Tibial Plateau Fractures Research Articles

Impact of Quadriceps and Hip Abductor Strengthening on Knee Joint Biomechanics During Gait After Schatzker Type III Tibial Plateau Fracture: A Case Study

Impact of Quadriceps and Hip Abductor Strengthening on Knee Joint Biomechanics During Gait After Schatzker Type III Tibial Plateau Fracture: A Case Study

Guiding significance of intra-articular sagittal reduction in the treatment of tibial plateau fractures

Tibial plateau fracture is a fracture involving the proximal articular surface of the tibia, and its injury mechanism is complex, the fracture morphology is different, and it is often accompanied by different degrees of soft tissue injury, which is difficult to diagnose and treat. In recent years, the research hotspot has focused on solving the reduction and fixation of the posterior lateral column of the tibial plateau, because it has been clinically found that the residual sagittal plane after tibial plateau fracture is insufficient reduction or loss of reduction leads to knee joint dysfunction. The posterior inclination angle of the tibial plateau is an important parameter to describe the sagittal alignment of the tibia. In the natural state, the posterior tibial slope(PTS) is altered to involve the soft tissues around the knee joint such as anterior cruciate ligament(ACL) and posterior cruciate ligament(PCL), which affects the stability of the knee joint. In total knee arthroplasty(TKA), choosing the appropriate PTS can effectively increase the prosthesis survival rate, improve the flexion and extension knee efficacy, which is beneficial to knee joint stability. In the field of orthopedic trauma, correction of sagittal deformity is equally important, following the principle of "reverse mechanism of injury". Quantitative evaluation of postoperative sagittal realignment of tibial plateau fractures and investigation of the effect of sagittal realignment on long-term outcomes and complications are still poorly understood and require further clinical and biomechanical studies.

A novel approach for managing the incisions of tibial plateau fractures with soft tissue swelling

To investigate the feasibility and clinical efficacy of a novel approach to managing the incisions used to treat tibial plateau fractures (TPFs) with soft tissue swelling. We retrospectively enrolled 64 patients with TPFs who underwent surgery at the Second Hospital of Shandong University. Patients were divided into two groups: Group A (n = 32) underwent early surgery with the novel incision management technique, and Group B (n = 32) underwent conventional surgery after swelling reduction. The perioperative data of the two groups were compared, including the time from injury to surgery, one-stage operation time, intraoperative blood loss, number of dressing changes, wound healing time, and hospitalization time. Preoperative and postoperative complications were assessed in both groups, and pain condition, degree of arthritis, limb function, imaging results, and quality of life were evaluated using validated scales. The time from injury to surgery, number of dressing changes, and hospitalization time in Group A were significantly lower than those in Group B (P < 0.05). There were no significant differences in one-stage operation time, intraoperative blood loss, or wound healing time between the two groups (P > 0.05). There were fewer preoperative and postoperative complications in Group A than in Group B (P < 0.05). The VAS and WOMAC scores were reduced in both groups (P < 0.05); Group A had lower VAS scores two weeks after surgery. There was no statistically significant difference in the WOMAC score between the groups. The modified Rasmussen functional and radiological scores were elevated in both groups (P < 0.05). There was no statistically significant difference between the two groups for the modified Rasmussen functional or radiological score at any of the time points (P > 0.05). In addition, the two groups did not differ in quality of life (P > 0.05). For patients with tibial plateau fractures without congestive blisters, open reduction and internal fixation at the early stage of swelling and wide-spacing interrupted suture and negative pressure wound therapy (NPWT) closure of the wound could help obtain excellent to good functional outcomes with fewer complications. This novel incision management approach and concept expands the surgical indications for these fractures.

High Detection Rate of Posterolateral Tibial Plateau Fractures and Poor Functional Outcomes in Type IIIB Impaction Fractures After Anterior Cruciate Ligament Rupture and Reconstruction.

