Treatment Of Tibial Plateau Fractures Research Articles

Functional outcome of internal fixation of tibial plateau fractures: an observational study

Background: Tibial plateau fractures are intra-articular fractures usually caused by high energy trauma either a valgus or varus force in combination with axial loading which affect the stability and function of weight bearing knee joint. Understanding the outcomes of surgical treatment for these fractures is crucial for both orthopaedic research and patient care. This study set out to examine the functional results of surgically managing tibial plateau fractures. Methods: This prospective observational study took place in the Department of Orthopedic Surgery at Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh, from January 2020 to December 2022. The study included 37 patients with tibial plateau fractures who underwent internal fixation. Data was analyzed using tools from Microsoft Office. Results: Among the study participants, 56.8% had an immobilization period of 1 week or less, and 32.4% were immobilized for 2-3 weeks. Complications included knee stiffness in 10.8% and malunion in 8.1% of cases. According to the Rasmussen grading system, 51.4% achieved an excellent outcome, 35.1% were categorized as good, while 8.1% and 5.4% fell into the fair and poor categories. Functional outcome was assessed by Oxford knee score is excellent 20 (54.5%), good 11 (29.7%), fair 4 (10.8%) and poor 2 (5.4%) respectively. Conclusions: Surgical treatment of tibial plateau fractures typically yields positive results in most cases. The use of internal fixation, particularly with locking compression methods, is considered an effective approach for treating these fractures. This technique is associated with a lower risk of complications and promotes efficient healing, contributing to favourable outcomes.

Digital virtual reduction combined with individualized guide plate of lateral tibial condyle osteotomy for the treatment of tibial plateau fracture.

Current treatments do not support direct exposure of fracture fragments, resulting in the inability to directly observe the articular surface during surgery for accurate reduction and firm fixation. The aim of the study was to explore the treatment effect of digital virtual reduction combined with individualized guide plate of lateral tibial condyle osteotomy on tibial plateau fracture involving the lateral posterior condyle collapse. 41 patients with tibial plateau fracture involving the lateral posterior condyle collapse were recruited in the trial. All patients underwent Computed Tomography (CT) scanning before operation. After operation, fracture reduction was evaluated using Rasmussen score and function of knee joint was assessed using hospital for special surgery (HSS) score. 41 patients were followed-up 6-26 months (mean, 15.2 months). Fracture reduction was good after operation, with an average of 13.3 weeks of fracture healing without serious complications. The excellent and good rate was 97.6%. The joint movement degree was -5∘∼0∘∼135∘ with an average of 125.5∘. Digital virtual reduction combined with individualized guide plate of lateral tibial condyle osteotomy was effectively for treating tibial plateau fracture involving the lateral posterior condyle collapse.

Use of arthroscopy in management of tibial plateau fractures

Introduction Tibial plateau fractures are periarticular injuries of the proximal tibia often associated with soft tissue injury. They account for 1-2% of all fractures. Their impact on the articular surfaces and the development of osteoarthritis make them an interesting research topic in the orthopaedic field. With the development of arthroscopic treatment methods, many are thinking of ways to incorporate less invasive methods in the reduction and fixation of these injuries. Review methods English-language scientific literature found in PubMed and Google Scholar was used for the review. Articles were searched based on keywords. Each article was analyzed for knowledge currency and relevance for use in the review. Description of the State of Knowledge After searching the articles, 35 articles were selected for final analysis. The collected data provided the latest information on treatment of tibial plateau fractures (TPF) using arthroscopic tools with studies diving deep into both the technique and longer-term results. Summary The use of arthroscopy in treatment of tibial plateau fractures grows year by year with more and more clinicians being interested in limiting the soft tissue damage and other adverse effects of ORIF Keywords: Schatzker, arthroscopy, tibial plateau fracture

Total Knee Replacement as Primary Management in Comminuted Tibial Plateau Fracture in Elderly Patients: A Systematic Review and Meta-Analysis

