Treatment Of Tibial Plateau Fractures Research Articles

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.

Race and Ethnicity Have a Mixed Effect on the Treatment of Tibial Plateau Fractures

To determine whether racial or economic disparities are associated with short-term complications and outcomes in tibial plateau fracture care. Retrospective cohort study. All New York State hospital admissions from 2000 to 2014, as recorded by the New York Statewide Planning and Research Cooperative System database. Thirteen thousand five hundred eighteen inpatients with isolated tibial plateau fractures (OTA/AO 44), stratified in 4 groups: white, African American, Hispanic, and other. Closed treatment and operative fixation of the tibial plateau. Hospital length of stay (LOS, days), in-hospital complications/mortality, estimated total costs, and 30-day readmission. There were no significant differences regarding in-hospital mortality, infection, deep vein thrombosis/pulmonary embolism, or wound complications between races, even when controlling for income. There was a higher rate of nonoperatively treated fractures in the racial minority populations. Minority patients had on average 2 days longer LOS compared with whites (P < 0.001), costing on average $4000 more per hospitalization (P < 0.001). Multivariate logistic regression found that neither race nor estimated median family income were independent risk factors for readmission. Although nature of initial injury, use of external fixator, comorbidity burden, age, insurance type, and LOS were independent risk factors for readmission, race and estimated median family income were not. In patients who sustained a tibial plateau fracture, race and ethnicity seemed to affect treatment choice, but once treated racial minority groups did not demonstrate worse short-term complications, including increased mortality and postoperative readmission rates. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Corrective Intra-articular Osteotomies for Tibial Plateau Malunion.

AbstractAnatomical reduction of the articular surface, restoration of mechanical axis, and containment of articular rim are the goals of the treatment of tibial plateau fractures, with an ultimate aim to restore joint congruity and stability. Tibial plateau malunions or nonunions are a result of a failed treatment. This article aims to review the most typical failure models and some strategies to overcome them by using joint preservation surgical techniques.

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

A study to evaluate the pattern and types of treatment of tibial plateau fracture at BPKIHS Dharan

Background: Tibial plateau fractures occur due to a combination of axial loading and varus/valgus forces leading to articular cartilage damage, mal-alignment and secondary osteoarthritis and functional loss.Objective: To know pattern and types of treatment of tibial plateau fractures and effect of fracture pattern on functional outcome. Method: We conducted prospective study over a period of one year. Fifty-three patients with tibial plateau fractures were presented during that period. Eighteen patients were excluded due to significant polytrauma and major limb injuries. Four patients did not give consent for the study. Thirty-one patients meeting the criteria were enrolled in the study. Two patients were lost during follow up. Remaining patients were evaluated at the end of one year. Data were recorded and analyzed using appropriate statistical methods.Result: Among 29 patients, 21 were male. Mean age was 35.07±11.96 years. 55.2% had RTA followed by 31 percent fall injury. 65% were treated with open reduction and internal fixation with plating followed by AK pop cast, cannulated cancellous screw and ilizarov fixation. Bone grafting was done in 3 cases. Twenty-five patients had excellent, two had good, two had fair and no patients had poor result. Three patients (10%) had complications. One had common peroneal nerve palsy, two had wound infections and no patient demonstrated early arthritic changes.Conclusion: Tibial plateau fractures treated with different modalities at our institute has been associated with excellent and good functional outcome at the end of short term follow up.Health Renaissance 2015;13 (3): 65-72

Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study

BackgroundThe aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome.MethodsAll consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome.ResultsThe charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (<45 years), male sex, higher Schatzker grade (IV-V-VI), higher tibial widening ratio (≥1.05) and higher femoral displacement ratio (≥0.08) were significantly associated in the analysis adjusted for age and sex.ConclusionsTwo parameters related to the occurrence of ACS in tibial plateau fractures were highlighted in this study: the presence of a non-contiguous tibia fracture or knee dislocation, and higher AO/OTA classification. They may be especially useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients), and should rise the suspicion level of the treating surgeon. In these cases, regular clinical examinations and/or intra-compartmental pressure measurements should be performed before and after surgery, even if acute compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and refine both factors in predicting the occurrence of acute compartment syndrome.

Complications and unplanned outcomes following operative treatment of tibial plateau fractures

IntroductionThe operative management of tibial plateau fractures is challenging and post-operative complications do occur. The purpose of this study was three-fold. 1). To report complications and unplanned outcomes in patients who had sustained tibial plateau fractures and were operatively managed 2). To report predictors of these post-operative events 3). To report if differences in clinical outcomes exist in patients who sustained a post-operative event. MethodsOver 11 years, all tibial plateau fractures were prospectively followed. Clinical outcomes were assessed using the validated Short Musculoskeletal Functional Assessment (SMFA) score. Demographics, initial injury characteristics, surgical details and post-operative events were prospectively recorded. Student’s t-tests were used for continuous variables and chi-squared analysis was used for categorical variables. Binary logistic regression and multivariate linear regression were conducted for independent predictors of post-operative events and complications and functional outcomes, respectively. Results275 patients with 279 tibial plateau fractures were included in our analysis. Ten patients (3.6%) sustained a deep infection. Six patients (2.2%) developed a superficial infection. One patient (0.4%) presented with early implant failure. Two patients (0.7%) developed a fracture nonunion. Eight patients (2.9%) developed a venous thromboembolism. Seventeen patients (6.2%) went on to re-operation for symptomatic implant removal. Nine patients (3.3%) underwent a lysis of adhesions procedure. Univariate analysis demonstrated bicondylar tibial plateau fractures (P<0.001), Moore fracture-dislocations (P=0.005), open fractures (P=0.022), and compartment syndrome (P=0.001) to be associated with post-operative complications and unplanned outcomes. Long-term functional outcomes were worse among patients who developed a post-operative complication or unplanned outcome (P=0.031). ConclusionOrthopaedic trauma surgeons should be aware of complications and unplanned outcomes following operatively managed tibial plateau fractures, along with having the knowledge of factors that are associated with development of post-operative events.