The incidence of anterior cruciate ligament (ACL) ruptures has been increasing annually. However, clinical surgeons have overlooked the impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with ACL ruptures. The purpose of the present study was to report the detection rate of the posterolateral tibial plateau impaction fractures in patients with ACL ruptures, and to evaluate the functional outcomes of patients following ACL reconstruction (ACLR) without treatment of the tibial fractures at a 2-year postoperative follow-up. Four hundred eighty-eight patients treated for ACL ruptures between January 2016 and June 2020 were retrospectively reviewed, and the posterolateral tibial plateau impaction fractures were classified based on MRI assessment. The detection rate of the posterolateral tibial plateau impaction fractures was calculated, and the functional outcomes (SF-12 Mental Component Summaries, SF-12 Physical Component Summaries, Tegner, Lysholm, IKDC, and KOOS) were evaluated at a 2-year postoperative follow-up. The detection rate of posterolateral tibial plateau impaction fractures was 41.6% among ACL ruptures. Of these, 285 cases (58.4%) had no fractures, 98 cases (20.1%) had type I impaction fractures, 41 cases (8.4%) had type IIA impaction fractures, 15 cases (3.1%) had type IIB impaction fractures, 22 cases (4.5%) had type IIIA impaction fractures, and 27 cases (5.5%) had type IIIB impaction fractures. Patients with type IIIA or IIIB impaction fractures showed an increased detection rate of contact mechanism compared to the other subgroups. Significant differences in Tegner (postoperation) and KOOS (QOL) were found between no fracture and type IIIB impaction fractures in patients following ACLR. The detection rate of posterolateral tibial plateau impaction fractures in patients with ACL ruptures was high. Patients with type IIIB impaction fractures following ACLR had poor functional outcomes.

The Functional Outcome of Open Reduction and Internal Fixation with Plate Versus closed Reduction and Fixation with Hybrid Ilizarov in the Treatment of Tibial Plateau Fractures

The Functional Outcome of Open Reduction and Internal Fixation with Plate Versus closed Reduction and Fixation with Hybrid Ilizarov in the Treatment of Tibial Plateau Fractures

A Study on Clinical Profile of Patients with Tibial Plateau Fractures Attending Tertiary Care Hospital

A Study on Clinical Profile of Patients with Tibial Plateau Fractures Attending Tertiary Care Hospital

Open Reduction and Internal Fixation with Plate Versus Closed Reduction and Fixation with Hybrid Ilizarov in the Treatment of Tibial Plateau Fractures: Complications

Open Reduction and Internal Fixation with Plate Versus Closed Reduction and Fixation with Hybrid Ilizarov in the Treatment of Tibial Plateau Fractures: Complications

Treatment of posterolateral tibial plateau fractures through the articular line approach

BackgroundPosterolateral tibial plateau fractures pose significant challenges for orthopedic surgeons due to the anatomical risks associated with the posterolateral approach. Despite numerous surgical techniques available, there lacks a consensus on the optimal approach.MethodsArticular line incision approach was employed on 12 patients suffering from posterolateral tibial plateau fractures. Preoperative CT scans were utilized to assess the fractures, followed by an articular line incision to expose and fix the fractures with a 3.5 mm low-profile lateral locking compression plate. The surgical outcomes were evaluated through postoperative recovery metrics including pain levels, knee joint stability, and recovery time.ResultsAll patients achieved articular surface reduction and stable fixation without complications, loss of reduction, or infection. Postoperative assessments showed normal knee extension, with patients returning to pre-injury work levels. The average range of motion (ROM) of the knee joint was 123.3°, and the average Hospital for Special Surgery (HSS) score was 96.4, indicating successful recovery outcomes.ConclusionThe articular line incision approach for posterolateral tibial plateau fractures provides a viable alternative to traditional methods. It offers the benefits of reduced trauma, shortened recovery times, and minimized risk of infection, making it a recommendable technique for such fractures.Trial registrationNot applicable.