Abstract Background Fracture of the tibial plateau represents approximately 8% of fractures in elderly patients. These injuries occur with an estimated incidence of 13.3 per 100,000 adults annually, with nearly a quarter of these occurring in elderly patients with concomitant osteoporosis. In young patients, the mainstay treatment for displaced tibial plateau fracture is open reduction and internal fixation (ORIF). However, in elderly patients with periarticular fracture, the combination of poor bone quality, metaphyseal bone comminution, and friable soft tissue envelope creates unique challenges to traditional ORIF. Aim of the Work To evaluate the perioperative complication rates and clinical outcomes in patients following TKA for primary treatment of tibial plateau fracture and to establish whether TKA can be considered a reliable primary treatment option in selected individuals. Patients and Methods The present systematic review will be performed in accordance with the preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search for all level I–IV evidence published articles using the online databases MEDLINE, Embase, and PubMed will be performed. The purpose of this search is to identify all eligible studies featuring perioperative complications or clinical outcomes in patients following TKA for primary treatment of tibial plateau fracture. Results The immediate management of acute tibial plateau fracture in elderly patients continues to be controversial. Although there is emerging evidence showing positive results for primary TKA for tibial plateau fracture, it is paramount to appreciate that performing TKA in the context of acute tibial plateau fracture is not a straightforward attempt. Many of these patients have notable loss of the articular surface, which disrupts normal anatomic references, and compromised soft tissue due to possible coexisting ligamentous injury. Conclusion Total knee arthroplasty for treatment of acute tibial plateau fracture is an enticing alternative to ORIF to allow early weight bearing, especially in elderly patients with poor bone quality and a friable soft tissue envelope. Our systematic review shows that functional scores are only average.

Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods.

Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences ( p > 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.

Meta-analysis of autologous bone grafts and bone substitute for the treatment of tibial plateau fractures

To explore clinical efficacy of autologous bone grafts and bone substitute for the treatment of tibial plateau fractures by Meta analysis. Controlled clinical studies on autogenous bone transplantation and bone substitutes in treating tibial plateau fractures published on PubMed,Web of Science,CNKI,Wanfang and other databases from January 2005 to August 2022 were searched by computer. Literature screening and data extraction were performed according to randomized controlled trial(RCT),and the quality of RCT were evaluated by using intervention meta-analysis criteria in Cochrane manual. Meta-analysis of joint depression,secondary collapse rate of articular surface,blood loss,operative time and infection rate between two methods were performed by Rev Man 5.3 software. Seven RCT studies (424 patients) were included,296 patients in bone replacement group and 128 patients in autograft group. Operative time [MD=-16.79,95%CI(-25.72,-7.85),P=0.000 2] and blood loss[MD=-70.49,95%CI(-79.34,-61.65),P<0.000 01] between two groups had statistically differences,while joint depression[MD=-0.17,95%CI(-0.91,0.58),P=0.66],secondary collapse rate of joint surface[RR=-0.74, 95%CI(0.35,1.57),P=0.43],infection rate [RR=1.21,95%CI(0.31,4.70),P=0.78] between two groups had no differences. The effects of bone substitute and autograft for the treatment of tibial plateau fracture have similar effects in terms of joint depression,secondary articular surface collapse rate and infection rate. However,compared with autologous bone transplantation,bone replacement could reduce blood loss and shorten operation time.

Research progress on biomechanics for internal fixation in tibial plateau fracture

To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic. The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed. Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient's condition is still a major difficulty in the surgical treatment of tibial plateau fractures. Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.

