Schatzker Type Research Articles

Advances in Surgical Management of Schatzker III Tibial Plateau Fractures

The tibial plateau Schatzker type Ⅲ fracture is a simple lateral collapse fracture, which is mainly seen in the low energy injuries of the knee joint in older patients with osteoporosis. The treatment options for this type of fracture are open reduction and internal fixation. Repairing the alignment of the collapsed joint surface and the tibial force line is the final goal of surgical treatment. Usually the choice of internal fixation is the combination of ship valve screw arrangement and support steel plate. Many authors recommend avoiding the use of simple hollow screws, especially in comminuted fractures with more severe joint defects, as this can easily lead to secondary collapse of the joint.(5)The traditional surgical method is an anterior-lateral approach with open reduction and internal fixation. Due to the long incision, large trauma, and poor medical compliance of the elderly, it is prone to complicated knee stiffness and traumatic arthritis. The surgical effect is not satisfactory.

COMPARISON OF BICONDYLAR TIBIAL PLATEAU FRACTURES WITH DOUBLE OR SINGLE LATERAL LOCKED PLATE.

ABSTRACTObjective: To compare postoperative radiographic outcomes of Schatzker type V and VI tibial plateau fractures treated with double-plate or single lateral locked plate.Methods: Sixty-three patients operated from December 2011 to February 2016 were selected, 47 from the double-plate group and 16 from the single lateral locked plate group. Minimum follow-up for all patients was 6 months. Fracture reduction evaluation was based on radiographic parameters: joint reduction, sagittal alignment, coronal alignment, and condylar width.Results: Radiographic evaluation showed no statistical difference in the immediate or late postoperative periods.Conclusion: Despite the reduced sample, this study is aligned with current results published in the medical literature. The severity of Schatzker type V and VI tibial plateau fractures can be minimized by the correct indication for the implant regarding fracture morphology. Level of Evidence III, Retrospective comparative study.

Integration of Three-dimensional Technologies in Orthopedics: A Tool for Preoperative Planning of Tibial Plateau Fractures.

Background:There is a growing scientific interest in the use of three-dimensional (3D) technologies in orthopedic surgery. Digitalization makes research in orthopedics more accurate and quantitative. Scientific literature describes an overview of current 3D technologies applications in orthopedics, without any emphasis on integrating available technologies as a clinical workflow.Objective:To develop a clinical workflow integrating 3D technologies for patient-specific applications in orthopedics validated in practice by employment of a free 3D software solution with the aim of minimizing the intervention.Method:By exploring the applications of 3D technologies in orthopedic surgery, we have created a clinical workflow integrating 3D technologies for patient-specific applications in orthopedics. It is validated in practice for preoperative planning of a 49-year-old male patient who had a tibial plateau fracture of Schatzker type VI in his right leg. The software solution we have used is Democratiz3D, from Embodi3d platform, which allows patient-specific modeling and surgical planning.Results:By using the proposed methodology we obtained the model of the tibial plateau fracture Schatzker type VI, as a “solid” representation in stl type files, which represents a numerically defined geometry of the bones fragments. It helps surgeons in planning the surgical approach. The time from the beginning to the end of the analysis was 193 min, which is 15% lower than times reported in similar studies.Conclusion:The planning potential of the 3D solution is a valuable instrument for surgeons in exploring the nature of tibial plateau fractures and the formulation of a suitable surgical plan for surface alignment, design and screw fixation guides, strength calculations of bone fragments, and printing surgical objects.

Schatzker Type VI Injury with Missed Posterior Dislocation of the Hip

ABSTRACT Introduction Posterior dislocation of the hip can be an associated injury with fracture neck and shaft of the femur fractures. Case description A 33-year-old male came to us with above knee slab of the left leg. He had a fall from the bike and took initial treatment elsewhere. The X-ray and diagnosis of Schatzker type VI injury of the left knee were already done in the previous hospital. The upper tibia fixed with L-plate with screws. When the patient started walking in parallel bar, he felt twisting strain on the left hip and complained of pain in the left hip region. Now, the patient had shortening and internal rotation of the left lower limb. Clinically diagnosed posterior dislocation of the left hip was confirmed with X-ray. Reduction of dislocation was done. Conclusion X-rays of proximal and distal joints are mandatory. The statement stands testimony every time. How to cite this article Mothilal M, Khader FA, Rajan TS, et al. Schatzker Type VI Injury with Missed Posterior Dislocation of the Hip. J Orth Joint Surg 2020;2(1):43–45.