Treatment of a collapse fracture of the anterolateral tibial plateau with a lateral locking plate and the Jail screw technique

BackgroundTo explore the advantages of a lateral tibial locking plate combined with Jail screw fixation in the treatment of anterolateral tibial plateau collapse fracture (ATPCF).MethodsA retrospective analysis was conducted on patients with ATPCFs admitted to our hospital from February 2019 to February 2023. Twenty-six patients were successfully included, including 15 males and 11 females, with an average age of 58.6 ± 7.8 years (range 45–68 years). All fractures were Schatzker type II fractures. After fracture reduction and fixation, a lateral locking titanium plate was placed through the anterolateral approach of the tibial plateau, and two screws of appropriate length were placed in the sagittal direction according to the Jail screw technique. Postoperative evaluation indices included surgery time, fracture healing time, the degree of tibial plateau collapse shown by computed tomography (CT) images at 3 days and 1 year after surgery, and the patient's knee range of motion at 1 year after surgery. The effects of fracture reduction and fixation before surgery, 3 days after surgery and 1 year after surgery were evaluated by the Rasmussen radiological score. The Hospital for Special Surgery (HSS) knee score was used to evaluate the knee joint function of patients at 1 year after surgery.ResultsThe average operation time was 64 ± 6.8 min (range 56–82 min). The fractures healed clinically at 13.8 ± 2.8 weeks (range 12–18 weeks) postoperation. After 15 ± 3.1 months (range 12–19 months) of average follow-up, all the patients were pain-free with a full range of motion and stable knees. At the 1-year postoperative assessment, the CT images showed no secondary collapse of the articular surface, the average knee range of motion was 136.3 ± 2.5° (range, -5° to 135°), the average Rasmussen radiological score was 16.2 ± 0.8 points, and the average HSS knee score was 93.6 ± 3.2 points.ConclusionsThe fixation of a anterolateral tibial plateau collapse fracture(ATPCF) using a lateral locking plate and the Jail screw technique has achieved good knee joint function, providing a new option for the treatment of ATPCFs. The clinical efficacy is satisfactory in the short term, avoiding secondary articular surface collapse.

Fracture characteristics and functional outcomes for Schatzker V/VI bicondylar tibial plateau fractures with a separate tubercle fragment: a comparative study.

A separate tibial tubercle fragment (TF) is found in up to half of all bicondylar tibial plateau (BTP) fractures. Adequate healing of the TF is required to reconstitute the extensor mechanism of the knee. The purpose of this study was to compare outcomes after surgical fixation of BTP fractures with and without a TF. Retrospective comparative study of adult patients undergoing open reduction internal fixation (ORIF) of a Schatzker V/VI BTP fracture at two Level 1 trauma centers. Primary outcomes were patient-reported outcomes as assessed by the PROMIS Physical Function (PF) score and EQ-5D-3L. Secondary outcomes included rates of infection, reoperation, and nonunion. Patient demographics, fracture characteristics, and outcomes were compared for patients with and without a TF. 189 patients (mean follow-up 8.1 yrs) were included. 55 patients (29%) had a separate TF. There was no significant difference in PROMIS PF (48.1 vs 47.5, p = 0.45) or EQ-5D-3L scores (0.82 vs 0.83, p = 0.32) between patients with and without a separate tubercle fragment.Patients with a TF had more open fractures (16% vs 5%, p = 0.02) and high energy injuries (66% vs 49%, p = 0.03).There was no significant difference in the rates of deep infection (15% vs 8%, p = 0.19) or unplanned reoperation (23% vs 13%, p = 0.09). There were more nonunions in the TF group (11% vs 2%, p = 0.02) but only two involved the tubercle fragment. In this comparative study, the presence of a TF did not portend a worse functional outcome for patients with a healed fracture. Rates of open fracture and high energy mechanism of injury were significantly higher in the TF group.. Surgeons should be aware that a separate TF may indicate a more severe injury. More studies are needed to determine whether the presence of a TF is associated with higher complication rates.

Impact of Systematic Post-operative Rehabilitation Training on Prognosis in Patients with Osteoporosis and Tibial Plateau Fractures: A Retrospective Study

Impact of Systematic Post-operative Rehabilitation Training on Prognosis in Patients with Osteoporosis and Tibial Plateau Fractures: A Retrospective Study

Detection of Multiple Tibial Malalignment-Induced Early Polyethylene Breakage Using Single Plane Fluoroscopy: A Case Report.

