Tibial Plateau Fracture Surgery Research Articles

Evaluation of the functional outcome after treatment of tibial plateau fractures by internal fixation- A retrospective study

Background and Aim: Tibial plateau fractures are challenging, attributing to the fact of their increased incidence, complexity, associated complications, and availability of different treatment options. In this study we evaluated the functional outcome after treatment of tibial plateau fractures by internal fixation. Material and Methods: This retrospective study was conducted on 44 patients who had undergone surgery for tibial plateau fractures over a period of 2 years. All patients were operated under suitable anaesthesia and tourniquet. In all patients, parapatellar approach (medial or lateral) was preferred. Once fracture site was exposed, depression and displacement was noted by elevating the meniscus. Type I Fracture: Percutaneous cannulated cancellous screws under image intensifier guidance were used. Type II Fracture: A lateral parapatellar approach was used. Functional Evaluation was: Knee Range of movements and ability to do day to day activities. Results: There were 13 patients in the age group of 21-30 years, 11in the age group 31-40 years, 9 in the age group 41-50 years, 11 in the age group 51-60 years. Out of 44, 11 were found to be females while 33 were males. Among all, 19 had excellent, 17 had good, 4 had fair and 4 had poor functional outcome. Conclusion: Treatment of tibial plateau fractures is a difficult task. Restoration of articular congruity and early rehabilitation is the primary goal. Proper preoperative planning and adequate reduction will help to achieve early mobilization and optimal functional outcome. The techniques demand considerable skill and timely and proper judgment. Keywords: Internal fixation, Mobilization, Surgery, Tibial plateau

Personalized finite element model for full weight-bearing after tibial plateau fracture surgery

Personalized finite element model for full weight-bearing after tibial plateau fracture surgery

Failure analysis of primary surgery and therapeutic strategy of revision surgery for complex tibial plateau fractures

PurposeTo analyze the cause of failure of the primary surgery for complex tibial plateau fractures and to define the therapeutic strategy of the revision surgery for the same.MethodsTwenty-one cases with failure of primary surgery for complex tibial plateau fractures were treated in our hospital from January 2012 to September 2016. There were 13 males and 8 females with an average age of 39.4 years (ranged between 27 and 58 years). Patients presented with different types of complex tibial plateau fractures like Schatzker type V (n=9), VI (n=12), type 41.C1 (n=9), type 41.C2 (n=6), and type 41.C3 (n=6). The therapeutic strategy for revision surgery in individual patients was decided following careful analysis and accurate assessment of the causes of failure of the primary surgery. All the patients were followed-up with Rasmussen radiographic scores and Hospital for Special Surgery (HSS) knee scores.ResultsAll 21 patients underwent clinical and radiological examination after a mean follow-up time of 32.6 months. The average time of fracture healing was 4.5 months (ranged between 3 and 6 months). During the last follow-up, the mean range of motion of knee extension was 2.3° and knee flexion was 123.8°. The mean radiological Rasmussen score was 15.6 points, with an overall success rate of 85.7%. The average HSS knee score was 84.3 points, with an overall success rate of 80.9%.ConclusionThe common reasons for the failure of primary surgery of complex tibial plateau fractures were inadequate experience of the surgeon, inaccurate diagnosis and management, improper selection of implants, and poor surgical techniques. The key factors to succeed revision surgery were adequate preoperative evaluation, accurate intraoperative procedures, and proper postoperative rehabilitation.Level of evidenceLevel IV, case series, treatment study

Restoring Condylar Width: Radiographic Relationship Between the Lateral Tibial Plateau and Lateral Femoral Condyle in Normal Adult Knees.