Functional and radiological outcome of schatzker type II, III, VI fractures treated via subchondral RAFT system combined with locking compression plate

Need for the study: Treatment of proximal tibia fracture is difficult especially when intraarticular and metaphyseal comminution present. The tibial plateau involves weight bearing so restoration of joint congruity is important to preserve normal function of knee. Subchondral raft construction is one popular method under investigation for this purpose where subchondral screws support the bone pieces along with cartilage and prevent it to depress again. Aim: to evaluate clinical and radiological results of Schatzker type II, III, VI fractures treated using open reduction and internal fixation with subchondral RAFT system combined with lateral plateau locking compression plates. Methods: 30 patients of proximal tibial plateau split fracture and depression, including men and women aged >18 years who came to department of orthopaedics GMCH between 2017 to 2019 were enrolled in the study. Diagnosis made by x-rays and computerized tomography. In all patients, the depressed joint line was elevated and fixed with subchondral RAFT screws through the locking compression plate. At the last follow up, clinical and radiological data were recorded. Results: The mean ROM was 110.50 (range 900- 1250), Mean KSS was 90.2 (range 65-100), Mean Rasmussen radio score was 15.6(range 10-18). All 30 patients showed signs of fracture healing on follow up x-rays and on final follow up complete bone union. Two patients developed superficial infection and one patient had screw backout on 2nd follow up. none encountered major intra or post-operative complications. Conclusion: Subchondral RAFT combined with locking compression plate helps surgeon to maintain the anatomical reduction of depressed intraarticular fragment with satisfactory functional and radiological outcome.

双螺钉与三螺钉固定方式治疗胫骨平台Schatzker I型骨折的效果比较

双螺钉与三螺钉固定方式治疗胫骨平台Schatzker I型骨折的效果比较

Minimally invasive plate oseosynthesis assisted by a self-designed lower limb axial tractor for treatment of complex tibial plateau fractures

Objective To investigate the clinical efficacy of minimally invasive plate oseoynthesis (MIPO) assisted by a self-designed lower limb axial tractor in the treatment of complex tibial plateau fractures. Methods The data were retrospectively analyzed of the 31 patients who had undergone surgical treatment for complex tibial plateau fractures from June 2015 to April 2018 at Department of Orthopeadics, Hospital Affiliated to Binzhou Medical College. MIPO was conducted with the assistance of the axial tractor in 17 of them. They were 12 men and 5 women with an age of 50.8±14.7 years, with 8 cases of Schatzker type Ⅴ and 9 ones of Schatzker type Ⅵ. MIPO was conducted without the assistance of the axial tractor but with the assistance of manipulation reduction in the other 14 patients. They were 9 men and 5 women with an age of 48.9±9.5 years, with 6 cases of Schatzker type Ⅴ and 8 ones of Schatzker type Ⅵ. The 2 groups were compared in terms of operation time, intraoperative bleeding, and Rasmussen scores for knee function and medial angle of the proximal tibia at the last follow-up. Results The 2 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The tractor and manipulation groups were followed up for a mean of 9.8 months and 10.9 months respectively. Bone healing was achieved in all patients. For the tractor and manipulation groups, respectively, the operation time was127.8±40.8 min and 174.1±66.8 min, and the intraoperative bleeding 115.6±41.7 mL and 184.3±91.4 mL, showing significant differences between them (P 0.05). Loss of force line was observed in none of the patients at the last follow-up. Conclusion Compared with conventional manipulation reduction, use of our self-designed lower limb axial tractor can shorten operation time, reduce bleeding and facilitate reduction of fracture fragments in the treatment of tibial plateau fractures of Schatzker types Ⅴ and Ⅵ. Key words: Knee joint; Fracture fixation, internal; Surgerical procedures, minimally invasive; Traction; Tibial plateau fracture

Surgical Treatment of Lateral Tibial Plateau Fractures Involving the Posterolateral Column.