A 75-year-old woman underwent cruciate retaining total knee arthroplasty (TKA) for osteonecrosis of the knee, converted from unicompartmental arthroplasty due to an intraoperative medial tibial plateau fracture. Four years later, she experienced persistent knee pain. Computed tomography revealed tibial malalignments in 2 planes. In vivo kinematic analysis using single-plane fluoroscopy, which can visualize the femorotibial contact, indicated varus thrust with lateral subluxation of the tibial component and the femoral component recessing into the polyethylene insert. Revision TKA affirmed the polyethylene insert breakage. Malalignment might have caused mechanical failure, and in vivo kinematic analysis was useful to visualize abnormal kinematics in TKA.

Surgical treatment of AO/OTA 41B3 and 41C tibial plateau fractures with a temporary bi-frame fixator combined with the MIPPO technique

BackgroundThis study evaluated the clinical effects of the use of a temporary bi-frame fixator in conjunction with minimally invasive percutaneous plate osteosynthesis (MIPPO) for treating AO/OTA 41B3 and 41C tibial plateau fractures (TPFs).MethodsThis was a retrospective analysis of 30 patients with TPFs affected by vertical compression seen from October 2019 to October 2020. All patients were treated with a bi-frame fixator to correct the vertical shortening deformity, with the MIPPO technique used after reduction. All patients underwent routine examinations at 1, 3, 6, 12 and 24months postoperatively and then annually. Clinical parameters assessed included the Hospital for Special Surgery score (HSS), number of assistants, intraoperative hemorrhage, intraoperative fluoroscopy frequency, length of hospital stay, and time to fracture healing. Radiographic findings were assessed using Rasmussen scores.ResultsAll patients had satisfactory fracture reduction on postoperative imaging. The average operating time was 112.03 ± 20.9 min, with 15.79 ± 3.45 fluoroscopic exposures; the average blood loss was 66.63 ± 10.88 mL, the average length of hospital stay was 12.86 ± 5.11 days, and the average fracture healing time was 10.33 ± 1.48 weeks. The mean follow-up time was 23.18 ± 2.59 months. At the last follow-up, the Rasmussen anatomical score was excellent in 22 (75.3%) patients, good in 5 (16.7%), and fair in 3 (10%). The average HSS was 65.7 ± 3.26, 82.26 ± 2.28, and 87.66 ± 2.4 after 1, 6, and 12 months, respectively, and it was 92.56 ± 2.96 at the last follow-up (F = 1073.073, P < 0.001). No complications occurred in any patient during follow-up.ConclusionFor AO/OTA 41B3 and 41C fractures of the tibial plateau, the use of a temporary bi-frame fixator combined with the MIPPO technique can correct the compressed displacement, reduce soft tissue damage, and facilitate surgical reduction, which aid the recovery of joint function.

Chimeric Free Flaps Based on End-to-Side Anastomosis for Complex Lower Extremity Reconstruction.

Complex lower extremity defects are difficult to cover and often require multiple free tissue transfers. Chimeric anterolateral thigh free flaps (ALTF) and peroneal artery perforator free flaps (PAPF) have been designed specifically as an alternative for reconstruction with arterial end-to-side (ETS) anastomosis. We aimed to assess our institutional experience with this technique and to define its role in complex lower extremity reconstruction. From July 2012 to March 2023, 27 patients with complex lower extremity defects underwent reconstruction with chimeric ALTF or PAPF. Patients were performed with retrograde flaps for repairing refractory wounds of tibia plateau fracture and antegrade flaps for distal 2/3 tibia and beyond. Demographic, clinical, and follow-up data on the patients were recorded with a special focus on complication profiles during a follow-up of 6 to 60 months. The mean defect size measured 121.1 ± 215.1 cm2, and the chimeric ALTF or PAPF flaps measured 143.9 ± 177.8 cm2. One patient lost the first free flap but successfully had a chimeric PAPF then. Three patients suffered partial free flap loss, and another 3 had minor complications. All 6 survived after an additional exploration, wound dressing, or antibiotics treatment. The retrograde flaps achieved similar blood flow to the antegrade flaps. Patients are all satisfied with functional and aesthetic outcomes. Given the incidence of complications, utilizing chimeric ALTF and PAPF either with retrograde or antegrade flow based on arterial ETS anastomosis is a reliable surgical option for complex lower extremity reconstructions.