We hypothesized that a constant radiographic relationship exists between the lateral tibial and femoral condyles and that no side-to-side variation exists. We reviewed anteroposterior x-rays of 217 uninjured adults ages 18-65, Included 109 unilateral and 108 bilateral radiographs with no or minimal osteoarthrosis (Kellgren-Lawrence grades 0-1). The perpendicular distance between the lateral-most margins of the tibial plateau articular surface (A) and the lateral femoral epicondyle (B) and the lateral femoral condyle articular surface (C) was measured in millimeters (mm). Medial and lateral measurements to point (A) were recorded as (-) and (+), respectively. First, the average of measured distances in all unilateral knees and randomly selected either right or left knees from the bilateral group (n = 217) was calculated. Comparison was made between both sexes. Next, A-B and A-C distances were compared between right and left knees in the bilateral group (n = 108) to find any significant difference (2-tailed t test, alpha = 0.05). The average A-B distance was 0.60 ± 2.40 mm (-4.82 to +6.49 mm). The mean A-C distance was -3.96 ± 2.07 mm (-8.51 to +3.98 mm). No significant difference was found between A-B and A-C distances between males (0.40 ± 2.62 mm and -3.91 ± 2.05 mm) and females (0.70 ± 2.28 mm and -3.99 ± 2.09 mm). Similarly, no significant difference was found between A-B and A-C distances between right (1.08 ± 2.31 mm and -3.90 ± 1.73 mm) and left knees (0.90 ± 2.38 mm and -4.31 ± 1.7 mm). Concordance coefficient for interobserver and intraobserver reliability showed substantial agreement. In conclusion, this study provided a "normal" range for the relationship of the proximal lateral tibial plateau relative to the lateral femoral condyle. The lateral femoral epicondyle is generally aligned with the lateral tibial articular margin. The relationship between the lateral tibial plateau, lateral femoral epicondylar surface, and lateral femoral articular surface is constant from side to side. This technique is reproducible in the setting of fracture, and templating off of the contralateral uninjured knee may be beneficial in tibial plateau fracture surgery.

Comparison of primary decompressive internal fixation versus delayed surgery for tibial plateau fractures combined with compartment syndrome

Objective To evaluate the clinical outcomes of primary decompressive internal fixation versus delayed surgery for tibial plateau fractures combined with compartment syndrome. Methods From January 2012 to June 2014, a total of 39 patients were treated at our department for tibial plateau fracture combined with compartment syndrome. Early operation was adopted for 18 patients in whom decompression by incisions via the medial and lateral approaches combined with internal fixation with plate and screws was performed at the primary stage and dermoplasty or wound closure conducted at the secondary stage after conditions of soft tissue allowed. Delayed operation was adopted for 21 patients in whom external fixation and decompression by incisions via the medial and lateral approaches was performed in the emergency management followed by selective open reduction and internal fixation. The 2 groups were compared in terms of indexes associated with surgery and hospitalization, Lysholm scores, EuroQol 5 dimensions (EQ-5D) indexes and visual analogue scale (VAS) at final follow-ups. Results All the patients were followed up for more than 2 years. The early operation group incurred significantly less operation time (229.1±43.7 min), intraoperative blood loss (297.5±51.5 mL), hospital stay (11.9±1.9 d) and expenditure [144,700 (103,200, 179,900) Yuan RMB] than the delayed operation group [322.1±62.2 min, 385.9±56.4 mL, 21.5±3.6 d, and 197,700 (137,200, 234,300) Yuan RMB, respectively] (P 0.05). Conclusions In the treatment of tibial plateau fractures combined with compartment syndrome, both primary decompressive internal fixation and delayed surgery can achieve satisfactory clinical outcomes. The former is more appropriate for those without obvious limb ischemia while the latter more appropriate for those whose priority is limb salvage due to serious osteofascial compartment syndrome. Surgeons should choose reasonable procedures according to the specific conditions of the patients and strict surgical indications. Key words: Tibial fracture; Wounds and injuries; Fracture fixation

One-stage minimally invasive surgery for femoral and ipsilateral tibial plateau fractures with a rapid reductor