Functional Outcome of Patients Following Intra-articular Tibal Plateau Fractures

Introduction. Tibial plateau fractures are injuries that often require surgical treatment due to their complexity. The management of these fractures can be challenging and may lead to complications and functional impairment, impacting daily activities significantly. Aim of the study. The aim of this study was to evaluate of the functional outcome of patients with intra-articular tibial plateau fractures following surgical treatment and to compare the functional outcome between low-energy and high-energy trauma patients following surgical treatment of tibial plateau fractures. Materials and methods. The study enrolled a total of 108 patients with proximal tibia fractures who were admitted to the Hospital of Traumatology and Orthopaedics between December of 2018 and December 2021. Among them, 88 patients (81,5%) underwent surgical treatment and were included in research groups. Fractures were evaluated using anteroposterior radiograph and computed tomography images and were categorized according to AO/OTA and Schatzker classifications. The patients were divided into two groups: Group A consisted of patients with low-energy trauma, and Group B included patients with high-energy trauma. Functional outcomes were assessed using the Lower Extremity Functional Scale (LEFS). Results. The study assessed the functional outcome of 45 patients (51,1%) who underwent surgery between 11 and 43 months ago. Among them, Group A consisted of 30 patients with an average age of 54,4 years, and they achieved a mean LEFS score of 54,3 SD +/- 17. On the other hand, Group B included 15 patients with a mean age of 53,4 years, and their average LEFS score was 52 SD +/- 16,8. Statistical analysis using the Mann-Whitney test revealed no significant differences in the mean LEFS score between the two groups, U = 210,0, p = 0,718. When examining the individual activities covered within the LEFS assessment, there were no statistically significant differences observed between the two groups. Conclusions. Our research findings suggest that, in patients with tibial plateau fractures resulting from low-energy and high-energy trauma, there is no significant difference in post-operative functional outcomes, as per the Schatzker classification of these fractures. This suggests that relying solely on the Schatzker classification may not be adequate for predicting functional outcomes. Factors beyond the appearance of the fracture on anteroposterior radiographs seem to wield substantial influence in determining functional outcomes. Keywords: tibial plateau fracture; functional outcomes; Schatzker classification.

Tibial Plateau Fracture Surgical Care Utilizing Standardized Protocols Over Time: A Single Center's Longitudinal View.

To report on demographics, injury patterns, management strategies and outcomes of patients who sustained fractures of the tibial plateau seen at a single center over a 16-year period. Prospective collection of data.Patients/ Participants: 716 patients with 725 tibia plateau fractures, were treated by one of 5 surgeons. Treatment of tibial plateau fractures. Outcomes were obtained at standard timepoints. Complications were recorded. Patients were stratified into 3 groups: those treated in the first 5 years, those treated in the second 5 years and those treated in the most recent 6 years. 608 fractures were followed for a mean 13.4 months (6-120) and 82% had a minimum 1-year follow up. Patients returned to self-reported baseline function at a consistent proportion during the 3 time periods. The average knee arc was 125 degrees (75 - 135 degrees) at latest follow up and did not differ over time. The overall complication rate following surgery was 12% and did not differ between time periods. Radiographs demonstrated excellent rates of healing and low rates of PTOA and improved articular reductions at healing (0.58 mm in group 3 compared to 0.94 mm in Group 1 and 1.12 mm in Group 2) (P<0.05). The majority of patients regained their baseline functional status following surgical intervention and healing. Over time the ability of surgeons to achieve a more anatomic joint reduction was seen, however this did not correlate with improved functional outcomes. Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Complications and secondary operations after non-operative and operative treatment of tibial plateau fractures: a population-based study of 562 patients with mean follow-up of 7years.

The incidence of tibial plateau fractures (TPF) is 1% of all fractures and increases with age. Whether non-operatively or operatively treated, complications (infection, malalignment, loss of reduction and delayed union or nonunion) and post-traumatic osteoarthritis are not uncommon, and the risk for complications has generally been assumed to rise with age. This study investigated all post-TPF complications and secondary surgery after non-operative and operative treatment. Secondary aims were to determine the incidence and epidemiology of TPF in the population of the Central Finland region. All patients over age 18years with a TPF, including incidence, etiology, fracture type, and possible complications and reoperations, sustained during the period 1998-2019 were retrospectively identified from hospital records. The annual mean incidence of TPF was 14.4/100,000, with older women at highest risk. The proportions of non-operative and operatively treated patients who had undergone at least one additional surgical operation were 6% and 26%, respectively. Age and female gender were identified as risk factors for complications and secondary operations. The risk peaked in patients aged 60-65years, decreasing thereafter. Non-operative treatment showed low risk for both non-union and loss of reduction. Older women were at the highest risk for TPF and for subsequent complications and secondary operations after TPF. Secondary operations after operatively treated TPF were not uncommon and patients aged 60-65years were at highest risk. Given the low rates of complications and re-operations, non-operative treatment may be a safe option in cases of all minimally displaced TPF.