BIOMECHANICAL EVALUATION OF POLYAXIAL ANGULAR STABLE PLATES IN THE MANAGEMENT OF TIBIAL PLATEAU FRACTURES

Biomechanical efficacy is critical in managing tibial plateau fractures. This study compared the performance of polyaxial screw-plate implant systems under axial loading conditions using synthetic bone models. Osteosynthesis methods involving lateral, medial, and combined (lateral + medial) plates were evaluated. Although no statistically significant differences in stiffness and stability were observed across all groups under progressive axial loading, the combined lateral and medial plate technique demonstrated superior biomechanical performance compared to individual plate use. Notably, the lateral plate method outperformed the medial plate approach but was surpassed by the dual plate configuration. A statistically significant, directly proportional relationship between time intervals and displacement, along with an inverse correlation between time intervals and stiffness, was observed across all test groups. These findings highlight that combining lateral and medial plates enhances rigidity and stability, particularly under axial loading, making it a preferred approach for treating tibial plateau fractures.

ADVANCEMENTS IN MODERN SURGICAL MANAGEMENT OF TIBIAL PLATEAU FRACTURES: A COMPREHENSIVE REVIEW

This review aims to summarize the literature on classic and advanced surgical management strategies for tibial plateau fractures. The primary objective in treating these fractures is to restore joint functionality and ensure favorable short- and long-term outcomes. Effective surgical management minimizes the risk of joint instability, enhances long-term prognosis, and maintains the patient's quality of life. Most orthopedic surgeons adopt a staged treatment strategy, involving initial stabilization followed by definitive surgical fixation, respecting soft tissue conditions, achieving precise anatomical reduction, ensuring stable fixation, and promoting early rehabilitation. Surgical techniques include open approaches with arthrotomy for articular surface reconstruction and fixation using plates and screws, as well as minimally invasive approaches such as arthroscopy or percutaneous fixation with screws or external fixators. Modern osteosynthesis techniques—plates, screws, external fixators, and rotating hinges—have become the standard of care, except in cases of minimal displacement. These approaches collectively aim to optimize patient recovery and joint functionality.

Evaluating Meniscus, Ligament and Soft Tissue Injury Using MRI in Tibial Plateau Fractures: A Tscherne Classification Approach.

Background and Objectives: This study investigated associated meniscus and ligament injuries in tibial plateau fractures using magnetic resonance imaging (MRI) and assessed soft tissue injuries in relation to the Schatzker classification and Tscherne classification. Materials and Methods: The data of 185 patients who sustained tibial plateau fractures from January 2010 to April 2021 were retrospectively reviewed. Fractures were classified according to the Schatzker classification system. Soft-tissue injuries were assessed using the Tscherne classification. Menisci and ligaments were evaluated using preoperative MRI. Nerve injuries, compartment syndrome and wound problems were also assessed. The incidence of soft tissue injuries, as well as the relationship between the Schatzker and Tscherne classification systems, were analyzed. Results: Evidence of derangement of meniscus and ligament around the knee was found in 183 (98.9%) patients. The most common injury was a medial collateral ligament injury. The incidence of lateral collateral ligament injury, nerve injury, compartment syndrome and wound problem was higher in high-energy tibial plateau fractures. A tendency was observed between the Schatzker and the Tscherne classifications (p value < 0.001). Higher Tscherne grade was also associated with the incidence of posterior cruciate ligament injury, nerve injury and compartment syndrome. Conclusions: In tibial plateau fractures, soft tissue injuries were highly prevalent. High-energy fractures tended to exhibit higher Tscherne classification grades and showed an increased incidence of meniscus and ligament injuries. The Tscherne classification appears to be a helpful system for predicting soft tissue injuries in tibial plateau fractures. And preoperative MRI can be a helpful tool.