Objective To investigate the fixation sequence, key points and clinical value of a new minimally invasive surgery for one-stage treatment of femoral and ipsilateral tibial plateau fractures with a rapid reductor. Methods From October 2015 to January 2017, 5 patients with femoral and ipsilateral tibial plateau fractures received surgery at our department. They were 4 men and one woman, aged from 23 to 65 years (mean, 45.5 years). The femoral fractures were type A in 2 cases, type B in 2 cases and type C in one case according to AO/OTA classification. The tibial plateau fractures were type Ⅴ in 2 cases and type Ⅵ in 3 according to Schatzker classification. After the tibial plateau fractures were first fixated, Kirschner wires were inserted via the femoral condyle and distal tibia. A rapid reductor was used to reduce the tibial plateau and dual plates were implanted by percutaneous minimally invasive internal fixation. Then the same set of rapid reductor was used to treat femoral fractures by antegrade femoral nailing. The bone traction was completed via the femoral condyle and anterior superior iliac spine. The operative time, bone union time, knee functional recovery and hospital stay were recorded. Results The 5 patients were followed up for an average of 10 months (from 7 to 17 months). No delayed union, nonunion or malunion happened of either femoral or tibial plateau fractures. The healing time for femoral fractures ranged from 4 to 8 months, averaging 5.5 months; the union time for tibial plateau fractures ranged from 10 to 14 weeks, averaging 12.0 weeks. The knee flexion averaged 110° (from 95° to 130°). The overall functional recovery was rated as excellent in 2 cases and good in 3 according to the Karlstrom & Olerud criteria. The average hospital stay was 18 days(from 13 to 32 days). Conclusion Minimally invasive surgery with a rapid reductor can treat femoral and ipsilateral tibial plateau fractures at one stage, leading to fine functional recovery of the knee and greatly reduced hospital stay in particular. Key words: Femur; Tibia; Fractures fixation, internal; One stage; Minimally invasive

The value of three dimensional printing technology assisted surgery in the treatment of complex tibial plateau fractures

Objective To investigate the advantage and application prospect of 3D printing technology in assisting surgery for complex tibial plateau fractures. Methods The complete clinical data of 41 patients (48 knees) were retrospectively analyzed. And these patients were divided into two groups as 3D printing assisted operation group and traditional operation group, according to whether 3D printing technology was applied. Study was carried out to compare the clinical efficacy of surgery assisted by 3D printing technology and traditional surgery in the treatment of complex tibial plateau fractures. The 3D printing assisted operation group included 18 patients (22 knees, 12 males and 6 females), aging from 16 to 68 (mean age 45.5±7.2), and there were 12 cases of Schatzker Ⅴ and 10 Ⅵ. The traditional operation group included 23 patients (26 knees, 15 males and 8 females), aging from 19 to 69 (mean age, 46.2±6.8), and there were 14 cases of Schatzker Ⅴ and 12 Ⅵ. The operation time, intraoperative blood loss, the Rasmussen score and hospital for special surgery knee score (HSS) at 6 weeks post-operation were analyzed and the difference between the two groups was tested. Results All those patients were followed up for 7 to 20 months (mean 15 months). For 3D printing assisted operation group, the mean operation time was 81.4±6.3 min for Schatzker Ⅴ and 90.6±15.4 min for Schatzker Ⅵ; the mean intraoperative blood loss was 200.4±72.3 ml for Schatzker Ⅴ and 280.6±101.6 ml for Schatzker Ⅵ; the result of 6-week Rasmussen score was 14 excellent, 6 good and 2 fair (excellent and good rate 90.9%); the result of 6-week HSS score was 15 excellent, 5 good and 2 fair (excellent and good rate 90.9%). Then for traditional operation group, the mean operation time was 100.4±15.3 min for Schatzker Ⅴ and 111.5±20.2 min for Schatzker Ⅵ; the mean intraoperative blood loss was 450.4±173.3 ml for Schatzker Ⅴ and 500.5±247.2 ml for Schatzker Ⅵ; the result of 6-week Rasmussen score was 14 excellent, 8 good, 2 fair and 2 bad (excellent and good rate 84.6%); the result of 6-week HSS score was 13 excellent, 8 good, 2 fair and 3 bad (excellent and good rate 80.8%). The difference in operation time, intraoperative blood loss had statistical significance between the two groups; but the difference in 6-month post-operation Rasmussen score and HSS score had no statistical significance. Conclusion Compared with traditional surgery, 3D printing technology assisted surgery for complex tibial plateau fracture possesses advantage such as shortened operation time, reduced intraoperative blood loss; but there’s no evidence for improved knee function at 6 weeks post-operation. Key words: Imaging, three-dimensional; Tibia; Fractures, bone

