Treatment Of Tibial Plateau Fractures Research Articles

Tibial plateau fractures in elderly people: an institutional retrospective study

BackgroundTibial plateau fractures are the most common intra-articular fractures, which require careful evaluation and preoperative planning. The treatment of tibial plateau fractures in elderly patients is challenging, and the comprehension of epidemiology and morphology can be helpful. This study described the characteristics of geriatric tibial plateau fractures.MethodsA total of 327 (23.24%) patients aged ≥60 years were reviewed in our level one trauma center over a 4-year period (from January 2013 to November 2016). The following parameters were collected and evaluated: (1) demographic data, (2) injury mechanisms and (3) fracture classifications.ResultsFemales accounted for 60.86% in all included elderly patients. Electric-bike accidents were the cause of 32.42% of all these injuries, and 39.62% of these led to high-energy injuries. The most common type of fracture was Schatzker II (54.74%). According to the three-column classification, single lateral column fracture (28.75%) and four-quadrant fracture (involving lateral, medial, posterolateral and posteromedial fractures) (23.24%) were the two most frequent patterns. In all cases, 67.58% involved the posterior column, and the prevalence of posterolateral and posteromedial fractures were 62.69% and 37.92% respectively. Isolated posterior column fractures accounted for 12.54% of patients in total, which mostly consisted of posterolateral fracture in older females (85.37%).ConclusionsThe majority of elderly patients with tibial plateau fractures are females, and Electric-bike accidents are an important cause of injury. Geriatric tibial plateau fractures have unique distribution in classification.

Surgical methods and curative effect of tibial plateau fracture with medial large block split

To explore the clinical effects of protecting the internal structure of the knee and internal fixation through two different directions for the treatment of tibial plateau fractures with medial large block split. From January 2010 to January 2016, data of 21 patients of tibial plateau with medial large block split fractures who were treated with protecting the internal structure of the knee and internal fixation through two different directions were retrospectively analyzed, including 17 males and 4 females, with an average age of (39.2±3.2) years old ranging from 27 to 63 years. Anteroposterior and lateral radiographs as well as computed tomography(CT) images were obtained in the course of preoperative. It was made in the operation to protect medial knee structure, combining with internal fixation via two different directions plates(medial and posteromedial). If the posterolateral condyle fracture was involved, a plate was applied through posterolateral approach. Rasmussen score was used for radiological assessment, and HSS knee score was used for efficacy assessment at 1 year after operation. The fracture healing time was judged by X-ray and clinical examinations, additionally, the complications and corresponding outcomes were also recorded. All patients were followed up for 10 to 24 months with an average of(17.2±1.7) months. All fractures were healed, the healing time was 9 to 16 weeks with an average of(11.1±3.2) weeks. The Rasmussen score after surgery was 1 to 18 points with an average of(16.7±1.5) points. Sixteen cases got excellent, 3 good and 2 fair. At the final follow-up, HSS functional scores ranged from 60 to 100 points with an average of (87.3±6.7) points, the result was excellent in 18 cases, good in 2 cases and fair in 1 case. For a split fracture of the medial tibial plateau, the medial incision, full protection of the medial knee structure, and two different directions of supporting plate fixation are feasible, and the short-term effect is satisfactory.

Duration of incapacity of work after tibial plateau fracture is affected by work intensity