ObjectiveTo summarize the indications and the clinical effects of a transfibular neck osteotomy approach and a combined anterolateral and posterolateral approach in the treatment of fractures of the lateral tibial plateau involving the posterolateral column.MethodsEleven patients with lateral tibial plateau fractures were included in the present study. The fractures were Schatzker type II or lateral platform fractures involving posterolateral column. The anterolateral combined posterolateral approach (lateral + posterolateral locking plate fixation) was applied in 7 patients and 4 patients underwent transfibular neck osteotomy (lateral + posterolateral locking plate fixation + 1/4 tubular plate edge fixation, fibular osteotomy with Kirschner wire tension band fixation, and hollow nail fixation for upper tibiofibular joint). All cases were followed up for 12–24 months, with an average follow‐up of 17.5 ± 5.0 months. At the last followup, the Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation. The knee joint function was evaluated using the knee function evaluation criteria of the Hospital for Special Surgery (HSS). The Lachman test and the pivot‐shift test were used to evaluate the anterior and posterior and rotational stability of the knee joint. The range of knee motion was recorded.ResultsBone healing was achieved in all patients with fractures treated with a transfibular neck osteotomy approach and a combined anterolateral and posterolateral approach. At the last follow‐up, both the Lachman test and the pivot‐shift test results were negative. All patients had complete knee extension. For the combined anterolateral and posterolateral approach, the knee flexion angle was 110°–130°, with an average of 122.86° ± 7.56°. For the transfibular neck osteotomy approach, the knee flexion angle was 115°–130°, with an average of 120.00° ± 7.07°. For the patients in which the combined anterolateral and posterolateral approach was used, the Rasmussen score was 12–18 points, with an average of 16.00 ± 2.56 points. The results were excellent in 4 cases and good in 3 cases; therefore, 100% of results were excellent or good. For patients in which the transfibular neck osteotomy approach was used, the Rasmussen score was 10–18 points, with an average of 15.25 ± 3.77 points. The results were excellent in 2 cases, good in 1 case, and acceptable in 1 case; therefore, 75% of results were excellent or good. The HSS score for the combined anterolateral and posterolateral approach was 76–98 points, with an average of 88.43 ± 7.55 points. The results were excellent in 5 cases and good in 2 cases; therefore, 100% of results were excellent or good. The HSS score for the transfibular neck osteotomy approach was 74–96 points, with an average of 87.25 ± 9.43 points. The results were excellent in 3 cases and good in 1 case; therefore, 100% of results were excellent or good. There were no significant differences in operation time, surgical blood loss, fracture healing time, postoperative imaging score, and knee function evaluation between the two approaches. One patient who underwent transfibular neck osteotomy had a 3‐mm step that gradually appeared, but no significant abnormalities were found in the width of the platform and the lower limb force line. One patient in whom the combined anterolateral and posterolateral approach was used showed numbness in the common peroneal nerve. No common peroneal nerve injury occurred through the transfibular neck osteotomy approach.ConclusionsThe anterolateral combined posterolateral approach and the transfibular neck osteotomy approach are effective in the surgical treatment of lateral tibial plateau fractures involving the posterolateral column. However, the transfibular neck osteotomy approach is more suitable for the posterolateral plateau articular surface damaged with bone separation and displacement, deep collapse, cases involving a large range of the posterolateral column, especially fractures of the lateral tibial plateau in the upper tibiofibular syndesmosis area of the line connecting the anterior and posterior margin of the fibular head to the midpoint of the plateau.