Treatment of open tibial plateau fractures with Hybrid external fixation

Objective To evaluate the clinical results of minimally invasive surgery for open tibial plateau fractures using minimally open reduction and Hybrid external fixation. Methods From January 2011 through January 2015, 9 complicated open tibial plateau fractures were treated with Hybrid external fixation. They were 6 males and 3 females, with an average age of 33.8 years (range, from 18 to 53 years). According to the Schatzker classification, there were 5 cases of type Ⅴ and 4 ones of type Ⅵ. According to the Gustilo classification, there were 5 cases of type Ⅱ, 3 ones of type ⅢA and one of type ⅢB. All the patients were treated with Hybrid external fixation with or without minimally open reduction. Results The average operation time was 185.6 minutes (from 140 to 240 minutes). The average time for hospital stay was 18.4 days (from 10 to 45 days). The patients were followed up for an average of 15.6 months (from 6 to 36 months). All the 9 fractures got united after an average time of 4.3 months (from 3 to 7 months). The external fixation was removed after confirmation of fracture union. According to Merchant scores, the clinical results were evaluated as excellent in 4 cases, as good in 3, as fair in one and as poor in one. The knee joint was stable in each case. Pin tract infection was observed in one and wire loosening in one. Conclusion Hybrid external fixation with or without minimally open reduction is a safe and feasible surgical method which avoids massive soft tissue dissection for complicated open tibial plateau fractures. Key words: Tibia; Fracture, open; External fixators; Hybrid

Predictive model for knee traumatic arthritis secondary to tibial plateau fracture surgery

Objective Establish a predictive model for investigating the risk factors of Knee traumatic arthritis (KTA) secondary to tibial plateau fracture surgery. Methods 258 consecutive patients with tibial plateau fracture between December 2009 and April 2015 were collected, 117 cases were male, 141 cases were female. All the patients were divided into the training cohort (2009-2012) and the validation cohort (2013-2015). In the training cohort, univariate and multivariate logistic regression was used to analyze the risk factors for traumatic arthritis; then Nomogram predicting model was built based on logistic regression model. In the validation cohort, goodness of fit test and ROC curve were used for testing calibration and discrimination power respectively. Results All the patients were divided into 151 cases for the training cohort and 107 cases for the validation cohort. In the training cohort (151 patients), 11 patients were diagnosed as KTA with the incidence of 7.3%. The results showed that body mass index, type of fracture, osteoporosis and poor reduction were risk factors of postoperative KTA. In the validation cohort (107 patients), 9 patients were confirmed as KTA, with the incidence of 8.4%. Goodness of fit test showed Pearson χ2 was 321.64, which indicated good calibration. The area under the receiver operating characteristic curve (ROC) was 0.7551, which indicated moderate discrimination. Conclusion High body mass index, unstable fractures, osteoporosis and non-anatomic reduction are independent risk factors for KTA secondary to open reduction internal fixation of tibial plateau fractures. The predictive model has good calibration and moderate discrimination power in predicting KTA secondary to tibial plateau fractures. Key words: Tibial fractures; Osteoarthritis, knee; Forecasting; Calibration

Adverse Events, Length of Stay, and Readmission After Surgery for Tibial Plateau Fractures

