixation modalities of fixation were employed. Functional outcome was evaluated with modified Rasmussen’s criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Results: &lt;/span&gt;&lt;/strong&gt;Most of the patient’s belonged to younger age groups (58.62%) and males (79.31%) were predominately involved. Road traffic accidents were the most common etiological factor (70.69%). Schatzker types I (29.31%) and II (27.59%) were the most common observed fracture type. The majority of the patients had a complication free recovery (81.03%). Infection was reported in only one case (1.72%). Similarly, malunion was noticed in only in one case (1.72%). None of the patients had complications like nonunion or neurovascular damage. The functional outcome assessment according to Modified Rasmussen’s criteria at the end of 12 months showed the excellent functional outcome in 41 (70.68%), good in eight (13.79%), fair in five (10.34%) and poor in four (6.9%) patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Conclusions: &lt;/span&gt;&lt;/strong&gt;Surgical treatment of tibial plateau fractures is challenging, yet it helps in achieving excellent anatomical restoration and rigid fracture fixation enabling in the restoration of articular congruity and facilitation of early knee motion thus achieving optimal knee function.&lt;/p&gt;

Fracture morphology and injury mechanisms of tibial plateau fracture: analysis of 200 cases

Objective To classify tibial plateau fractures based on the analysis of the morphology and injury mechanisms of 200 cases of tibial plateau feature. Methods We collected the X-ray and CT images of 200 consecutive cases of tibial plateau fracture in 199 patients who had been treated at our department from January 2010 to April 2011. They were 134 males and 65 females, from 15 to 77 years of age (average, 45.7 years). According to the Schatzker classification, 9 cases were type Ⅰ (4.5% ), 105 type Ⅱ (52.5% ), 19 type Ⅳ (9.5% ), 37 type Ⅴ (18.5% ), 30 type Ⅵ (15.0% ), and none type Ⅲ. The fracture morphology and injury mechanism of each case were analyzed to propose a new classification system. Results Fractures of tibial plateau can be classified into the following five types: (a) Lateral condylar fracture and valgus injury (100 cases, 50% ). The injury mechanism is the axial force on the valgus and extended knee joint. (b) Fracture-dislocation injury (24 cases, 12.0% ). This type includes typical Schatzker type Ⅳ, and some cases of Schatzker type Ⅵ associated with lateral subluxation. Its mechanism is a compound force of valgus, varus, rotational and axial stresses. The rotational force is the key factor leading to subluxation of the knee joint. (c) Double-condylar fracture (40 cases, 20.0% ). This type is caused by an axial force on the extended knee, including Schatzker type Ⅴ and some cases of Schatzker type Ⅵ not associated with knee subluxation. (d) Posterior condylar fracture and flexion injury (32 cases, 16.0% ). This type only involves the posterior condylar plateau, and is caused by an axial force on the flexed knee. Based on the morphology, posterior condylar fractures can be further divided into three subtypes: simple split of posteromedial condyle, simple collapse of posterolateral condyle, and a combination of the two. (e) Frontal plateau compression fracture and hyperextension injury (4 cases, 2.0% ). This type is caused by an axial force on the hyper-extended knee. It is characterized by significant compression of the anterior plateau and intact posterior plateau. Conclusion Based on the morphological features and injury mechanisms, tibial plateau fractures can be classified into 5 types: lateral condylar fracture, fracture-dislocation injury, double-condylar fracture, posterior condylar fracture, and frontal plateau compression fracture. Key words: Knee joint; Fractures, bone; Radiography; Injury mechanism; Fracture classification

Treatment of complex tibial plateau fractures using Ilizarov external fixator with or without minimal internal fixation

