Tibial Plateau Fracture Patients Research Articles

Development of a nomogram for deep vein thrombosis in patients with tibial plateau fractures based on systemic Immune-inflammation index

In recent years, the incidence of tibial plateau fractures (TPF) has been on the rise. Deep vein thrombosis (DVT) may lead to poor prognosis in patients. The systemic immune-inflammation index(SII) are novel biomarkers of inflammation, and this study aims to verify their predictive effect and construct the nomogram model. This study used binary logistic regression analysis to predict the predictive effect of SII on the occurrence of DVT in tibial plateau fracture patients. And use R studio to construct nomogram model. The results showed that Age (1.03 [1, 1.06], p = 0.032), SII (3.57 [1.68, 7.61], p = 0.04), and NC (7.22 [3.21, 16.26], p < 0.001) were independent predictive factors for DVT. The nomogram demonstrated good predictive performance with small errors in both the training and validation groups, and most clinical patients could benefit from them. The nomogram constructed based on SII can assist clinicians in early assessment of the probability of DVT occurrence.

Conversion of Tibial Plateau Fractures to Total Knee Arthroplasty is Associated With Worse Patient-Reported Outcomes, Increased Operative Times, and Increased Complications

BackgroundPrior open reduction and internal fixation (ORIF) of tibial plateau fracture (TPF) adds complexity to subsequent total knee arthroplasty (TKA). The purpose of this study was to compare the outcomes of patients undergoing a TKA following prior ORIF of TPF to patients undergoing a primary TKA for osteoarthritis and an aseptic revision TKA. MethodsThere were 52 patients who underwent primary TKA following prior ORIF of TPF between January 2009 and June 2021, who were included and matched in a 1:4 ratio to 208 patients undergoing primary TKA. A second 1:1 matched comparison to 52 aseptic revision TKA patients was also included. The Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores were obtained preoperatively and at two years postoperatively. Independent t-tests and Chi-square tests were used for statistical comparisons. ResultsThe TPF patients were significantly younger than both primary and revision cohorts (55 ± 14.0 versus 63 ± 16.3 versus 64 ± 9.5, P < 0.001). Compared to primary TKA patients, the TPF group had worse Knee injury and Osteoarthritis Outcome Score for Joint Replacement scores at two years (46.9 ± 18.5 versus 66.2 ± 17.8, P = 0.0152), higher rates of wound complications (15.4 versus 3.9%, P = 0.0020), and increased operative times (140.2 ± 45.3 versus 95.2 ± 25.7, P < 0.0001). Additionally, TPF patients were more likely to require a manipulation under anesthesia than both primary and revision patients (21.2 versus 5.8 versus 5.8%, P = 0.001). ConclusionsThe TKAs following ORIF of TPF are more like revision TKAs than primary TKAs in terms of patient-reported outcomes, operative times, and wound complications. The rate of manipulation under anesthesia was higher than in both matched groups. These findings provide valuable information that can affect preoperative patient education and postoperative management regimens. They also emphasize the need for a conversion TKA code due to increased complexity and complications seen in this more difficult subset of TKAs.

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

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

Construction of a nomogram model for deep vein thrombosis in patients with tibial plateau fracture based on the Systemic Inflammatory Response Index

BackgroundIn recent years, the incidence of tibial plateau fracture has been on the rise, predominantly affecting the elderly population. Deep vein thrombosis may lead to poor prognosis in patients. the Systemic Inflammatory Response Index are novel biomarkers of inflammation, and this study aims to verify their predictive effect and construct the nomogram model.MethodThis study used binary logistic regression analysis to predict the predictive effect of SIRI on the occurrence of DVT in tibial plateau fracture patients. And use R studio to construct nomogram model.ResultThe results showed that NC (7.036 [3.516, 14.080], p < 0.001), LYM (0.507 [0.265, 0.969], p = 0.04), and SIRI (2.090 [1.044, 4.182], p = 0.037) were independent predictive factors for DVT. The nomogram demonstrated good predictive performance with small errors in both the training and validation groups, and most clinical patients could benefit from them.ConclusionThe nomogram constructed based on SIRI can assist clinicians in early assessment of the probability of DVT occurrence.

The Relationship Between Intra-articular Fracture Energy and a Patient's Inflammatory Response.