BackgroundTibial plateau fractures requiring surgery are severe injuries of the lower extremity. Tibial plateau fractures have an impact not only on physically demanding jobs but notably on general professional life too. The aim of this study was to assess how the professional activity of patients will be affected after a tibial plateau fracture.Methods39 consecutive patients (ages 20–61 years) were retrospectively included in the study and were clinically examined at a minimum of 14 month postoperatively. Inclusion criteria were surgical treatment of tibial plateau fractures between November 2009 and December 2012. The clinical evaluation included the Lysholm score and the Oxford Knee Score. Fractures were classified and analyzed using the AO classification. Intensity of work was classified as established by the REFA Association. The patients themselves provided postoperative duration of the incapacity of work and subjective ratings.Results17 (43.6%) women and 22 (56.4%) men were examined with a mean follow-up of 29.7 ± 10.4 months (range 14–47). According to the AO classification there were 20 (51.3%) B-type-fractures and 19 (48.7%) C-type-fractures. The median incapacity of work was 120 days (range 10–700 days) with no significant differences between B- and C-type-fractures. Four (10.3%) patients reduced their working hours by 10.5 h per week on average. Patients with low workload (REFA 0–1, median incapacity of work 90 days, range 10–390 days) had a significant shorter incapacity of work than patients with heavy workload (REFA 2–4, median incapacity of work 180 days, range 90–700 days) (p < 0.05). The median Lysholm score decreased significantly from 100 points (range 69–100) before the injury to 73 points (range 23–100) at the time of the follow-up. All patients received postoperative physiotherapy (median 25 appointments, range 6–330), with a significant higher number of appointments for C-type-fractures than for B-type-fractures (p = 0.004).ConclusionA relationship was found between workload and the duration of incapacity of work after tibial plateau fractures. The post-injury shift to less demanding jobs and the reduction of working hours highlight the impact of a tibial plateau fracture on a patient’s subsequent physical ability to work.

Single medial approach for the treatment of Schatzker IV tibial plateau fractures

Objective Try to treat the Schatzker Ⅳ tibial plateau fractures with a single medial approach. Methods A single medial longitudinal incision was used to treat 16 cases of Schatzker type Ⅳ tibial plateau fractures admitted to hospital from January 2013 to January 2016 which diagnosed by computed tomography (CT). The range of peeling up to the anterior edge of the tibia, the back side skipping over the posterior bone crest to expose the Posterior surface, persisting the joint capsule and the medial collateral ligament, and the far end reached 3-5 cm beyond the fracture line. As the lower limbs in the situation of external rotation with hip and knee flexion, open the medial fracture, using a strutting forceps to brace the bone block, made out he collapsing cartilage and subchondral bone which belong to de back column, Using the detacher to lift the subchondral bone together with the cartilage surface, lift up to the lateral side until it can’t be raised again, fixed them with 2-3 Kirschner-pins of 1.5 mm-diameter. And then used a large C type Matta forceps to clamp the fracture line for recovering the width of tibial platform. A Tomofix plate was used to fix the fracture in the position of posterior bone crest. The intercondylar eminence fracture of the anterior cruciate ligament was fixed under direct vision, and the supporting plate was placed in the posterior medial wall to fix the posterior medial small fracture. The standard X-ray films of bilateral knee joint were taken and compared after the operation. The knee joint activity was measured at 1 year follow-up after 1 years. The healing of subchondral fracture and no secondary collapse were performed by plain scan, and the function of the knee joint was evaluated by Lysholm scoring system. Results 15 cases were followed up for more than 1 years. All the X-ray showed fracture healing at half a year. CT confirmed that the fracture healed completely at the time of reexamination. The condylar crest avulsion fracture healed well, there was no secondary cartilage surface collapse, no obvious osteoarthritis, the average knee joint activity was 118°, and the average of Lysholm score was 87. Conclusion Combined approach is an effective method for the treatment of complex tibial plateau fractures, but for Schatzker Ⅳ fractures, a good reduction can be achieved with a single medial approach combined with some proper tools. Key words: Tibial plateau fractures; Medial approach; Schatzker Ⅳ

Functional assessment of tibial plateau fracture by various modalities of treatment

Background: Tibial plateau is the most important weight bearing surface. These intraarticular fractures are difficult to treat and presented with different fracture morphology. Due to in-crease in incidence of high velocity trauma and higher functional demands of patients, surgery is indicated in most of the cases. Even though, there is advancement in fracture fixation methods, treatment of tibial plateau fractures still remains controversial. Methods: In our series, we analyzed the functional outcomes of 18 of surgically treated tibial plateau fractures. Fractures were classified with Schatzker’s classification. Various fixation modalities of fixation were employed. Functional outcome was evaluated with modified Rasmussen’s criteria.Results: The functional outcome assessment according to Modified Rasmussen’s criteria at the end of 12 months showed the excellent functional outcome in 5 (27.7%), good in eight (44.4%), fair in four (22.2%) and poor in one (5.6%) patients.Conclusions: Road traffic accidents are the main cause of injury with males affected more commonly than females. CT scan with three dimensional reconstructions gives accurate fracture geometry for preoperative planning for osteo-synthesis. Result of various types surgeries are good for various types of fracture pattern except when complications developed in elderly patients of type VI fracture pattern in the form of stiffness which led to an unacceptable outcome.