Single-Incision Fasciotomy Decreases Infection Risk Compared with Dual-Incision Fasciotomy in Treatment of Tibial Plateau Fractures With Acute Compartment Syndrome.

Comparison of surgical site infection (SSI) rates in tibial plateau fractures with acute compartment syndrome treated with single-incision (SI) versus dual-incision (DI) fasciotomies. Retrospective cohort study. Two, Level-1, academic, trauma centers. Between January 2001 and December 2021, one-hundred ninety patients with a diagnosis of tibial plateau fracture and acute compartment syndrome met inclusion criteria (SI: n = 127, DI: n = 63) with a minimum of 3-month follow-up after definitive fixation. Emergent 4-compartment fasciotomy, using either SI or DI technique, and eventual plate and screw fixation of the tibial plateau. The primary outcome was SSI requiring surgical debridement. Secondary outcomes included nonunion, days to closure, method of skin closure, and time to SSI. Both groups were similar in demographic variables and fracture characteristics (all P > 0.05). The overall infection rate was 25.8% (49 of 190), but the SI fasciotomy patients had significantly fewer SSIs compared with the DI fasciotomy patients [SI 18.1% vs. DI 41.3%; P < 0.001; OR 2.28, (confidence interval, 1.42-3.66)]. Patients with a dual (medial and lateral) surgical approach and DI fasciotomies developed an SSI in 60% (15 of 25) of cases compared with 21.3% (13 of 61) of cases in the SI group ( P < 0.001). The nonunion rate was similar between the 2 groups (SI 8.3% vs. DI 10.3%; P = 0.78). The SI fasciotomy group required fewer debridement's ( P = 0.04) until closure, but there was no difference in days until closure (SI 5.5 vs. DI 6.6; P = 0.09). There were zero cases of incomplete compartment release requiring return to the operating room. Patients with DI fasciotomies were more than twice as likely to develop an SSI compared with SI patients despite similar fracture and demographic characteristics between the groups. Orthopaedic surgeons should consider prioritizing SI fasciotomies in this setting. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

S2k Guideline for Tibial Plateau Fractures - Classification, Diagnosis, and Treatment.

Tibial plateau fractures are mostly complex and surgically demanding joint fractures, which require a comprehensive understanding of the fracture morphology, ligamentous and neurovascular injuries, as well as the diagnostic and therapeutic options for an optimal clinical outcome. Therefore, a standardised and structured approach is required. The success of the treatment of tibial plateau fractures relies on the interdisciplinary cooperation between surgical and conservative physicians in an outpatient and inpatient setting, physical therapists, patients and service providers (health insurance companies, statutory accident insurance, pension providers). On behalf of the German Society for Orthopaedics and Trauma Surgery (DGOU), the German Trauma Society (DGU) and the Society for Arthroscopy and Joint Surgery (AGA), under the leadership of the Fracture Committee of the German Knee Society (DKG), a guideline for tibial plateau fractures was created, which was developed in several voting rounds as part of a Delphi process. Based on the current literature, this guideline is intended to make clear recommendations and outline the most important treatment steps in diagnostics, therapy and follow-up treatment. Additionally, 25 statements were revised by the authors in several survey rounds using the Likert scale in order to reach a final consensus.

Comparison of the intraarticular osteotomy and the “window” osteotomy in the treatment of tibial plateau fracture involving depressed posterolateral fragments

ObjectivesThe methods of reduction of depressed posterolateral fragments in tibial plateau fracture through anterolateral approaches remain controversial. This paper aimed to compare the intraarticular osteotomy technique and the “window” osteotomy technique for the reduction of depressed posterolateral fragments through anterolateral approach.MethodFrom January 2015 to January 2022, we retrospectively reviewed the data on patients with tibial plateau fracture involving depressed posterolateral fragments treated with the intraarticular osteotomy or the “window” osteotomy. 40 patients underwent the intraarticular osteotomy were divided into group A, while 36 patients underwent the “window” osteotomy were divided into group B. The operative time, bone grafting volume, fracture healing time, complication, reduction quality and postoperative functional results were compared between the two groups.ResultsThe average follow-up duration was 16.6 ± 3.7 months. The average bone grafting volume for all patients in group B was essential larger than group A (p = 0.001). Compared to group B, patients in groups A had significantly shorter fracture healing time (p = 0.011). The depth of depressed articular surface, PSA and the radiographic evaluation at 2 days and 6 months after surgery in group A were significantly lower than group B (p<0.05). Based on the HSS knee-rating score, no significant difference in function results was found between the two groups (p>0.05). No significant difference was found in operation time and blood loss between the two groups (p>0.05).ConclusionThe intraarticular osteotomy could obtain satisfactory clinical results in tibial plateau fracture involving posterolateral fragments.