Prior studies have demonstrated elevated inflammatory cytokine concentrations in the synovial fluid of articular fracture patients postinjury. Similarly, CT-based fracture energy measurements have been correlated with posttraumatic osteoarthritis risk after pilon fracture. The purpose of this study was to determine the associations between synovial fluid cytokine levels, fracture energy, and overall trauma to the body in articular fracture patients. Acute tibial plateau, tibial plafond, and rotational ankle fracture patients were prospectively enrolled from December 2011 through January 1, 2019. Synovial fluid concentrations of interleukin-1 beta, interleukin-1 receptor antagonist, IL-6, IL-8, IL-10, matrix metallopeptidase-1, MMP-3, and MMP-13 were quantified. Patient CT scans were used to calculate fracture energy. The Injury Severity Score (ISS) was used to relate cytokine levels to whole-body injury severity. Spearman rho correlation coefficients were calculated to assess the relationship between injury severity metrics and synovial fluid cytokine, chemokine, and matrix metallopeptidase concentrations. Eighty-seven patients were enrolled with 42 had a tibial plateau fractures (OTA/AO 41B1-2, 41B2-14, 41B3-3, 41C1-3, 41C2-4, 41C3-16), 24 patients had a tibial plafond fracture (OTA/AO 43B1-2, 43B2-4, 43B3-5, 43C1-2, 43C2-3, 43C3-8), and 21 had a rotational ankle fracture (OTA/AO 44B1-3, 44B2-3, 44B3-6, 44C1-4, 44C2-5). Fracture energy significantly differed between fracture patterns, with ankle fractures involving substantially less fracture energy (median = 2.92 J) than plafond (10.85 J, P < 0.001) and plateau fractures (13.05 J, P < 0.001). After adjustment for multiple comparisons, MMP-3 was significantly correlated with transformed fracture energy (r = 0.41, 95% confidence interval [CI], 0.22-0.58, P < 0.001), while IL-1β was significantly correlated with the Injury Severity Score (Spearman ρ = 0.31, 95% CI, 0.08-0.49, P = 0.004). Synovial fluid MMP-3 concentration was significantly correlated with CT-quantified fracture energy in intra-articular fracture patients. Given that in clinical practice fracture energy tends to correlate with posttraumatic osteoarthritis risk, MMP-3 may warrant further investigation for its role in posttraumatic osteoarthritis development after articular fracture. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

3D surgical planning including patient-specific drilling guides for tibial plateau fractures.

Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026). The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort.

Correlation of preoperative CT imaging shift parameters of the lateral plateau with lateral meniscal injury in Schatzker IV-C tibial plateau fractures

BackgroundSchatzker IV-C is a high-energy tibial plateau fracture often accompanied by lateral meniscus injuries. While imaging examinations are routine preoperative measurements, the correlation between CT imaging shift parameters of the lateral plateau and lateral meniscal injury in Schatzker IV-C fractures remains uncovered.MethodsThis retrospective study enrolled a total of 60 patients with Schatzker IV-C tibial plateau fractures at the First People’s Hospital of Hefei. Prior to surgery, CT imaging was used to measure the numerical values of lateral plateau depression (LPD) and lateral plateau widening (LPW). The degree of lateral meniscus injury was confirmed based on intraoperative direct vision, with patients being classified into meniscus injury and non-meniscus injury groups. Dichotomous logistic regression was employed to evaluate the correlation between LPD, LPW, and lateral meniscus injury, while the optimal cut-off points for predicting lateral meniscal injury with LPD and LPW were determined using receiver operator characteristic (ROC) curves.ResultsThe meniscus injury group exhibited a mean LPD of 15.3 ± 3.5 mm, which was significantly higher than the non-meniscus injury group’s mean LPD of 8.4 ± 3.4 mm (P < 0.05). Similarly, the meniscus injury group had a larger mean LPW of 9.4 ± 1.8 mm compared to the non-meniscus injury group’s mean LPW of 6.9 ± 0.9 mm (P < 0.05). The optimal cut-off points for predicting lateral meniscal injury were determined to be 8.40 mm for LPD (with a sensitivity of 95%, specificity of 85%, and AUC of 0.898) and 7.90 mm for LPW (with a sensitivity of 75%, specificity of 90%, and AUC of 0.897).ConclusionsPatients with Schatzker IV-C tibial plateau fractures are at a significantly higher risk of lateral meniscal injury when the LPD exceeds 8.40 mm and/or the LPW exceeds 7.90 mm. Our results may provide novel reference metrics for the early diagnosis of lateral meniscal injury in Schatzker IV-C tibial plateau fracture patients when the MRI examination is not available.