Primary and Secondary Total Knee Arthroplasty for Tibial Plateau Fractures.

The surgical management of tibial plateau fractures can be technically demanding. In younger patients, the mainstay is fixation with cartilage preservation. In older patients with osteoporotic bone, this method has higher rates of fixation failure; in addition, it requires prolonged bed rest or protected weight bearing, which are major challenges in this group. In contrast, total knee arthroplasty performed acutely for primary treatment of tibial plateau fractures has potential advantages for elderly patients, such as immediate stability, early mobilization, and positive functional outcomes with decreased rates of reoperation. Additionally, arthroplasty can be technically challenging in younger patients with previous tibial plateau fractures in whom debilitating posttraumatic arthritis develops. In these patients, old wounds, retained metalwork, bony deficiency, and instability can lead to poorer outcomes and higher complication rates than in routine knee arthroplasty. In both cases, we recommend surgery be performed by experienced arthroplasty surgeons with ample access to a range of implants with varying constraints and the option of stems and augments.

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

Angle Stable Interlocking Intramedullary Nails for Tibial Plateau Fractures.

Angle stable interlocking intramedullary nail (ASIN), a novel technique, has rarely been used for treatment of tibial plateau fractures (TPF). This retrospective study was designed to introduce this novel technique, ASIN, as well as to describe the initial experience and verify the effectiveness when ASIN was used for the management for TPF. A cohort of 19 cases with closed TPF aged from 18-70 years with at least 23 months follow-up from November 2008 to September 2013 was analyzed retrospectively. All patients underwent the ASIN procedure, which was performed by the same group of surgeons. Perioperative and postoperative parameters like the measurement of radiographic pictures, surgical data, and clinical function were recorded including the changes in treatment. A modified Hohl-Luck radiological and functional score combined with the Hospital for Special Surgery (HSS) score were applied to evaluate the final results and to provide reliable data through the whole procedure when applying the ASIN procedure. The patients were followed up regularly for an average of 26.3 (range, 23-34) months. All patients achieved a bony union at an average of 15.1 weeks with no incidences of malunion, nonunion, or infection. Anatomical reduction of the articular surface was obtained in 16 patients. No secondary failure of fixation occurred. The mean postoperative knee flexion was 122.9°. The modified Hohl-Luck radiological and functional score was excellent and good, respectively, in 16 patients. The mean HSS score was 89.4. The angle stable interlocking intramedullary nail system turned out to be a viable alternative protocol in the treatment of tibia plateau fractures and provided satisfactory results, with good fracture reduction, biomechanical fixation, low rates of complications, and passable postoperative knee function.

Open reduction and internal fixation in a one-stage anterior cruciate ligament reconstruction surgery for the treatment of tibial plateau fractures: A case report and literature review

Treatment of tibial plateau fractures associated with anterior cruciate ligament (ACL) injuries can be challenging. Maintaining the joint surface and axis are two main principles for the management of patients with tibial plateau fractures. Herein, we describe a patient with tibial plateau fracture of Schatzker type VI associated with complete ACL rupture. Although in a two-stage reconstruction surgery for treatment of its rupture seem to be accepted by most orthopaedic surgeons in cases of ACL injuries, we treated our patient with ORIF in a one-stage ACL reconstruction surgery. At the 1-year follow-up, the patient gained full range of motion and was functioning well. We reviewed the literature on performing ORIF in a one-stage ACL reconstruction for the treatment of tibial plateau fractures, which seemed to be a reasonable management approach that supported its use for the treatment of this patient.