Early versus Standard Weight Bearing Following Operative Treatment of Tibial Plateau Fractures: Do We Really Have to Wait So Long?

Postoperative management of tibial plateau fractures classically involves a prolonged period between 10 and 12 weeks of nonweight bearing or partial weight bearing. In recent years, there has been some support for earlier weight-bearing protocols although this remains controversial. The goal of this study was to investigate the difference in outcomes between early weight-bearing (EWB) and traditional weight-bearing (TWB) protocols. This investigation is a retrospective review of 92 patients treated with open reduction and internal fixation of tibial plateau fractures at a single institution, from August 2018 to September 2020. Subjects were divided into EWB (< 10 weeks) and traditional nonweight bearing groups (≥ 10 weeks). Key outcome measures collected include injury classification, mechanism of injury, surgical fixation method, bone grafting, time to full weight bearing, radiographic time to union, range-of-motion, all-cause complications, and subsidence at an average follow-up time of 1 year. The EWB group had an earlier average time to weight bearing versus the TWB group (6.5 ± 1.4 vs. 11.8 ± 2.3 weeks, p < 0.0001). There was no difference in the classification of fractures treated between the two groups, with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association B3 fractures the most common in the EWB group, and C3 fractures the most common in the TWB group. Radiographic time to union was no different between the two groups (93.5 ± 53.7 days for EWB vs. 103.7 ± 77.6 days for TWB, p = 0.49). There was no significant difference in complication rates or subsidence. Following operative treatment of tibial plateau fractures, patients who underwent a weight-bearing protocol earlier than 10 weeks were able to recover faster with similar outcomes and complications compared with patients who started weight bearing after 10 weeks or more. LEVEL OF EVIDENCE: III.

Primary Versus Secondary Total Knee Arthroplasty for Tibial Plateau Fractures in Patients Aged 55 or Over—A Systematic Review and Meta-Analysis

BackgroundTotal knee arthroplasty allows immediate postoperative weight-bearing and is increasingly recognized as a suitable treatment option for older patients who have tibial plateau fractures (TPFs). This systematic review evaluated the clinical and functional outcomes associated with primary versus secondary TKA for the treatment of TPFs in patients aged ≥55 years. MethodsVarious databases were searched from inception to December 2021. Studies investigating outcomes of primary TKA (pTKA) as the initial treatment for TPFs in patients of mean age ≥55 years or those investigating outcomes of secondary TKA (sTKA) following any other primary treatment for TPFs were included. Quality of included studies was assessed using a methodological scale. Of 767 potentially relevant studies, 12 studies comprising 341 patients were included: 121 patients underwent (pTKA) and 220 patients underwent sTKA. There were 3 high-quality studies. Patients in the sTKA cohort were significantly younger at the time of TKA compared with those undergoing pTKA (mean 61.3 versus 72.2 years, P < .001, 95% confidence interval (CI) 8.2 to 13.6). ResultsIntraoperative and postoperative complication rates were lower with pTKA; in particular, sTKA was associated with a significantly increased rate of stiffness requiring reintervention and patella tendon rupture. Functional outcome was greater after pTKA, but this did not reach statistical significance (85.2 versus 79.9%, P = .359, 95% CI -16.7 to 6.1). ConclusionPrimary TKA was associated with lower complication rates than secondary TKA after TPF. In appropriate cases of TPF in older adults, it may be preferable to proceed with TKA as primary treatment rather than delaying until after fracture union or malunion.