Background The tibial plateau is a critical weight-bearing area located on the upper end of the tibia. The lesion may be restricted to the tibia or associated with significant soft-tissue injury. The aim of the present study is to assess the results of closed reduction and Ilizarov external fixation in management of comminuted tibial plateau fractures. Patients and methods The study included 20 patients with high-energy tibial plateau fractures (Schatzker types V and VI). The ages ranged from 23 to 56 years, with an average of 30 years. The trauma was a road traffic accident in 11 cases and a fall from a height in nine cases. The fractures were closed in 16 cases and open in four cases. The open fractures were Gustilo–Anderson type I in one case and type II in three cases. Soft-tissue injuries associated with closed fractures were classified according to Tscherne system. The follow-up period averaged 31 months. The mean duration of surgery was 70 min (range: 40–120 min). The mean time to union was 10.4 weeks. At the final follow-up, the average total range of knee flexion was 112.5° (range: 0–170°). Results Results were satisfactory in 18 cases and unsatisfactory in two cases according to the Rasmussen knee functional score. Complications included pin-tract infection in 12 cases, an extension lag in two cases and varus deformity of about 15° in one case. Conclusion Hybrid external fixation is a good method for the treatment of comminuted tibial plateau fractures. It allows for early joint movement and reduces the risk of serious complications.

Operative management of tibial plateau fractures

Background and Objectives: Advance in mechanization and acceleration of travel have been accompanied by increase in number and severity of fractures and those of tibial plateau are no exception. Treatment modality in these fractures has been a controversial question. The objectives of the study were assessment of the functional outcome of fixation of proximal tibial fractures using cannulated cancellous screws or ORIF with BP/LCP or External fixator, comparing the results of different treatment modalities and at the same time, identifying the complications associated with them.Materials and Methods: 22 cases of tibial plateau fractures in K.V.G. Medical College, Sulia were treated in from October 2013 to October 2015 with the objectives of precise reconstruction of articular surface, stable fragment fixation and early range of motions Totally 23 patients were treated, among which 6 patients were treated by cancellous screws fixation, 13 patients by ORIF with BP, 3 patients by ORIF with LCP and 1 patient with Hybrid external fixator. The functional evaluation of knee joint was done using modified Hohl and Luck Criteria.Results: The result revealed most patients were aged between 31–50 years (56.5%) with male preponderance, commonest mode of injury being RTA (86.2%).Schatzker type I fracture was commonest (26.7%).The functional result for ORIF with Buttress plate was excellent in 25.2% of cases and good in 50.1% of cases.66.7% of cases treated with LCP had good functional result. cancellous screws fixation was associated with equal number of good and fair results (33.3%). Commonest complication with operative treatment were wound related (37.5%) followed by knee stiffness (36.36%).Interpretation and Conclusion: Operative management of tibial plateau fractures will give excellent anatomical reduction to restore articular congruity and rigid fixation to fascilitate early motion thereby reducing post-traumatic OA and achieving optimal knee function.

Evaluation of Hybrid External Fixator for Tibial Plateau Fractures: A Prospective Study

Background: Tibial plateau fracture is one of the common injuries encountered in our daily clinical practice. The goals of management of these peri-articular fractures are restoration of joint congruity by anatomic reduction of the articular fragments, stable fixation of fragments, early joint movements, care of injured soft tissues and prevention of fracture related, surrounding soft tissue and wound related complications. Though open reduction and internal fixation is preferred in the current day practice for such fractures, they are associated with a variety of complications leading to poor outcome. Ligamentotaxis and percutaneous fixation has been advocated by many authors to improve the results and to minimize the risk of serious complications. The aim of the present study is to evaluate and assess the results of closed reduction and hybrid external fixator application in the management of tibial plateau fractures. Materials and methods: Study included 28 patients with Schatzker type II and above closed tibial plateau fractures treated by Hybrid external fixator by the same team of surgeons on a tertiary care center following relevant investigations and assessment. Patients were followed up at regular intervals and finally evaluated clinically and radiologically at the end of one year. Conclusion: Our study highlighted the success of indirect reduction and hybrid external fixation application as the definitive method for the management of tibial plateau fractures. It minimizes the risk of soft tissue damage and reduces the incidence of serious complications with good fracture union and functional outcome in patients. Keywords: Hybrid external fixator, Tibial plateau fracture, Schatzker

Functional and Radiological Outcome of Schatzker type V and VI Tibial Plateau Fracture Treatment with Dual Plates with Minimum 3 years follow-up: A Prospective Study.