To identify factors that are associated with short-term outcomes after open reduction and internal fixation (ORIF) for tibial plateau fracture. Patients who underwent ORIF for tibial plateau fracture from 2009 to 2012 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patient characteristics were tested for association with any adverse event (AAE), severe adverse events (SAEs), infectious complications, extended length of stay (LOS), and readmission within 30 days. A total of 519 tibial plateau fracture patients met inclusion criteria. Ten percent had AAE, 7% had SAEs, and 4% had an infectious complication. Extended LOS was defined as LOS >3 days (75th percentile LOS). Four percent of patients were readmitted. AAE was associated with increased American Society of Anesthesiologists (ASA) class [relative risk (RR) = 3.8] and history of pulmonary disease (RR = 2.1) on multivariate analysis. SAE was associated with male sex (RR = 2.2) and increased ASA class (RR = 3.6). Infectious complications were associated with male sex (RR = 3.0), increased ASA class (RR = 3.3), smoking (RR = 2.8), pulmonary disease (RR = 2.9), and bicondylar fracture (RR = 2.7). Extended LOS was associated with increased age (RR = 2.1), increased ASA class (RR = 2.0), diabetes (RR = 1.6), pulmonary disease (RR = 1.8), bicondylar fracture (RR = 1.6), and increased operative time (RR = 1.6). Readmission was associated with increased ASA class (RR = 3.9), diabetes (RR = 2.9), dependent functional status (RR = 8.1), and discharge to home (RR = 5.7). The above-identified factors associated with outcomes after ORIF for tibial plateau fracture may be useful for patient counseling. Prognostic level II. See Instructions for authors for a complete description of levels of evidence.

Improved accuracy of 3D-printed navigational template during complicated tibial plateau fracture surgery.

This study was aimed to improve the surgical accuracy of plating and screwing for complicated tibial plateau fracture assisted by 3D implants library and 3D-printed navigational template. Clinical cases were performed whereby complicated tibial plateau fractures were imaged using computed tomography and reconstructed into 3D fracture prototypes. The preoperative planning of anatomic matching plate with appropriate screw trajectories was performed with the help of the library of 3D models of implants. According to the optimal planning, patient-specific navigational templates produced by 3D printer were used to accurately guide the real surgical implantation. The fixation outcomes in term of the deviations of screw placement between preoperative and postoperative screw trajectories were measured and compared, including the screw lengths, entry point locations and screw directions. With virtual preoperative planning, we have achieved optimal and accurate fixation outcomes in the real clinical surgeries. The deviations of screw length was 1.57 ± 5.77 mm, P > 0.05. The displacements of the entry points in the x-, y-, and z-axis were 0.23 ± 0.62, 0.83 ± 1.91, and 0.46 ± 0.67 mm, respectively, P > 0.05. The deviations of projection angle in the coronal (x-y) and transverse (x-z) planes were 6.34 ± 3.42° and 4.68 ± 3.94°, respectively, P > 0.05. There was no significant difference in the deviations of screw length, entry point and projection angle between the ideal and real screw trajectories. The ideal and accurate preoperative planning of plating and screwing can be achieved in the real surgery assisted by the 3D models library of implants and the patient-specific navigational template. This technology improves the accuracy and efficiency of personalized internal fixation surgery and we have proved this in our clinical applications.

Risk of Total Knee Arthroplasty After Operatively Treated Tibial Plateau Fracture