Effect of BMI on outcomes of surgical treatment for tibial plateau fractures: A comparative retrospective case series study

PurposeTibia plateau fracture (TPF) treatment aims at achieving a stable, aligned, mobile, painless knee and preventing post-traumatic osteoarthritis. To achieve this goal, surgeons consider criteria such as patients' characteristics, severity, risk of complications, fracture displacement/depression, degree of soft tissue injury. However, body mass index (BMI) is not considered as a risk factor in literature. Our study was conducted to find out any possible correlation between BMI and functional scores or radiological score separately. MethodsRetrospective analysis of case series between 2011 and 2014 was done on the database of a tertiary hospital in Istanbul. There were 67 TPF patients (54 males, 13 females) in the study. Relationship between BMI and functional knee scores or radiological score was compared statistically. Closed fractures with both high-energy and low-energy injury were included in the study. Patients with open fracture, multi-trauma presence, meniscus and/or ligamentous injury, increased co-morbidity, inadequate records (25 cases in all) were excluded. Surgery type, Schatzker classification, injury side, trauma energy, and gender were considered as possible risk factors. Binary regression analysis was done for possible factors affecting functional knee scores and radiologic score. ResultsModel summary calculations were done as Nagelkerke R2 test for Knee Society score, Lysholm knee score, and Ahlback and Rydberg radiologic scores, which were 0.648, 0.831, and 0.327 respectively. Homer–Lemeshow test values were 0.976, 0.998, and 0.362, respectively. There is negative correlation between BMI and both knee function scores. There is no correlation between BMI and radiologic score. ConclusionAn increase in BMI has a negative effect on functional knee scores after surgical treatment of TPFs. Therefore, BMI should be considered as a risk factor for surgical treatment of TPFs.

Função e qualidade de vida de pacientes com fratura do planalto tibial operados com placa bloqueada ou convencional: estudo comparativo

ObjectiveTo compare clinical, functional, and quality of life outcomes between patients with tibial plateau fractures operated with locked or conventional plates, and to compare costs between those implants. MethodsComparative cross‐sectional study of a consecutive series of patients with tibial plateau fractures treated surgically from August 2015 to June 2016. Patients under 18 years, those unable to answer the questionnaires or to attend the outpatient reassessment, polytrauma patients, those with associated injuries on the ipsilateral limb, and patients who had not undergone treatment with bone plates were excluded. This study compared the costs of implants for the hospital, quality of life (SF‐12), Lysholm score, pain scale, and clinical and radiological parameters. ResultsForty‐five patients with tibial plateau fractures were admitted and 11 cases were excluded. Two cases were lost to follow‐up, thus 32 remained for the analysis (94%). Mean follow‐up time was 15.1 months (SD=4.8 months). In group A (locked plates), there were 22 patients (69%), at an average hospital cost of the implants of BRL 4,125.39/patient (SD=1,634.79/patient). In group B (conventional plates) there were ten patients (31%), at an average cost of BRL 438.53 (SD=161.8/patient) (p<0.00001). For the other parameters, no differences were observed, except for a greater articular depression in group A (2.7mm±3.3mm vs. 0.5mm±1.6mm, p=0.02; TE=0.90). ConclusionThe costs of locked implants for the treatment of tibial plateau fractures are significantly higher than conventional implants, without any clinical, quality of life, radiological, or functional advantages demostrated in this series.

Evaluation of operative results of displaced tibial plateau fractures

Objective The aim of this study was to evaluate knee function in patients with displaced tibial plateau fractures treated with open reduction internal fixation and minimally invasive percutaneous plate osteosynthesis techniques. Background Proximal tibial fracture is a common injury; these fractures represent surgical challenge because of the variety of fracture patterns and the associated soft tissue injuries. If not adequately treated, these fractures often cause persistent knee pain, arthritis, stiffness, and angular deformity. Patients and methods This prospective study was conducted on 30 tibial plateau fractures in 30 patients who were functionally and radiologically evaluated according to the knee scoring system. The cases were managed with open reduction and internal fixation with plate and screws and using minimally invasive percutaneous plate osteosynthesis. The entire limb (except the foot) and the ipsilateral iliac crest were prepped and draped into the surgical field under complete aseptic technique. Results In this study, the majority of fractures occurred between the ages of 26 and 44 years with a mean ± SD of 37.6 ± 4.7 years, and the majority of fractures were found to be of type V (23.3%) and type VI (23.3%) according to the Schatzeker classification. In this study, we had 27 (90%) patients with no complications and three (10%) patients with infection who were treated with open reduction internal fixation. In this study according to Oxford and International Knee Documentation Committee knee scores, there was a highly significant difference between results after 1, 3, and 6 months. The end results were as follows: 59.3%, excellent; 37%, good; and 3.7%, fair. Conclusion Tibial plateau fractures occur due to high-energy trauma. The minimally invasive plate osteosynthesis technique is a good method for the treatment of tibial plateau fractures and it results in good clinical and functional outcome. The functional results of this fracture improve with time, reaching the maximum by 6 months. Despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage and meniscal injury.