Tibial plateau fractures in older adults are associated with a clinically significant deterioration in health-related quality of life.

To investigate health-related quality of life (HRQoL) of older adults (aged ≥ 60 years) after tibial plateau fracture (TPF) compared to preinjury and population matched values, and what aspects of treatment were most important to patients. We undertook a retrospective, case-control study of 67 patients at mean 3.5 years (SD 1.3; 1.3 to 6.1) after TPF (47 patients underwent fixation, and 20 nonoperative management). Patients completed EuroQol five-dimension three-level (EQ-5D-3L) questionnaire, Lower Limb Function Scale (LEFS), and Oxford Knee Scores (OKS) for current and recalled prefracture status. Propensity score matching for age, sex, and deprivation in a 1:5 ratio was performed using patient level data from the Health Survey for England to obtain a control group for HRQoL comparison. The primary outcome was the difference in actual (TPF cohort) and expected (matched control) EQ-5D-3L score after TPF. TPF patients had a significantly worse EQ-5D-3L utility (mean difference (MD) 0.09, 95% confidence interval (CI) 0.00 to 0.16; p < 0.001) following their injury compared to matched controls, and had a significant deterioration (MD 0.140, 95% CI 0 to 0.309; p < 0.001) relative to their preoperative status. TPF patients had significantly greater pre-fracture EQ-5D-3L scores compared to controls (p = 0.003), specifically in mobility and pain/discomfort domains. A decline in EQ-5D-3L greater than the minimal important change of 0.105 was present in 36/67 TPF patients (53.7%). Following TPF, OKS (MD -7; interquartile range (IQR) -1 to -15) and LEFS (MD -10; IQR -2 to -26) declined significantly (p < 0.001) from pre-fracture levels. Of the 12 elements of fracture care assessed, the most important to patients were getting back to their own home, having a stable knee, and returning to normal function. TPFs in older adults were associated with a clinically significant deterioration in HRQoL compared to preinjury level and age, sex, and deprivation matched controls for both undisplaced fractures managed nonoperatively and displaced or unstable fractures managed with internal fixation.

Pes anserine detachment in posteromedial approach to the tibial plateau fracture provides better intraoperative exposure without compromising the flexor muscle strength.

During the posteromedial approach to the tibial plateau fracture (TPF), pes anserine is generally retracted. However, pes anserine detachment could provide a better fracture site exposure. Even so, the general conception is that the latter could negatively affect flexor muscle strength. We aimed to evaluate the effect of pes anserine detachment on the flexion force and functional outcomes of TPF with posteromedial involvement. In this retrospective-prospective cohort study, 22 TPF patients with Schatzker type IV who were managed with posteromedial approach and pes anserine detachment were included. The knee flexion force was measured 12months after the surgery at several angles of flexion (30°, 60°, and 90°) and rotations (internal and external). The International Knee Documentation Committee (IKDC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess knee function. A visual analog scale (VAS) was used to measure knee pain. The mean strength of the knee flexor muscle was not statistically different between the involved and non-involved sides at 30°, 60°, and 90° knee flexion, and also at the internal and external rotation. The mean IKDC score of the patients was 81.6 ± 7.8. The mean KOOS score of the patients was 82.2 ± 9.1. The mean VAS for pain was 2.4 ± 1.8. The mean knee range of motion was 124 ± 10.5°. Pes anserine release and re-attachment in the posteromedial approach to the TPF has no detrimental effect on the flexion muscle strength and knee function. Therapeutic Level IV.