Development and clinical application of a new reduction device for the treatment of tibial plateau fracture under arthroscopic monitoring

To develop a reduction device for the arthroscopy-assisted treatment of tibial plateau fracture and explore its clinical efficacy. From May 2018 to September 2019, 21 patients with tibial plateau fracture were treated, including 17 males and 4 females. Their ages ranged from 18 to 55 years old with an average of (38.6±8.7) years old. There were 5 cases of Schatzker typeⅡand 16 cases of Schatzker type Ⅲ. The self-designed reductor combined with arthroscope was used for auxiliary reduction and fixation(minimally invasive percutaneous plate osteosynthesis). The efficacy was analyzed by observing the operation time, blood loss, fracture healing time and knee function(HSS and IKDC scoring criteria). All the 21 patients were followed up for 8 to 24 with an average of(14.0±3.1) months. The operative time ranged from 70 to 95 min with an average of(81.7±7.6)min, incision length ranged from 4 to 7 cm with an average of(5.3±0.9) cm, intraoperative blood loss ranged from 20 to 50 ml with an average of(35.3±5.2) ml, postoperative weight-bearing time ranged from 30 to 50 d with an average of(35.1±9.2) d, fracture healing time ranged from 65 to 90 d with an average of(75.0±4.4) d, and complications were 0 cases, respectively. The fracture was well healed and no screw plate fracture was observed. The knee function scores of HSS and IKDC 18 months after operation were significantly higher than those before operation(P<0.05). The custom-made reduction tool for the arthroscopic management of tibial plateau fracture is reasonable in design and simple in operation. The specific reduction tool could effectively reduce the fracture, and shorten the fixation time with minimally invasive procedure.

Surgical Treatment of Tibial Plateau Fractures About 100 Cases

Tibial plateau fractures are articular fractures that must benefit from anatomical reduction to avoid the occurrence of complications, a source of serious functional sequelae. Their management has become largely surgical. We report a retrospective study of 100 tibial plateau fractures treated surgically between 2012 and 2018. The objectives were to study the epidemiological characteristics of tibial plateau fractures, to evaluate and compare the clinical and radiological results, in the short and long term, of different techniques for the surgical treatment of tibial plateau fractures. The average age of our patients was 45 years old. The male sex was affected in 66% with a sex ratio of 1.94. The etiologies were dominated by domestic accidents in 52% of cases, followed by public voting accidents (47%). The fracture was open in 3 cases. We adopted the classifications of DUPARC and FICAT and of SCHATZKER, thus the patients were classified: 30 cases of unituberosity fractures, 41 cases of spinotuberosity fractures and 29 cases of bituberosity fractures. Stabilization was provided by a screwed plate in 62 cases and by screwing in 32 cases, 26 of which were percutaneous. Only 1 patient had stabilization with a HOFFMAN-type external fixator for an open CAUCHOIX II fracture. 5 patients had an ILIZAROV type external fixator. Autologous corticocancellous bone grafting was performed in 12 cases. According to the criteria of HOLH AND LUCK, the anatomical results were satisfactory in 77% of cases. According to the criteria of MERLE AUBIGNE and MAZAS, the functional results were satisfactory in 82% of cases. In the light of our results and a review of the literature, it appears that the prognosis of these fractures depends on the type of fracture, the degree of comminution, the quality of the reduction, the patient's age, the time to treatment, meniscal and ligament lesions, type of surgical treatment and quality of rehabilitation.

Effects of sodium hyaluronate administration on levels of antioxidant enzymes, serum substance P and neuropeptide Y in patients undergoing locking plate fixation for tibial plateau fractures.

To analyze the effects of sodium hyaluronate administration on the serum levels of antioxidase, substance P (SP), and neuropeptide Y (NPY) in patients undergoing locking plate fixation (LPF) for tibial plateau fractures (TPF). We retrospectively analyzed the records of 66 patients with TPF who received treatment in the Beijing Chao-yang Hospital[PJMS1][2] from February 2017 to August 2020. According to the treatment records, 33 patients underwent LPF surgery (control-group), and 33 patients underwent LPF plus sodium hyaluronate treatment (observation-group). The levels of antioxidant enzymes (superoxide dismutase (SOD), catalase (CAT) and total antioxidant capacity (TAC)), SP and NPY. Seven days after LPF operations, both groups showed lower levels of SOD, CAT, and TAC compared to pre-surgery levels, while levels of SP and NPY were higher. However, the observation group showed higher levels of SOD, CAT, and TAC compared to the control group, and lower levels of SP and NPY in the control group (P<0.05). The treatment of TPF with LPF plus sodium hyaluronate administration has been shown to effectively reduce oxidative stress reactions, improve SP and NPY levels.[PJMS3][4].