The aims of operative treatment of displaced tibial plateau fractures are to stabilize the injured knee to restore optimal function and to minimize the risk of posttraumatic arthritis and the eventual need for total knee arthroplasty. The purpose of our study was to define the rate of subsequent total knee arthroplasty after tibial plateau fractures in a large cohort and to compare that rate with the rate in the general population. All patients sixteen years of age or older who had undergone surgical treatment of a tibial plateau fracture from 1996 to 2009 in the province of Ontario, Canada, were identified from administrative health databases with use of surgeon fee codes. Each member of the tibial plateau fracture cohort was matched to four individuals from the general population according to age, sex, income, and urban/rural residence. The rates of total knee arthroplasty at two, five, and ten years were compared by using time-to-event analysis. A separate Cox proportional hazards model was used to explore the influence of patient, provider, and surgical factors on the time to total knee arthroplasty. We identified 8426 patients (48.5% female; median age, 48.9 years) who had undergone fixation of a tibial plateau fracture and matched them to 33,698 controls. The two, five, and ten-year rates of total knee arthroplasty in the plateau fracture and control cohorts were 0.32% versus 0.29%, 5.3% versus 0.82%, and 7.3% versus 1.8%, respectively (p < 0.0001). After adjustment for comorbidity, plateau fracture surgery was found to significantly increase the likelihood of total knee arthroplasty (hazard ratio [HR], 5.29 [95% confidence interval, 4.58, 6.11]; p < 0.0001). Higher rates of total knee arthroplasty were also associated with increasing age (HR, 1.03 [1.03, 1.04] per year over the age of forty-eight; p < 0.0001), bicondylar fracture (HR, 1.53 [1.26, 1.84]; p < 0.0001), and greater comorbidity (HR, 2.17 [1.70, 2.77]; p < 0.001). Ten years after tibial plateau fracture surgery, 7.3% of the patients had had a total knee arthroplasty. This corresponds to a 5.3 times increase in likelihood compared with a matched group from the general population. Older patients and those with more severe fractures are also more likely to need total knee arthroplasty after repair of a tibial plateau fracture.

Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee.

This study was conducted to examine the long-term survivorship and functional outcome of distal femoral varus osteotomy with fresh osteochondral allograft following failed lateral tibial plateau fracture surgery. We hypothesized that this procedure would be associated with a low rate of conversion to total knee arthroplasty (TKA) at medium to long-term follow-up. A consecutive series of 27 of distal femoral varus osteotomy combined with fresh osteochondral allograft following (27 patients) conducted between January 1981 and January 2005 for failed lateral tibial plateau fracture was retrospectively reviewed. Outcome measures included the Knee Society Knee Score (KSKS) and Knee Society Function Score (KSFS) and conversion rates to TKA. The study group consisted of 15 females (55.6 %) and 12 males (44.4 %), with a median age of 41.2 years (range 17-62 years). The median follow-up was 13.3 years (range 2-31 years). The knee function scores improved significantly at 2 years post-surgery (p < 0.01) from a median of 54.6 points preoperatively to 83.8 points (KSKS) and median of 50.6 points to 71.1 points (KSFS) at 2 years post-distal femoral varus osteotomy with fresh osteochondral allograft following surgery. At most recent follow-up, 4/27 patients had required conversion to TKA, and one patient had fractured the FOCA, requiring revision of the allograft. The survivorship for distal femoral varus osteotomy with fresh osteochondral allograft following was 88.9 ± 4.6 % at 10 years, 71.4 ± 18.1 % at 15 years, and 23.8 ± 11.1 % at 20 years. The use of distal femoral varus osteotomy combined with fresh osteochondral allograft following in patients with failed lateral tibial plateau fracture results in the majority of patients having good or excellent clinical outcomes and significantly delays the need for TKA in most patients. Case series, Level IV.

Radiographic and clinical results after surgically treated tibial plateau fractures at three and twenty two years postsurgery

We examined the development of osteoarthritis (OA) and post-traumatic bone loss after surgery for tibial plateau fractures (TPF). Patients who had participated in previous follow-up (FU) examinations after TPF and primary reduction and internal fixation were re-evaluated. At the first FU, a median of threeyears after the accident (short-term FU), the patients underwent functional assessments and standardised X-rays to grade radiological OA and post-traumatic bone loss. At the second FU, a median of 22years after the accident (long-term FU), 30 patients were available. An identical protocol was applied, and additional investigations [Knee Injury and Osteoarthritis Outcome Score (KOOS) and magnetic resonance imaging (MRI) of the injured knee] were performed. When the subjective and objective results at first FU were compared with those of the second FU for the same patients, deterioration of symptoms, signs and radiological OA was noted; however, ten patients had no OA even after the long-term FU. Some patients developed post-traumatic bone loss. In 13 of 31 knees, there was little or no radiological evidence of bone loss at the second FU. The short-term FU examination results after TPF have little prognostic value for the individual patient, as good results may deteriorate over the long run; however, there were some knees with no OA at the long-term FU. This is the first report focusing on post-traumatic bone loss after TPF.