Periarticular multimodal analgesia in decreasing perioperative pain in tibial plateau fractures: A double blind randomized controlled pilot study

IntroductionThe use of periarticular multimodal analgesia injections is increasing and has become commonplace in some surgeries. However, there is no data on the effectiveness of local periarticular multimodal analgesia for tibial plateau fractures. We hypothesized that closed tibial plateau fracture patients receiving the local multimodal analgesic medications would experience a decrease in VAS pain scores. MethodsPatients aged between 18 and 79 with an isolated closed tibial plateau fracture (AO 41-B and C) were prospectively enrolled and randomized in a 1:1 double blinded fashion to either a placebo or active medication treatment arm. After ORIF, gel-foam sponges soaked in either multimodal analgesic solution or normal saline. Patients were followed for 24 h post-operatively with Visual Analog pain Scores (VAS). Patients were monitored post-operatively for complications including compartment syndrome, infection, and non-union. ResultsThe planned study was terminated prior to completion due to higher than anticipated rates of infection (18%), distributed equally among active (3) and placebo (2) groups, raising concerns that this may have been due to the presence of the delivery device. Twenty-eight patients were enrolled, 15 in the active group and 13 in the placebo group. Patients in the active medication group had significantly decreased pain scores at hours 4 (p = 0.005, 4.2 vs 6.9), 8 (p = 0.05, 5 vs 7), and 12 (p = 0.02, 3.8 vs 6.2). Pain scores at hours 16 (p = 0.10, 4.5 vs 6.5), 20 (p = 0.08, 4.6 vs 6.4), and 24 (p = 0.10, 4.8 vs 6.5) were also decreased but did not reach significance. DiscussionThe use of local multimodal periarticular analgesic for closed tibial plateau fractures appears to be beneficial for short-term pain control post-operatively. Concerns regarding an implantable delivery vehicle leading to infection has warranted a change in method of drug administration. Completion of the full study will permit us to validate or refute these findings. Level of EvidenceTherapeutic Level 1

Is the timing of fixation associated with fracture-related infection among tibial plateau fracture patients with compartment syndrome? A multicenter retrospective cohort study of 729 patients

BackgroundTibial plateau fractures with an ipsilateral compartment syndrome are a clinical challenge with limited guidance regarding the best time to perform open reduction and internal fixation (ORIF) relative to fasciotomy wound closure. This study aimed to determine if the risk of fracture-related infection (FRI) differs based on the timing of tibial plateau ORIF relative to closure of ipsilateral fasciotomy wounds. MethodsA retrospective cohort study identified patients with tibial plateau fractures and an ipsilateral compartment syndrome treated with 4-compartment fasciotomy at 22 US trauma centers from 2009 to 2019. The primary outcome measure was FRI requiring operative debridement after ORIF. The ORIF timing relative to fasciotomy closure was categorized as ORIF before, at the same time as, or after fasciotomy closure. Bayesian hierarchical regression models with a neutral prior were used to determine the association between timing of ORIF and infection. The posterior probability of treatment benefit for ORIF was also determined for the three timings of ORIF relative to fasciotomy closure. ResultsOf the 729 patients who underwent ORIF of their tibial plateau fracture, 143 (19.6%) subsequently developed a FRI requiring operative treatment. Patients sustaining infections were: 21.0% of those with ORIF before (43 of 205), 15.9% at the same time as (37 of 232), and 21.6% after fasciotomy wound closure (63 of 292). ORIF at the same time as fasciotomy closure demonstrated a 91% probability of being superior to before closure (RR, 0.75; 95% CrI, 0.38 to 1.10). ORIF after fasciotomy closure had a lower likelihood (45%) of a superior outcome than before closure (RR, 1.02; 95% CrI; 0.64 to 1.39). ConclusionData from this multicenter cohort confirms previous reports of a high FRI risk in patients with a tibial plateau fracture and ipsilateral compartment syndrome. Our results suggest that ORIF at the time of fasciotomy closure has the highest probability of treatment benefit, but that infection was common with all three timings of ORIF in this difficult clinical situation.

Tibial plateau fractures: three dimensional fracture mapping and morphologic measurements

PurposeThe injury mechanisms and classifications of tibial plateau fractures (TPFs) are still controversial. The aim of this study is to show 3D fracture mapping of different types of tibial plateau fractures. Moreover, combined with Schatzker and ten-segment classification, we aimed to analyze the injury frequency and characteristics of different segments.MethodsIn total, 346 patients with TPFs treated at level I trauma centres from 2017 to 2021 were reviewed. The CT files of the included cases were typed and categorized. 3D reconstruction of TPFs patients’ CT files were performed using software. All fracture lines were superimposed on the standard model by the software to create TPFs 3D fracture mapping.ResultsThis study included 204 male and 142 female patients (average age, 47 years [range, 18 to 83 years]) with a tibial plateau fracture. Using the Schatzker classification, we found 39 type I (11.27%), 103 type II (29.77%), nine type III (2.60%), 71 type IV (20.52%), 52 type V (15.03%), 59 type VI (17.05%) fractures, and 13 others (3.76%). The density areas of fracture lines are mainly located in the ALC and PLC segments (74.3%, 69.1%). In different views, fracture lines of different Schatzker types showed distinct distribution characteristics.ConclusionsSchatzker classification combined with 3D fracture mapping provides a new presentation of tibial plateau fracture morphology. According to the 3D fracture mapping, different types of TPFs have distinctly different distribution characteristics of fracture lines. There are significant differences between different types of fracture injury segments.