To study outcomes in patients with schatzker type V and VI tibial plateau fracture treated with single 4.5mm lateral locking compression plate

To study outcomes in patients with schatzker type V and VI tibial plateau fracture treated with single 4.5mm lateral locking compression plate

Epidemiological survey of tibial plateau fractures in the Third Hospital of Hebei Medical University from 2009 to 2018

Objective To analyze the epidemiological characteristics of all the patients with tibial plateau fracture admitted to the Third Hospital of Hebei Medical University in the past 10 years. Methods The picture achieving and communication system was used to collect the general information and disease-related information from the hospitalized patients with tibial plateau fracture who met the inclusion and exclusion criteria from January 1, 2009 to December 31, 2018. The patients from January 1, 2009 to December 31, 2013 were assigned into group A while those from January 1, 2014 to December 31, 2018 into group B. The 2 groups were compared to find out the epidemiological characteristics and trends of tibial plateau fractures in the past 10 years in gender, age, occupation, injury cause and Schatzker classification. Results A total of 1,936 patients with tibial plateau fracture were included in the study, including 1,352 males and 584 females with a male to female ratio of 2.32∶1. The peak age ranged from 50 to 59 years, with 40 to 49 years for males and 50 to 59 for females. There were 793 cases in group A (a male to female ratio of 1.89∶1) and 1,143 ones in group B (2.69∶1), showing a significant difference between the 2 groups in the male to female ratio (P<0.05). The peak age ranged from 40 to 49 years (25.09%, 199/793) in group A and from 50 to 59 years (23.27%, 266/1,143)in group B. There were significant differences between the 2 groups in the constituent ratios of age groups from ≥50 years (P<0.05). Physical workers accounted for the highest proportion in group A (57.12%, 453/793) and group B (52.58%, 601/1,143). There were significant differences between the 2 groups in the constituent ratios of occupations (P<0.05). In all the 1,837 patients with a definite injury cause, the fall and indoor activity accounted for the highest proportion(41.92%, 770/1,837), the traffic accident(33.25%, 248/769) in group A did and the fall and indoor activity(48.88%, 522/1,068) in group B did too. There were significant differences between the 2 groups in the injury causes (P<0.05). Of all the 1,658 patients with X-ray films available, by the Schatzker classification, types Ⅱ and Ⅵ were the most common. Type Ⅵ accounted for the highest proportion in group A (33.25%, 248/769) while type Ⅱ did in group B (48.88%, 522/1,068). There were significant differences between the 2 groups in the proportions of Schatzker types (P<0.05). Conclusions The tibial plateau fractures admitted to the Third Hospital of Hebei Medical University in the past 10 years were more common in males than in females, and predominant in physical workers. Fall and indoor activity was the most common injury cause. Schatzker types Ⅱ and Ⅵ prevailed. The fractures showed an aging trend by comparing the former 5 years and the latter 5 years. Key words: Knee joint; Epidemiology; Age distribution; Gender distribution; Tibial plateau fracture

Complex Tibial Plateau Fractures: Primary Fixation Using the Ilizarov External Fixator. A Two-year Study at Civil Hospital Karachi, Pakistan.

BackgroundThe proximal tibia with the meta-diaphysis junction is a critical weight-bearing area. An injury around this region may be restricted to the tibia or associated with a significant soft-tissue injury. The objective of the present study is to assess the results of closed reduction and Ilizarov external fixation in the management of complex tibial plateau fractures.Patients and methodsThe study included 26 patients with high-energy tibial plateau fractures (Schatzker types V and VI). The ages ranged from 23 to 60 years, with an average of 35 years. The trauma was a road traffic accident in 19 cases and a fall from a height in eight cases. The fractures were closed in 18 cases and open in five. The open fractures were Gustilo-Anderson type I in three cases and type II in five cases. Soft-tissue injuries associated with closed fractures were classified according to the Tscherne system. The follow-up period averaged 24 months. The average time of surgery was 85 mins (range: 60-120 min). The mean time to union was 12 weeks. At the final follow-up, the average total range of knee flexion was 120° (range: 0-170°).ResultsResults were satisfactory in 22 cases and unsatisfactory in four cases according to Rasmussen's knee functional score. Complications included pin-tract infection in 10 cases, an extension lag in three cases and varus deformity of about 17° in one case.ConclusionHybrid 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.

Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept.