Minimally invasive treatment of tibial plateau fracture guided by knee arthroscopy

Objective To analyze the effect of minimally invasive treatment of tibial plateau fractures guided by knee arthroscopy. Methods Eighty patients with tibial plateau fractures underwent minimally invasive surgery under the guidance of knee arthroscopy were selected, and they were divided into control group and observation group according to the order of visits, 40 cases in each group.The patients received traditional open surgery + internal fixation surgery or knee arthroplasty under the guidance of minimally invasive surgery.The treatment effect was analyzed in the two groups. Results The duration of operation, time of getting out of bed, amount of blood flow during surgery, postoperative fracture volume and the incidence of complications in the observation group were significantly better than those in the control group (t=2.360, 3.141, 4.106, 3.232, 7.439, all P<0.05). The excellent rate of improvement of joint function and the score of quality of life in the observation group were significantly higher than those in the control group (all P<0.05). Conclusion The minimally invasive treatment of tibial plateau fractures guided by knee arthroscopy is better, the safety is higher and the postoperative recovery is good. Key words: Tibial fractures; Knee joint; Surgical procedures, minimally invasive

Joint awareness in posttraumatic osteoarthritis of the knee: validation of the forgotten joint score in long term condition after tibial plateau fracture

BackgroundEvaluating patient-reported outcomes (PRO) in early osteoarthritis (OA) of the knee is difficult. Established measurement tools are focused on one of the two major patient groups in knee surgery: young, highly active patients, or older patients with advanced degenerative OA of the knee. Joint awareness in everyday life is a crucial criterion in measuring PRO. The purpose of this study was to validate a German version of the “Forgotten Joint Score” (FJS) in patients after surgical treatment of tibial plateau fractures.MethodsIn this prospective cohort study, clinical and radiological outcomes data were collected from patients after surgical treatment of tibial plateau fractures following a skiing accident. Functional outcome questionnaires were administered including the FJS, the Lysholm-Score, the Tegner-Activity Scale (TAS), the EuroQol-5D (EQ 5-D), and a subjective rating of change. The validation study was carried out according to the COSMIN checklist protocol. The KLS was used to measure the presence and severity of OA on knee radiographs, and correlation with the FJS was measured.ResultsCronbach‘s alpha was .96 (95%-CI .92, .99) confirming good internal consistency. Test-retest reliability of the FJS was high with an ICC(67) = .91 (95%-CI .85,.95). Furthermore, no relevant floor or ceiling effects were observed. FJS significantly differed in patients with different OA degrees (p = .041). Symptomatic patients had significant lower FJS than asymptomatic patients (p < .001).ConclusionsThis is the first study validating a disease-specific PRO, the FJS, in long-term outcomes after joint fracture. We demonstrated good psychometric properties and a significant correlation between the FJS and the radiologic degree of OA in patients with a history of tibial plateau fracture.Trial registrationClinical Trial Registry University of Regensburg Z-2015-0872-2. Registered 01. October 2015.

Long-term radiographic appearance of calcium-phosphate synthetic bone grafts after surgical treatment of tibial plateau fractures