Effect of Supplemental Perioperative Oxygen on SSI Among Adults with Lower-Extremity Fractures at Increased Risk for Infection: A Randomized Clinical Trial.

Supplemental perioperative oxygen is a low-cost intervention theorized to reduce the risk of surgical site infections, but its effect among patients undergoing surgery for a tibial plateau, tibial pilon, or calcaneal fracture is unknown. We aimed to determine the effectiveness of a high fraction of inspired oxygen (FiO 2 , 80%) versus low FiO 2 (30%) in reducing surgical site infections in these patients. A randomized controlled trial was conducted at 29 U.S. trauma centers. We enrolled 1,231 patients who were 18 to 80 years of age and had a tibial plateau, tibial pilon, or calcaneal fracture and were thought to be at elevated risk for infection based on their injury characteristics. Patients were randomized to receive 80% FiO 2 (treatment group) or 30% FiO 2 (control group) in the operating room and for up to 2 hours in the recovery room. The primary outcome was a composite of either deep surgical site infection (treated with surgery) or superficial surgical site infection (treated with antibiotics alone) within 182 days following definitive fixation. Secondary outcomes included these surgical site infections at 90 and 365 days after surgery. The modified intention-to-treat analysis included 1,136 patients with 94% of expected follow-up through 182 days. Surgical site infection occurred in 40 (7.0%) of the patients in the treatment group and 60 (10.7%) of the patients in the control group (relative risk [RR], 0.65; 95% confidence interval [CI], 0.45 to 0.96; risk difference [RD], -3.8%; 95% CI, -7.2% to -0.4%; p = 0.03). The treatment intervention demonstrated a similar effect at 90 days (RR, 0.59; 95% CI, 0.37 to 0.93) and 365 days (RR, 0.62; 95% CI, 0.44 to 0.87). Secondary analyses demonstrated that the effect was driven by a reduction in superficial surgical site infections. Among tibial plateau, pilon, or calcaneal fracture patients at elevated risk for surgical site infection, a high perioperative FiO 2 lowered the risk of surgical site infection. The findings support the use of this intervention, although the benefit appears to mostly be in reduction of superficial infections. Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Risk factors of hospitalization costs and length of stay for tibial plateau fractures.

This study aimed to analyze the factors influencing the length of stay (LOS) and the cost of hospital stay in patients with tibial plateau fractures (TPFs). We enrolled 233 patients with TPFs in this retrospective study. The general conditions, hematological indicators, and imaging data of hospitalized patients were collected. The factors influencing the cost and LOS were determined by a multivariate logistic regression model controlling confounding factors. Receiver operating characteristic (ROC) curve is used to determine the sensitivity and specificity of risk factors. The hospitalization cost of hypoproteinemia was significantly higher than that of the standard group (OR 3.07; 95% CI 1.23-7.69; P = 0.017); Low hemoglobin levels in the male will significantly affect patient hospitalization costs (OR 8.32; 95% CI 2.82-24.57; P = 0.015), will also extend the LOS (OR 3.02; 95% CI 1.15-7.89; P = 0.024). Among Schatzker classification of the tibial plateau, hospitalization costs of type V, VI above fractures were significantly higher than those of class I, II, III, and IV fractures (OR 8.78; 95% CI 3.34-23.09; P < 0.001). In this study, hypoproteinemia and the Schatzker classification appeared to be a useful indicator for predicting hospitalization costs for TPFs patients; Male hemoglobin level appears to be an independent risk factor for hospital cost and LOS.

The comparison of clinical effect, knee function, prognosis of double plate fixation and locking plate internal fixation for tibial plateau fractures.