ObjectivesCT-based three-column classification (TCC) has been widely used in the treatment of tibial plateau fractures (TPFs). In its updated version (updated three-column concept, uTCC), a fracture morphology-based injury mechanism was proposed for effective treatment guidance. In this study, the injury mechanism of TPFs is further explained, and its inter- and intraobserver reliability is evaluated to perfect the uTCC.MethodsThe radiological images of 90 consecutive TPF patients were collected. A total of 47 men (52.2%) and 43 women (47.8%) with a mean age of 49.8 years (sd 12.4; 17 to 77) were enrolled in our study. Among them, 57 fractures were on the left side (63.3%) and 33 were on the right side (36.7%); no bilateral fracture existed. Four observers were chosen to classify or estimate independently these randomized cases according to the Schatzker classification, TCC, and injury mechanism. With two rounds of evaluation, the kappa values were calculated to estimate the inter- and intrareliability.ResultsThe overall inter- and intraobserver agreements of the injury mechanism were substantial (κinter = 0.699, κintra = 0.749, respectively). The initial position and the force direction, which are two components of the injury mechanism, had substantial agreement for both inter-reliability or intrareliability. The inter- and intraobserver agreements were lower in high-energy fractures (Schatzker types IV to VI; κinter = 0.605, κintra = 0.721) compared with low-energy fractures (Schatzker types I to III; κinter = 0.81, κintra = 0.832). The inter- and intraobserver agreements were relatively higher in one-column fractures (κinter = 0.759, κintra = 0.801) compared with two-column and three-column fractures.ConclusionThe complete theory of injury mechanism of TPFs was first put forward to make the TCC consummate. It demonstrates substantial inter- and intraobserver agreement generally. Furthermore, the injury mechanism can be promoted clinically.Cite this article: B-B. Zhang, H. Sun, Y. Zhan, Q-F. He, Y. Zhu, Y-K. Wang, C-F. Luo. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res 2019;8:357–366. DOI: 10.1302/2046-3758.88.BJR-2018-0331.R1.

Functional evaluation in high energy (Schatzker Type IV, V, VI) tibial plateau fractures treated by open reduction internal fixation

Introduction and Objectives: The Purpose of this study is to assess the Radiological outcome of Total Hip Arthroplasty in Displaced fracture Neck of femur. Materials and Methods: 22 patients of displaced intracapsular neck of femur fracture were included in this study of which 14 patients managed through cemented and 8 managed through Uncemented Total Hip Arthroplasty, respectively. In this study patients operated with uncemented implants were assessed for radiological outcome by utilizing Andrew Whaley and Daniel et al and Engh’s criteria while patients operated with cemented implants were assessed for radiological outcome by utilizing De Lee and Charnley criteria and Gruen Zone Criteria. The Data was analyzed by SPSS 20.00 using Chi-square test. Results: In our study period no loosening of acetabular or femoral components were noticed. Acetabular cup inclination was normal in 77%, vertical in 14% and horizontal in 9%. Position of the stem of femoral component was neutral in 73% with 13.5% of varus and valgus each. No vertical subsidence and no migration of acetabular cup was seen in our study. There was 4.5% i.e., one patient developed Type II Heterotopic ossification. Conclusion: The results of this study shows that Total Hip Arthroplasty gave better results in Displaced Intracapsular Neck of femur fractures radiologically. Also there was no loosening of Acetabular component or migration of acetabular cup and cup position was normal in 77% cases. Femoral stem position was Neutral in 73% of cases with no vertical subsidence and no femoral component loosening. Keywords: Total hip arthroplasty, Radiological outcome, Neck of femur fracture.

A prospective study of surgical management of bicondylar schatzker type V &amp; VI tibial plateau fracture by dual plating and dual incision