What is the Radiographic Factor Associated with Meniscus Injury in Tibial Plateau Factures? Multicenter Retrospective (TRON) Study.

Tibial plateau fracture (TPF) is a complex intra-articular injury involving comminution and depression of the joint, which can be accompanied by meniscal tears. The aims of this study were (1) to demonstrate the rate at which surgical treatment for lateral meniscal injury and (2) to clarify the explanatory radiographic factors associated with meniscal injury in patients with TPF. We extracted the patients who received surgical treatment for TPF from our multicenter database (named TRON) included from 2011 to 2020. We analyzed 79 patients who were received surgical treatment for TPF with Schatzker type II and III and evaluation for meniscal injury on arthroscopy. We investigated the rate at which surgical treatment of the lateral meniscus was required in patients with TPF and the explanatory radiographic factors associated with meniscal injury. Radiographs and CT scans were evaluated to measure the following parameters: tibial plateau slope, distance from lateral edge of the articular surface to fracture line (DLE), articular step, and width of articular bone fragment (WDT). Meniscus tears were classified according to whether surgery was necessary. The results were analyzed by multivariate Logistic analyses. We showed that 27.7% (22/79) of cases of TPF with Schatzker type II and III had lateral meniscal injury that required repair. WDT ≥ 10mm (odds ratio 10.9; p = 0.005) and DLE ≥ 5mm (odds ratio 5.7; p = 0.05) were independent explanatory factors for meniscal injury with TPF. Bone fragment size and the location of fracture line on radiographs in patients with TPF are associated with meniscus injuries requiring surgery. The online version contains supplementary material available at 10.1007/s43465-023-00888-5.

Implementing 3D fluoroscopy in the management of tibial plateau fractures: Shorter hospitalization and decline in revision surgery, but increase in the duration of surgery and radiation exposure

BackgroundIntraoperative 3D fluoroscopy (3DRX) is increasingly used in fracture management instead of conventional fluoroscopy (RX), but its effect on the treatment and outcome of tibial plateau fractures (TFs) is not well known. This study aims to evaluate whether the use of 3DRX in the treatment of tibial plateau fractures reduces the number of revision surgeries. MethodsThis retrospective cohort study includes all patients who underwent surgical treatment for TF in a single center from 2014 to 2018. Patient-, fracture-, and treatment characteristics were compared between the 3DRX and RX subgroups. The primary endpoint was the number of patients requiring revision surgery. Secondary endpoints were surgery duration, hospital length of stay, radiation exposure, postoperative complications, and secondary total knee arthroplasty. ResultsEighty-seven patients were included, of which 36 were treated with 3DRX. Three patients in the RX group required revision surgery, while no revision surgery was performed in the 3DRX group (p = 0.265). The use of 3DRX resulted in significantly more intraoperative adjustments (25% versus 6%; p = 0.024) and an increase in surgery duration (by average of 28 min, p = 0.001), without a significant increase in postoperative wound infections (12% versus 19%; p = 0.374) or fracture-related infections (2% versus 2.8%; p = 0.802). The 3DRX group had an average radiation exposure of 7,985 mGy versus 1,273 mGy in the RX group (p<0.001). The hospital length of stay was 1 day shorter in the 3DRX group (5 days versus 4 days; p = 0.058). ConclusionsImplementing 3DRX in treating TFs improves the assessment of fracture alignment and implant position perioperatively, resulting in more intraoperative corrections and no revision surgeries within 6 weeks postoperatively. However, using 3DRX significantly increases perioperative radiation exposure and surgery duration without a significant rise in postoperative infections and a shorter hospital length of stay.