Objectives:The purpose of this study was to investigate the clinical effect, knee function improvement and prognosis of double plate internal fixation and locking plate internal fixation in the treatment of tibial plateau fractures.Methods:Clinical data from 96 tibial plateau fracture patients treated at our hospital were analyzed retrospectively. Of these, 46 had been treated using locking plate internal fixation and 50 were treated with double T-shaped plate fixation. Clinically related indices, Hospital for Special Surgery (HSS) score of knee function, and ability of daily living (ADL) score were evaluated during postoperative follow-up.Results:No significant differences were observed in pre-operative patient characteristics in both groups. Healing time, time to weight-bearing, tibial plateau angle (TPA) and lateral posterior angle (PA) were all superior in the locking plate fixation group compared to the double plate fixation group. At three months post-operative visit, range of motion, knee function, flexion deformity, muscle strength, pain, and stability metrics were all superior in the locking plate fixation group compared to the double plate fixation group. ADL scores were also higher in the locking plate fixation group than in the double plate fixation group at three and six months follow-up.Conclusions:The clinical effect, knee function improvement and prognosis of locking plate internal fixation in the treatment of tibial plateau fractures are better than those of double plate fixation.

Application of nanomaterials in martial arts sports injury patients

Objective: This paper discusses the curative effect and influencing factors of the implantation of nano-hydroxyapatite rods in the treatment of martial arts sports Schatzker III tibial plateau fractures. Methods: The thesis research included 36 martial arts Schatzker type III tibial plateau fracture patients who were admitted to the hospital from July 2017 to July 2019. In the control group, 18 patients received traditional incision bone plate screw internal fixation. Results: The HSS knee function scores at 1, 3, and 6 months after surgery were all higher than those of the control group (P < 0.05); univariate analysis showed that age was <0.05). Conclusion: Arthroscopic nano-hydroxyapatite rod implantation for minimally invasive treatment of Schatzker type III tibial plateau fracture injury in martial arts sports can promote fracture healing, relieve pain, and promote joint function recovery.

A Comparative Study of Clinical Outcomes and Functional Status after Knee Fracture and Knee Fracture Dislocation.

The aim of this study was to compare outcomes of tibial plateau fracture dislocations (FD) with tibial plateau fractures alone. This study was an analysis of a series of tibial plateau fractures, in which FD was defined as a fracture of the tibial plateau with an associated loss of congruent joint reduction and stability of the knee, and classified by the Moore system. Patient data collected included demographics, injury information, and functional outcomes (short musculoskeletal function assessment [SMFA] score and Pain by the visual analog scale). Clinical outcomes at follow-up were recorded including knee range of motion, knee stability and development of complications. There were a total of 325 tibial plateau fracture patients treated operatively, of which 22.2% were identified as FD (n = 72). At injury presentation there was no difference with regard to nerve injury or compartment syndrome (both p > 0.05). FD patients had a higher incidence of arterial injury and acute ligament repair (both p < 0.005). At a mean follow-up of 17.5 months, FD patients were similar with regard to pain, total SMFA scores, and return to sports than their non-FD counterparts (p = 0.884, p = 0.531, p = 0.802). FD patients were found to have decreased knee flexion compared with non-FD patients by 5 degrees (mean: 120 and 125 degrees) (p < 0.05). FD patients also had a higher incidence of late knee instability and subsequent surgery for ligament reconstruction (p < 0.005 & p < 0.05). However, there was no difference in neurological function between groups at follow-up (p = 0.102). Despite the higher incidence of ligamentous instability and decreased range of motion, FD patients appear to have similar long-term functional outcomes compared with non-FD of the tibial plateau. While FD patients initially presented with a higher incidence of arterial injury, neurovascular outcomes at final follow-up were similar to those without a dislocation.

Assessing Soft Tissue Perfusion Using Laser-Assisted Angiography in Tibial Plateau and Pilon Fractures: A Pilot Study.