Comparative finite element analysis between three surgical techniques for the treatment of type VI schatzker tibial plateau fractures

Introduction. Open reduction internal fixation (ORIF) and external fixation are traditional surgical techniques for treating type VI Schatzker tibial plateau fractures. A newly developed technique integrates the intramedullary tibial nail with condylar bolts. This finite element study investigated the mechanical response of three surgical techniques for fixing type VI Schatzker tibial plateau fractures. We compared the intramedullary nail-bolt (IMNB) technique with the single lateral locking plate (SLLP) and dual plating (DP) techniques.Materials and Methods. A 4th generation Sawbone model of a left tibia with a Type VI tibial plateau fracture was scanned using computed tomography and reconstructed into a 3D model. The plates were digitally reconstructed using 3D scanning technology, while the screws, condylar bolt, and nail were replicated using commercial computer-aided design software. An application engineer guided by a surgeon, virtually positioned the bone-implant construct for the three surgical techniques to align with physical constructs from a previousin-vitrobiomechanical study. A commercial finite element analysis software was used for the computer simulation, with the tibial plateau subjected to uniaxial loads at 500, 1000, and 1500 Newton while the distal tip of the tibia remained fixed. Measurements of vertical subsidence, horizontal diastasis, and passive construct stiffness were recorded and compared to those of the previousin-vitrobiomechanical experiment.Results.DP had the highest stiffness, followed by IMNB and SLLP techniques. DP also resulted in smaller values for measured subsidence and diastasis compared to SLLP and IMNB. The simulation results aligned with those of thein-vitrobiomechanical study.Conclusions.The simulation results may further support the initial suggestion of thein-vitrobiomechanical study that the IMNB technique is a biomechanically suitable method for fixing Type VI Schatzker injuries.

Bilateral Gastrocnemius Flap For Harlequin Defects Around The Knee

Background : Tibial plateau fractures (especially bicondylar Schatzker type 5 and type 6) are a result of high energy trauma. Along with bony component, soft tissue injury is a major determinant in the treatment and final outcome. Bicondylar fractures needs bicolumnar fixation and as such require separate approaches: postero-medial and lateral incisions. The soft tissue of the proximal tibia swells significantly after the injury, coupled with extensive soft tissue dissection during fixation this can lead to subsequent wound breakdown and infection along either side of the proximal tibia which resembles “harlequin eyes”. This study describes outcome of management of post operative soft tissue complications following bicolumnar fixation of proximal tibia with medial and lateral gastrocnemius flap. Method : Three patients who had bilateral soft tissue necrosis at surgical incision sites treated with debridement and bilateral gastrocnemius flaps between January 2016 and December 2017 were included in this study. The mean age was 38 years (range 18–50 years) and the mean duration of follow-up was 10 months. Outcome assessments included the condition of the flap and fracture healing time. Result : All fractures united after surgery. There were no soft tissue complications and all flaps healed well. The mean bony union time was 6 months. Conclusion: Our technique of covering soft tissue loss at surgical site on medial and lateral side of proximal tibia with bilateral gastrocnemius flap in the same setting is a reliable and safe surgical method for these conditions.

Predicting deep infection in pilon and tibial plateau fractures: a secondary analysis of the VANCO and OXYGEN trials.

To develop and validate a prediction model for a deep surgical site infection (SSI) after fixation of a tibial plateau or pilon fracture. Pooled data from 2 randomized trials (VANCO and OXYGEN). Fifty-two US trauma centers. In total, 1847 adult patients with operatively treated tibial plateau or pilon fractures who met criteria for a high risk of infection. We considered 13 baseline patient characteristics and developed and externally validated prediction models using 3 approaches (logistic regression, stepwise elimination, and machine learning). The primary prediction model outcome was a deep SSI requiring operative debridement within 182 days of definitive fixation. Our primary prognostic performance metric for evaluating the models was area under the receiver operating characteristic curve (AUC) with clinical utility set at 0.7. Deep SSI occurred in 75 VANCO patients (8%) and in 56 OXYGEN patients (6%). The machine learning model for VANCO (AUC = 0.65) and stepwise elimination model for OXYGEN (AUC = 0.62) had the highest internal validation AUCs. However, none of the external validation AUCs exceeded 0.64 (range, 0.58 to 0.64). The predictive models did not reach the prespecified clinical utility threshold. Our models' inability to distinguish high-risk from low-risk patients is likely due to strict eligibility criteria and, therefore, homogeneous patient populations.