Cardiac arrest after tourniquet deflation in tibial plateau fracture surgery in a healthy man

Surgical tourniquets are commonly used in orthopedic and trauma surgery. Although the pneumatic tourniquet has been classified by the US Food and Drug Administration as a class I medical device, there are still reports of hazards related to its use. Here, we describe an unusual complication experienced by a healthy man after he underwent surgery for trauma to the lower extremity. The patient experienced cardiac arrest 5 minutes after tourniquet release and was resuscitated immediately. He regained consciousness without any symptoms, and the electrocardiographic signs of arrhythmia completely resolved within 30 minutes of leaving the operating room. The patient recovered completely and was discharged 5 days later. The mechanism underlying the incidence of cardiac arrest after tourniquet deflation is still not clear. By ruling out other common intraoperative triggers as possibilities and upon reviewing the literature, we conclude that reperfusion injury is a plausible and the most likely explanation. Injuries resulting from tourniquet use are commonly pressure-related, and can also be caused by excessive tourniquet time. To reduce these injuries, an adequate pressure set-up (a cuff pressure not exceeding 300mmHg) and tourniquet ischemia time less than 2 hours should always be the preferred option. Even then, it may be impossible to eliminate all associated complications.

Arthroscopically assisted surgery for tibial plateau fractures

Objective To report outcomes of arthroscopically assisted surgery for tibial plateau fractures of Schatzker types Ⅰ-Ⅳ. Methods From October 2002 to October 2009, 26 patients with tibial plateau fracture were treated with arthroscopically assisted surgery at our department.They were 15 males and 11 females, aged from 24 to 68 years (average, 43.6 years).Accordingto Schatzker classification, 3 cases were of type Ⅰ, 8 of type Ⅱ, 9 of type Ⅲ and 6 of type Ⅳ.Fracture segments of the tibial plateau were reduced under arthroscopy, and bone defects were filled with autografts or allografts before fixation with compression lag screws or buttress plates.Results The mean operation time was 92.6 minutes (from 60 to 120 minutes) .The satisfactory reduction rate was 100%.Postoperative traumatic reactions were slight,without local infection.Incisions healed well, without serious vascular or neural complications.All the 26 patients were followed up for an average of 14.6 months (from 10 to 24 months).All the fractures healed well after 12 to 24 weeks (average, 16 weeks).According to the Rasmussen scoring for knee function, 16 cases were excellent, 9 good and one was fair, with an excellent-to-good rate of 96.2%.Conclusion In treatment of tibial plateau fractures of Schatzker types Ⅰ-Ⅳ, arthroscopically assisted surgery has advantages of satisfactory reduction, limited operative invasion, mild postoperative reaction, fine bone healing and fast functional recovery. Key words: Arthroscopy; Tibia; Fractures; Fracture fixation, internal

Arthroscopy-Assisted Surgery for Tibial Plateau Fractures: 2- to 10-Year Follow-up Results

Arthroscopy-Assisted Surgery for Tibial Plateau Fractures: 2- to 10-Year Follow-up Results

Arthroscopy-Assisted Surgery for Tibial Plateau Fractures: 2- to 10-Year Follow-up Results