ObjectivesSynthetic bone grafts (SBGs) are widely used to fill bone defects after fracture reduction. This study assessed the long-term resorption of two different calcium phosphate products (A=ChronOS™ inject and B=Norian® SRS®; both DePuy Synthes, Oberdorf, Switzerland) used in the surgical treatment of tibial plateau fractures. DesignLong-term clinical and radiologic follow-up of 52 patients after surgical treatment of intraarticular tibial plateau fractures augmented with SBGs. SettingThe study was performed at a level 3 trauma center. PatientsBetween January 2000 and December 2006 a total of 52 patients with intraarticular tibial plateau fractures were operatively treated and augmented with SBGs consisting of a Brushite matix with β-TCP granules (SBG A) or hydroxylapatite with 4–6% carbonate content (SBG B). 46 patients could be contacted and 38 were included in the study. Half of the patients received SBG A and the other half SBG B. Main outcome measurementsLoss of reduction and SBG resorption was investigated by comparison of follow-up X-ray images to pre- and postoperative X-ray images. Furthermore, pain, activity level and knee function were evaluated by means of questionnaires and clinical examination. ResultsThe mean age of patients was 59.7±12.5years. The follow-up was 8.6±0.9years for SBG A and 11.6±1.4years for SBG B (p<0.001). In most cases SBG A was completely resorbed in a homogenous pattern, while SBG B was still visible on the X-ray images revealing a peripheral resorption pattern. A loss of reduction (>2mm) could be observed in two patients with SBG A and two patients with SBG B, although only one of them had an impaired knee function. ConclusionsThe composite SBG A reveals a comprehensive long-term resorption in comparison to SBG B. Nevertheless, both provided suitable mechanical support as part of the surgical treatment of tibial plateau fractures. Level of evidenceCase series, Level IV.

A finite element analysis of fractures of extended tibial plateau

Objective To analyze the stress distributions under static loading and impact simulation in the process of tibial plateau fracture using finite element analysis, providing evidence for individualized diagnosis and treatment of tibial plateau fracture. Methods A healthy male volunteer was recruited. A 3D finite element model of a whole knee joint with ligaments, menisci and articular surfaces was generated using CT, MRI and 3D finite element software. The knee joint model was given the nature and parameters after reconstruction. According to the features of tibial plateau fracture, different operating conditions were designed. The stress distributions under static loading and impact simulation in the process of tibial plateau fracture were characterized by finite element analysis. Results Under static loads on the lateral condyle of the tibia, the stress was mainly concentrated on the front edge of the tibial plateau, especially the lateral stress. The stress on the medial condyle of the tibia was significantly increased, and the medial stress extended downwards to the tibial shaft. When the vertical stress moved towards outside, it extended from both sides of the internal and external condyles downwards to the tibia, and the value of lateral platform stress was slightly larger than that on the inside. In collisions, the stresses distributed on the neutral position were the same with the static loads. The stress on the medial condyle of the tibia was significantly increased, extending downwards the tibial shaft when it fell to the inside slope. When it fell to the outside slope, the stress on the tibial plateau was mainly distributed on most of the front edges of lateral and medial platforms, and the stress distributed on the fibula increased obviously. Conclusions The medial tibial plateau plays a major role in bearing stress loads. The stress is more concentrated on the lateral platform but distributed on a larger area of the medial platform, extending downwards the metaphysis. Therefore, small split fractures are likely to occur on the outer edge of the platform while fractures of a large fragment are likely to occur on the medial platform, even involving the metaphysis. Key words: Knee joint; Tibial fractures; Finite element analysis; Static load; Collision

Internal fixation for tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury

Objective To report the operative procedures and clinical outcomes of open reduction and internal fixation for the treatment of tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury. Methods From December 2013 to December 2015, 11 patients with tibial plateau fracture involving anteromedial margin caused by hyperextension varus injury were treated at our department. They were 6 males and 5 females with a mean age of 42.3 years (range, from 19 to 65 years). Simple medial column fracture happened in 2, fractures of medial and lateral columns in 4, fractures of medial and posterior columns in 3, and 3-column fractures in 2 cases. The cortical bone fractures of anteromedial margin were fixated by open reduction and internal fixation using self-clipped joint line plating. Bone grafting was conducted if necessary. Results The 9 patients were followed up for an average of 17.6 months (range, from 12 to 30 months). All the fractures healed. The average time for radiographic bony union and full weight bearing was 11.4 weeks (range, from 9 to 14 weeks) and 16.1 weeks (range, from 14 to 19 weeks), respectively. On average, the Rasmussen’s radiological grading scored 16.9 (range, from 14 to 18) immediately after operation; the Hospital for Special Surgery scores of all the patients at 12 months postoperatively averaged 89.1 (range, from 75 to 94), yielding an excellent to good rate of 92.3%. The average range of motion of the affected knee was from 2.3° to 125.1°. There were significant differences in both tibial plateau angle and posterior slope angle on radiography between preoperation and postoperation (P 0.05). Partial incision necrosis occurred postoperatively in one case which was uneventfully healed after wound management. One case complicated with preoperative common peroneal nerve injury reported dorsal sense of numbness which was healed after administration of neurotrophic drugs. No screw loosening, plate breakage or fixation failure was found during follow-ups. Conclusions It is difficult to treat the tibial plateau fractures involving anteromedial margin caused by hyperextension varus injury. Internal fixation with joint line plating is an appropriate treatment for this fracture pattern, leading to satisfactory clinical outcomes. Key words: Tibial fractures; Fracture fixation, internal; Bone plates; Hyperextension; Varus