To determine whether skin perfusion surrounding tibial plateau and pilon fractures is associated with the Tscherne classification for severity of soft tissue injury. The secondary aim was to determine if soft tissue perfusion improves from the time of injury to the time of definitive fracture fixation in fractures treated using a staged protocol. Prospective cohort study. Academic trauma center. Eight pilon fracture patients and 19 tibial plateau fracture patients who underwent open reduction internal fixation. Skin perfusion (fluorescence units) as measured by LA-ICGA. Six patients were classified as Tscherne grade 0, 9 as grade 1, 10 as grade 2, and 2 as grade 3. Perfusion decreased by 14 fluorescence units (95% confidence interval, -21 to -6; P < 0.01) with each increase in Tscherne grade. Sixteen patients underwent staged fixation with an external fixator (mean time to definitive fixation 14.1 days). The mean perfusion increased significantly at the time of definitive fixation by a mean of 13.9 fluorescence units (95% confidence interval 4.8-22.9; P = 0.01). LA-ICGA perfusion measures are associated with severity of soft tissue injury surrounding orthopaedic trauma fractures and appear to improve over time when fractures are stabilized in an external fixator. Further research is warranted to investigate whether objective perfusion measures are predictive of postoperative wound healing complications and whether this tool can be used to effectively guide timing of safe surgical fixation. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Diagnostic evaluation of low‐rank matrix denoising algorithm‐based magnetic resonance imaging on tibial plateau fracture complicated with meniscus injury

AbstractIt was to analyse the denoising ability of low‐rank matrix‐based denoising algorithms for magnetic resonance imaging (MRI) images, and explore the diagnostic value of MRI for tibial plateau fracture (TPF) with meniscus injury. The Gaussian mixture algorithm was introduced based on low‐rank matrix algorithm, and a new algorithm Gaussian mixture model‐based low‐rank matrix factorization (GLRMF) was established. Then, the root‐mean‐squared error (RMSE) of the GLRMF algorithm under different noise intensities was calculated, and the structural similarity (SSIM) of the GLRMF algorithm, anisotropic diffusion filter (ADF), and nonlocal means (NLM) algorithm was compared. Sixty cases of TPF patients diagnosed in the Department of Orthopaedics and Traumatology of X Hospital from March 2018 to October 2019 were recruited as the research objects. The results of Schatzker classification of patients were counted, and the results of intraoperative exploration or arthroscopy were used as the standard to analyse the accuracy of MRI in diagnosing TPFs with meniscus injuries. It was found that with the increase of noise intensity, the RMSE of the GLRMF algorithm showed an increasing trend. When the K value was 100, the denoising effect was relatively good. Under the same noise intensity, the SSIM of the GLRMF algorithm was higher than the other two algorithms. Moreover, type VI patients accounted for 55% at most. MRI diagnosed 56 cases (93.33%) of TPF patients with meniscus injury, and 52 cases (86.67%) of meniscus injury were found in intraoperative exploration. The sensitivity of MRI in diagnosing meniscus injury was 94.76%, the accuracy was 93.33%, and the specificity was 89%. It showed that the new GLRMF algorithm based on the low‐rank matrix algorithm had a good noise reduction effect and significantly improved the image quality. The accuracy of knee MRI scanning was significantly improved, it was safe, and it was worthy of clinical application.

Incidence and risk factors for decreased range of motion of the knee joint after surgery for closed tibial plateau fracture in adults

PurposeThe aim of this study was to quantify the incidence of and identify independent risk factors for decreased range of motion (ROM) of the knee joint after surgery for closed tibial plateau fractures in adults.MethodsThis retrospective study was performed at the trauma centre in our hospital from January 2018 to December 2019. Data from adult patients with tibial plateau fractures treated by surgery were extracted from the electronic medical records. A total of 220 tibial plateau fracture patients were enrolled. We extracted the patients’ demographic characteristics, fracture characteristics, and surgery-related variables. Univariate and multivariate logistic regression models were used to investigate the potential independent risk factors.ResultsFifty-seven patients developed decreased ROM of the knee joint at the 1-year follow-up in this study. The overall incidence was 25.9%. The independent predictors of decreased ROM after surgery, as identified in the multivariate analysis, were orthopedic polytrauma (odds ratio = 3.23; 95% CI = 1.68–6.20; p = 0.000), fracture type (Schatzker V-VI) (odds ratio = 2.52; 95% CI = 1.16–5.47; p = 0.019), and an open reduction and internal fixation approach (odds ratio = 2.10; 95% CI = 1.07–4.12; p = 0.031).ConclusionsThe study confirmed that patients with orthopaedic polytrauma, more complex fractures and those treated with open reduction and internal fixation (ORIF) surgery were more likely to suffer decreased ROM of the knee joint 1 year after surgery.