Aim: To assess the clinical and functional outcome of surgically treated Bicondylar Tibial schatzker type V and VI plateau fractures with dual plating at SSIMS-RC, Davanagere during August 2015 TO August 2018.Objectives 1. To assess the anatomical reduction of articular surface of upper end of tibia perfectly by operative treatment with internal fixation.2. To assess the radiological union of fractures after internal fixation with dual plating3. To assess the clinical outcome associated with this treatment modality a. Knee Range of movementsb. Pain relief c. Return to normal activities and work Materials and Methods: Total number of cases studied were 30. Inclusion criteria: All skeletal mature patients with proximal tibia fracture Schatzker type V and VI (>18years), AO Muller type 41-C1, 41-C2, 41-C3, Gustilo-Anderson type I and II compound proximal tibial fractures.Exclusion Criteria: Patients with Gustilo- Anderson Type 3 compound tibial plateau fractures, Children with proximal tibial fractures in whom the growth plate is intact, patients with pathological proximal tibial fractures apart from osteoporosis. Observation and Results: Our study used Honkonen Jarvinen Criteria for radiological, functional, clinical outcome which showed excellent to good result.Our study reported Honkonen Jarvinen Clinical outcome to be 86% excellent, 11.7% good and 1.7% fair. The functional outcome was 81% excellent, 13% good, 5% fair and 1% poor. The Radiological outcome showed 79.2% excellent, 12% good, 0.70% fair results.Conclusion: From this study we conclude that, surgical management of bicondylar tibial plateau fractures with dual plating gives excellent anatomic reduction, accurate axial and articular alignment with rigid internal fixation by dual locking plate, achieving a stable and functional knee joint.

Proximal tibia non-union: A case report and review of literature

Fractures of proximal tibia are common yet serious injuries, if not treated well, it results in significant functional impairment. The treatment of metaphyseal nonunions can be particularly difficult, and may present unique issues compared to diaphyseal nonunions. The first main variable the surgeon needs to consider is whether the nonunion site is capable of a biologic response. While the biologic capability is usually preserved in metaphyseal bone, severe osteopenia may exist due to prolonged immobilization or limited weight bearing. The soft tissue envelope may be compromised due to traumatic devascularization or chronic infection. Both of these factors may act to devitalize a short periarticular fragment and may make stable internal fixation difficult. Locking periarticular plates for the proximal tibia may be advantageous for achieving implant stability and restoring anatomic alignment. We present you a case of 11 months old operated Schatzker type 6 right proximal tibia non-union treated with fibrous tissue excision, freshening of fracture site, cancellous bone grafting and open reduction internal fixation with plating and encirclage wiring with fibulectomy.

Surgical outcome of Schatzker type 5 and type 6 tibial plateau fractures treated by plating with or without Cannulated Cancellous screws augmentation: A prospective study of 45 cases

Surgical outcome of Schatzker type 5 and type 6 tibial plateau fractures treated by plating with or without Cannulated Cancellous screws augmentation: A prospective study of 45 cases

Management of split depression tibial plateau fractures with a raft construct through a locking plate without bone graft

Aim:- Aim of this study is to assess the outcome after open reduction and internal fixation using a periarticular raft plating with screw fixation without bone grafting for split – depression tibial plateau fractures. Methods:- 15 patients with 15 knees in 10 male and 5 female were managed by open reduction & internal fixation with, raft locking plate with raft screws through plate without use of bone graft or bone substitute for split depression fracture (> 5 mm.). Proximal tibial fractures (Schatzker type II or Ao / OTA type 4.1 B3) were treated and the result were assessed by radiographs & clinical examination. The Rasmussen radiological score & clinical score, the Lysholm knee score, and the Tegner activity score were also assessed. Result:- The mean follow was 12.5 (rang, 6 -19) months. All patients achieved bone union after a mean of 12.4 (range 8 -24) weaks. The mean range of motion was 116 degree (100o – 130 o). The Rasmussen radiological score was excellent in 10 patients, good in 4, and fair in 1. The Rasmussen clinical score was excellent in 8, good in 6, and fair in 1 patient. The Lysholm was excellent in 9 patients, good in 4, and fair in 2. 13 out of 15 patients recovered to their pre operative Tegner activity scores. Only 1 patients having severe communition had loss of reduction after full weight bearing. Conclusion:- Internal fixation using a periarticular raft locking compression plate without using a bone graft or bone substitute for split depression proximal tibial plateau fractures is a viable option. Keywords: bone graft, raft plate & screws, internal fixation

Comparison of Postoperative Outcomes Between Open Reduction and Internal Fixation and Ilizarov for Schatzker Type V and Type VI Fractures.