This study evaluated the outcome of arthroscopy-assisted reduction with internal fixation for treating tibial plateau fractures at 2- to 10-year follow-up. Fifty-four patients with tibial plateau fractures treated by arthroscopy-assisted reduction with internal fixation were enrolled in this prospective study. According to the Schatzker classification, the fractures types were as follows: type I, 1 (2%); type II, 21 (39%); type III, 4 (7%); type IV, 10 (19%); type V, 8 (15%); and type VI, 10 (19%). The mean age at operation was 48 years (range, 22 to 68 years). The mean follow-up period was 87 months (range, 28 to 128 months). Clinical and radiologic outcomes were scored by the Rasmussen system. The mean postoperative Rasmussen clinical score was 28.4 (range, 19 to 30), and the mean radiologic score was 16.1 (range, 12 to 18). Good or excellent clinical and radiologic results were achieved in 96% of patients. The 6 fracture types did not significantly differ with regard to Rasmussen score or rate of satisfactory results (P > .05). Secondary osteoarthritis was noted in 10 injured knees (19%). All 54 fractures were successfully united. The mean preoperative fracture depression was 13.7 mm (range, 6 to 25 mm). Fracture depression at the final follow-up averaged 0.3 mm (range, 0 to 4 mm). No complications directly associated with arthroscopy were noted in any of the 54 patients. Arthroscopic surgery for tibial plateau fractures with associated soft-tissue injuries is a safe, reproducible, and effective procedure that provides precise diagnosis and effective treatment in a 1-stage procedure. Level IV, therapeutic case series.

Arthroscopic-Assisted Surgery for Tibial Plateau Fractures (SS-30)

Arthroscopically assisted surgery for tibial plateau fractures gives better results and it provides the precise diagnosis with adequate treatment at one-stage surgery. Undoubtedly the superior clinical results also depend upon the experienced and skillful arthroscopic technique. The purpose of this study is to evaluate the clinical and radiological outcome of the patients with tibial plateau fractures treated by arthroscopic-assisted surgeries after 2- to 10-year follow-up. Fifty-four patients with tibial plateau fractures treated by arthroscopically assisted surgeries were enrolled in the prospective study. According to Schatzker’s classification, the fractures types were: 1 type I (2%), 21 type II (39%), 4 type 3 (7%) and 10 type 4 (19%), 8 type 5 (15%), 10 type 6 (19%). Average age at operation was 48 years (range, 12-88 years). Mean follow up period was 87 months (range 28-128 months). The clinical and radiological outcomes were determined according to Rasmussen’s system. Mean postoperative Rasmussen score was 28.4 (range, 19-30). Overall 44 (81%) patients were rated as excellent, 8 (15%) as good, 1 (2%) as fair and 1 (2%) as poor. Secondary osteoarthritis appeared in none of injured knees but 10 (19%) traumatic osteoarthritis were reported. There were no complications directly associated with arthroscopy in any of the 54 patients. There was 89% excellent and good results radiologically (33% excellent and 56% good). All of the 54 fractures were united. Preoperative fracture depression average 13.7 mm (range, 3-80 mm). Fracture depression at the final follow average 2 mm (range, 0 -9 mm). Arthroscopically assisted surgery for tibial plateau fractures gives better results and it provides the precise diagnosis with adequate treatment at one-stage surgery. Undoubtedly the superior clinical results also depend upon the experienced and skillful arthroscopic technique.

Arthroscopy-assisted operative management of tibial plateau fractures.

This retrospective review evaluated the results of arthroscopy-assisted surgery for tibial plateau fractures in 45 patients with closed tibial plateau fractures. The fracture involved articular depression in 27 patients in whom lifting and bone grafting with autogenous corticocancellous iliac bone graft was required. In 23 patients there were also meniscal lesions, which were treated by partial resection in 16 and repaired in 7. Internal fixation was performed using screws in 36 knees and plate in 10 knees. Radiological results were evaluated according to the Resnic-Niwoyama criteria; mean follow-up was 36 months (range 14-72). There was no intraoperative complication in the series, but postoperatively there were one infection and one loss of correction. Results were satisfactory in 89% of cases, according the Rasmussen criteria. Arthroscopy is thus an excellent and minimally invasive method for assessment and treatment of tibial plateau fractures. The advantages are complete and anatomical reduction in the fractured articular surface and evaluation of other concomitant intra-articular pathology and entails only little additional morbidity, especially compared to arthrotomy.