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

Surgical outcome of tibial plateau fracture using minimally invasive technique with locking compression plate

Introduction: The following study was conducted to examine the short term clinical and radiological results particularly early complications and healing rate of tibial plateau fractures treated with LCP by minimally invasive technique. Methodology: The study was conducted in patients treated for tibial plateau fractures (type 1 to 4 Schatzker classification) at Adhichunchangiri Institute of Medical Science, BG Nagar from the month of May 2011 to May 2016. Fifty tibial plateau fracture patients were taken into the study, all were fixed with LCP using minimally invasive technique. Patients’ age ranged from 20 to 70 years with a mean of 45. Results: The sample consisted of twenty patients with 38 males and 12 were females. The patients’ ages ranged from 20-70 years with a mean age of 45 years. The causes of fractures were motorvehicle accident in 36 patients and fall in 14 patients. There were no sports or industrial accidents. 31 fractures involved the right side and 19 involved the left. The average length of hospitalisation was 12 days with a range of 7 to 20 days. The average number of days from injury to surgery was 5 days with a range of 2 to 10 days. The operative time ranged from 45 minutes to 100 minutes. Patients were followed up from 01 to 24 months. Functional outcome was rated as per NEER’S RATING SCORE, we got excellent results in 24 cases, good in 15, fair in 08 and poor in 03 patients. Conclusion: Treatment of tibial plateau fractures using LCP provides good results. Since we have used minimally invasive technique soft tissue damage is minimal thus promoting good healing of fracture and less infection rates. Our early results were encouraging but long term studies are needed to prove definitively acceptable outcomes so that the technique can become part of the in the armamentarium of the orthopaedic trauma surgeon.

External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation.

The aim of this study was to evaluate the clinical efficacy of external fixation, delayed open reduction, and internal fixation in treating tibial plateau fracture with dislocation.Clinical data of 34 patients diagnosed with tibial plateau fracture complicated with dislocation between January 2009 and May 2015 were retrospectively analyzed. Fifteen patients in group A underwent early calcaneus traction combined with open reduction and internal fixation and 19 in group B received early external fixation combined with delayed open reduction and internal fixation. Operation time, postoperative complication, bone healing time, knee joint range of motion, initial weight-bearing time, Rasmussen tibial plateau score, and knee function score (HSS) were statistically compared between 2 groups.The mean follow-up time was 18.6 months (range: 5–24 months). The mean operation time in group A was 96 minutes, significantly longer than 71 minutes in group B (P < .05). In group A, 5 cases had postoperative complications and 1 in group B (P < .05). The mean bone healing time in group A was 6.9 months (range: 5–9 months) and 6.0 months (range: 5–8 months) in group B (P > .05). In group A, initial weight-bearing time in group A was (14.0 ± 3.6) weeks, significantly differing from (12.9 ± 2.8) weeks in group B (P < 0.05). In group A, the mean knee joint range of motion was 122° (range: 95°–150°) and 135° (range: 100°–160°) in group B (P > 0.05). Rasmussen tibial plateau score in group A was slightly lower than that in group B (P > .05). The excellent rate of knee joint function in group A was 80% and 84.21% in group B (P > .05).External fixation combined with delayed open reduction and internal fixation is a safer and more efficacious therapy of tibial plateau fracture complicated with dislocation compared with early calcaneus traction and open reduction and internal fixation.