IntroductionOpen reduction and internal fixation (ORIF), hybrid fixation, and external fixation are available treatment options for bicondylar fractures of the proximal tibia but which one is superior to the others is not yet established. Therefore, the study aimed to establish a gold standard treatment option for bicondylar fractures by comparing the clinical, functional, and radiological outcomes managed by Ilizarov and ORIF at 24 months.MethodsThis was a retrospective study conducted from 2009 to 2014 at a public sector, tertiary care, level I trauma center. Patients with Schatzker type V and type VI open and closed fractures were included. Floating knee, pathological fractures of the tibia, and patients having medical conditions were excluded from the study. Honkonen and Jarvinen (HJ) criteria for subjective, clinical, radiological, and functional outcomes were used to compare between the two groups at 24 months. Demographic data included age, gender, Schatzker type, mechanism of injury, and range of knee flexion. Chi-square was used to find the level of significance, which was 0.05.ResultsA total of 137 patients were included in this study, with 68 patients in the ORIF group and 69 in the Ilizarov group during the study period. The mean age of the patients was 45.08 ± 10.52, respectively. The male to female distribution was 107/30 (78.1% and 21.89%). According to the mechanism of injury, road traffic accidents (RTA) were the primary cause of injury: 96 (70.07%), falls were 21 (15.32%), and gunshots were 18 (13.13%). Seventy-four were Schatzker type VI (54.01%) whereas 63 (45.98) were Shcatzker V. The average knee flexion at 24 months was 115.51 ± 16.82. There were no differences in the clinical, functional, and radiological outcomes at 24 months between the two treatment groups.ConclusionNo single treatment option can be applied in all cases, and the decision depends on the complexity of the injury, the surgeon’s expertise, and host factors.

Arthroscopically assisted reduction and internal fixation (ARIF) versus open reduction and internal fixation (ORIF) for lateral tibial plateau fractures: a comparative retrospective study

BackgroundThis study aims to explore if the arthroscopically assisted reduction and internal fixation (ARIF) technique is superior to the traditional open reduction and internal fixation (ORIF) technique in the treatment of tibial lateral plateau fractures.MethodsForty patients with tibial plateau fractures (Schatzker type I–III) treated with ARIF or ORIF from 2012 to 2017 were included in this retrospective study. All patients received pre-operative radiographs and CT scans. The patients were divided into two groups (ARIF or ORIF). All patients had a minimum follow-up of 12 months and an average follow-up of 44.4 months. The clinical and radiographic outcomes were evaluated according to the Knee Society Score (KSS) and the modified Rasmussen radiological score.ResultsSatisfactory clinical and radiological results were found in 39 out of 40 (97.5%) patients. KSS and modified Rasmussen radiological score were significantly better in ARIF group. The mean KSS was 92.37 (± 6.3) for the ARIF group and 86.29 (± 11.54) for the ORIF group (p < 0.05). The mean modified Rasmussen radiographic score was 8.42 (± 2.24) for the ARIF group and 7.33 (± 1.83) for the ORIF group (p = 0.104). Worst clinical and radiological results were related to concomitant intra-articular lesions (p < 0.05). Meniscal tears were found and treated in 17 out of 40 (42.5%) patients. The overall complication rate was 10%.ConclusionsBoth ARIF and ORIF provided a satisfactory outcome for the treatment of Schatzker I–III tibial plateau fractures. However, ARIF led to better clinical results than ORIF. No statistically significant differences were found in perioperative complications, radiological results, and post-traumatic knee osteoarthritis.Level of evidenceLevel III

All-Arthroscopic Treatment of Schatzker Type III Lateral Tibial Plateau Fracture Without Fluoroscopy

Tibial plateau fracture treatment remains challenging for orthopaedic surgeons around the world, especially in case of type III fractures according to the Schatzker classification, which are a pure depression of the lateral tibial plateau. Whereas open surgical procedures are associated with increased soft-tissue trauma because of the extent of the surgical approach and do not always allow for proper visualization of the fracture site, arthroscopic-assisted surgeries have been proven to have benefits over the former in terms of minimizing soft-tissue trauma, improved visual control of the fracture reduction, and the time of recovery. Most arthroscopic techniques, however, require using fluoroscopy. We present an all-arthroscopic procedure for Schatzker type III lateral tibial plateau fractures with using a trans-septal portal for visualization, which does not demand fluoroscopy.