High energy intra-articular fractures involving the tibial plateau causes various problems related to management like wound dehiscence, severe comminution leading to malalignment and delayed complications like varus collapse, implant failure and arthritis of knee joint. This study was done to determine functional, radiological outcome and the complications of Schatzker V and VI tibial plateau fractures treated with bipillar plating with dual plates with a regular follow-up of atleast 3 years. Total 34 cases of tibial plateau fracture type V and VI treated with dual plating were studied from January 2011 to December 2013 in KIMS Hospital were followed for minimum of 3 years. The patients were operated through an anterolateral approach for lateral plate and a medial column plate was put through a minimally invasive medial approach or an open posteromedial approach. Total 34 patients were evaluated postoperatively thoroughly for functional outcome using The Knee Society Score and radiological outcomes by Modified Rasmussen Assessment criteria which showed 29 patients (85.29%) had excellent and 5 patients (14.71%) had good objective knee society score. 24 patients (70.59%) had excellent, 8 patients (23.53%) had good and 1patient (2.94%) were each of poor and fair functional knee society score. Eleven patients (32.35%) had excellent, 21patients (61.76%) had good and 2 patients (5.88%) had fair radiological outcome. We conclude that open reduction and internal fixation of high-energy tibial plateau fractures with dual plates via 2 incisions gives excellent to good functional outcome with minimal soft tissue complications. Thus, a minimally invasive approach should be used which helps in preventing soft tissue problems and helps in early wound healing. Fixation done by bipillar plating is important for early mobilization of knee joint. Early mobilization leads to better range of movements and thereby better functional outcome.

Treatment Experience of 16 Cases in Combined with Posterior Condylar Fractures Schatzker types II and III Tibial Plateau Fracture

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; Exploring the treatment of combined posterior lateral approach with open reduction and internal fixation for the treatment of combined fractures of the ankle on the treatment of tibial plateau fractures with Schatzker types II and III. &lt;strong&gt;Method: &lt;/strong&gt;Between April 2012 and March 2015, 16 cases of Schatkzer types II and III tibial plateau fractures were treated with T or L type limited contact dynamic compression plate (LC-DCP). &lt;strong&gt;Results: &lt;/strong&gt;All 16 cases were followed-up for 12 to 36 months, with an average of 18.3 months. According to the Merchant score, 10 cases were excellent, good in 4 cases, and in 2 cases, the excellent and good rating was 87.5%. &lt;strong&gt;Conclusion:&lt;/strong&gt; After treatment, anatomical reduction and stability of the posterior condyle was emphasized, and there were early functional usage and recovery of the joint functions. At the same time, the external side of the incision can be used to restore the external and rear sides to avoid replacement of the body position and improve the operation efficiency.&lt;/p&gt;

Use of a raft construct through a locking plate without bone grafting for split-depression tibial plateau fractures.

To review the outcome after open reduction and internal fixation using a periarticular raft construct through a locking plate without bone grafting for split-depression tibial plateau fractures. Records of 38 knees in 31 men and 7 women aged 25 to 75 (mean, 42.7) years who underwent open reduction and internal fixation using a periarticular raft construct through a locking plate without use of a bone graft or bone substitute for split-depression (>5 mm) proximal tibial plateau fractures (Schatzker type II or AO/OTA type 4.1 B3) were reviewed. The integrity of the articular surface was assessed using radiographs. The Rasmussen radiological score and clinical score, the Lysholm knee score, and the Tegner activity score were also assessed. The mean follow-up period was 22.8 (range, 6-36) months. All patients achieved bone union after a mean of 13.2 (range, 8-26) weeks. The mean range of motion was 118º (range, 100º-130º). The Rasmussen radiological score was excellent in 27 patients, good in 9, and fair in 2. The Rasmussen clinical score was excellent in 15 patients, good in 21, and fair in 2. The Lysholm knee score was excellent in 26 patients, good in 8, and fair in 4. 32 of the 38 patients recovered to their preoperative Tegner activity scores. Only one patient with severe comminution had loss of reduction after full weightbearing. Fixation using a periarticular raft construct through a locking plate without use of a bone graft or bone substitute for split-depression proximal tibial plateau fractures is a viable option.

Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture: a comparative finite element study.

PurposeThe purpose of this study is to compare the stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture.MethodsA three-dimensional (3D) finite element model of the medial tibial plateau fracture (Schatzker type IV fracture) was created. An axial force of 2500 N with a distribution of 60 % to the medial compartment was applied to simulate the axial compressive load on an adult knee during single-limb stance. The equivalent von Mises stress, displacement of the model relative to the distal tibia, and displacement of the implants were used as the output measures.ResultsThe mean stress value of the plate-screw fixation system was 18.78 MPa, which was significantly (P < 0.001) smaller than that of the screw fixation system. The maximal value of displacement (sum) in the plate-screw fixation system was 2.46 mm, which was lower than that in the screw fixation system (3.91 mm). The peak stress value of the triangular fragment in the plate-screw fixation system model was 42.04 MPa, which was higher than that in the screw fixation model (24.18 MPa). But the mean stress of the triangular fractured fragment in the screw fixation model was significantly higher in terms of equivalent von Mises stress (EVMS), x-axis, and z-axis (P < 0.001).ConclusionsThis study demonstrated that the load transmission mechanism between plate-screw fixation system and screw fixation system was different and the stability provided by the plate-screw fixation system was superior to the screw fixation system.

Balloon tibioplasty for reduction of depressed tibial plateau fractures: Preliminary radiographic and clinical results.

In vitro studies have shown promising results for balloon-guided inflation tibioplasty. It was our hypothesis that this technique may be safe and effective for use in depressed lateral tibial plateau fracture. We performed a prospective study of all patients suffering from a depressed lateral tibial plateau fracture, managed in our institution with inflation tibioplasty and a resorbable calcium phosphate bone substitute injection, between January 2012 and December 2013. Twenty patients, mean age 54.3 ± 12. 8years, suffering from a depressed lateral tibial plateau fracture (Schatzker type II and III) were included. We then aimed to evaluate at a minimum follow-up of one year: (1) the rate of complications, (2) the clinical outcome (Knee Injury and Osteoarthritis Outcome (KOO) and 12-Item Short Form Health Survey (SF-12) scores); and (3) the radiographic outcome (evaluated by CT-scan). No peri-operative complications occurred. In one patient, calcium phosphate substitute was found in the infrapatellar fat pad on post-operative radiography with no clinical or radiographic consequences at one year. At one year after surgery, the KOO subscores were: Pain 80 (range 64-93), other symptoms 81.3 (69-93), daily living activities 81.9 (46-99), sport 65.83 (20-100), and quality of life 67.04 (31-100). The SF-12 activity component was 40.4 (28.6-52.2) and SF-12 mental component 47.71 (28 - 67.1). The mean depressed step-off of the lateral joint decreased from 10.7± 4.8 mm pre-operatively to 2.7 ± 1.7mm post-operatively (p < 0.0001). Our observations suggest that the use of balloon-guided inflation tibioplasty with injection of a resorbable bone substitute is safe, and results in a high rate of anatomic reduction and good clinical outcomes in patients with depressed tibial plateau fractures. Therapeutic Level IV.

Clinical Outcomes of 20 Schatzker Type II Tibial Plateau Fractures after Open Reduction, Internal Fixation and Bone Grafting

Clinical Outcomes of 20 Schatzker Type II Tibial Plateau Fractures after Open Reduction, Internal Fixation and Bone Grafting