Study of results of “operative management of intra-articular fractures of upper end tibia”

Intra- Articular Fracture of upper end of Tibia occurring with increased frequency because of high velocity injuries as a result of growth of no. of vehicles & increased speed on expressways. Management of such high velocity trauma to joint is still a challenge to Orthopaedic surgeons. This study carried out to analyze various Operative methods of treatment of tibial plateau fractures. This is a prospective study of 22 cases of Tibial Plateau fractures treated operatively. Patients were followed from 6 months to 2 years. All fractures were classified with Schatzgar classification and treated with various operative methods like close reduction & percutaneous fixation, Open reduction & Internal Fixation (ORIF) or Minimally Invasive Plate Osteosynthesis (MIPO). All patients were assessed with Lansinger Criteria. Results suggests of operative treatment in displaced fractures of Tibial Plateau. Aim is Anatomical reduction, stable fixation & soft tissue preservation. MIPO technique is favored in fractures where closed reduction method achieves near anatomical reduction of fracture fragments. Open reduction is preferred in displaced and depressed Tibia Plateau fractures.

Treatment of complex tibial plateau fractures with improved three combined approaches

Objective To evaluate the outcomes of open reduction and internal fixation of complex tibial plateau frac-tures with improved three combined approaches. Methods In the period from July 2014 to February 2016, 7 complex tibial pla-teau fractures underwent surgical treatment. These patients included 5 male and 2 female, aged from 24 to 68 years old (average, 39.7±15.3 years). According to Schatzker classification, they were all of type V. And all of type 41B-3.1 by AO/OTA classification. All these fractures were exposed and reduction via three combined approaches. First let the patients lied in lateral prone position, expose the anterolateral and the posterolateral of the tibial plateau, and fix the fractures of the posterior in the posterolateral ap-proach, then fix the fractures of the lateral in the anterolateral approach. Then turn the patients to supine position, fix the fractures of the medial in the anteromedial incision. All patients received regular reexamination. The knee function was evaluated at the fi-nal follow-up using The Hospital for Special Surgery (HSS) score, the activity of the knee was evaluated by Lysholm score, and the stability of the knee was checked by Lachmantest and Pivot-shift test. The tibial plateau angle, the posterior slope angle and Ras-mussen X-ray score were assessed on the X-ray films. Results The average time of operation is (3.3±0.9) h, and the hemorrhage volume in operation was (341±106) ml for the 7 patients. The wounds of 6 patients healed by (11.8±1.3) days, while the wound of the rest one of them occurred fat liquefaction after operation who is very fat (BMI>30) and suffered from diabetes. His wound healed by 21 days. These patients obtained follow-ups of 8 to 14 months (average, 11.4±2.8 months). The average full weight-bear-ing time was 2-3 months (average, 2.5±0.4 months). The fractures healed after 8 to 16 weeks (average, 11.1±2.8 weeks). No dis-placement of the fractures or breakage of the implants occurred in our series. Nobody has activity limitation of the knee or pain be-cause of the implant, and no never symptoms were noted postoperatively, so we would not take out the implant for these patients. The mean HSS score was 93.1±4.8 (range, from 85 to 100) at the final follow-up, and the excellent rate is 100%. The Lysholm score was 97.1±3.6 (range, from 90 to 100) at the final follow-up. The Lachman test and the Pivot-shift test were negative in our pa-tients, and the mean knee flexion was 128.6±12.8°(range, from 105°to 140°). The fractures were all anatomical reduction by the X-ray after operation, and there had being no displacement of the fractures or breakage of the implants occurred during the follow-up period. The mean posterior slope angle was 8.29±2.87° (range, from 4 °to 12°), which was 8.71±2.63° (range, from 5 °to 14°) 6 months after operation. The mean tibial plateau angle was 86.00±1.41° (range, from 84 °to 88°), which was 86.43±1.62° (range, from 84 °to 89°) 6 months after operation. The mean Rasmussen X-ray score was 16.86±1.57 (range, from 14 to 18), which was 16.57±1.51 (range, from 14 to 18) 6 months after operation, and the excellent rate are 100%. Conclusion For the complex tibial plateau fractures which simultaneous involved the medial, the lateral and the posterior, the improved three combined approaches showed the advantages of the convenient operation, the satisfactory results of reduction and fixation, and the less trauma and sec-ondary damage, and could be worth for clinic. Key words: Tibial fractures; Knee joint; Fracture fixation, internal

Is the AO guideline for postoperative treatment of tibial plateau fractures still decisive? A survey among orthopaedic surgeons and trauma surgeons in the Netherlands

IntroductionThe standard aftercare treatment (according to the AO guideline) for surgically treated trauma patients with fractures of the tibial plateau is non-weight bearing or partial weight bearing for 10–12 weeks. The purpose of this study was to investigate the current state of practice among orthopaedic surgeons and trauma surgeons in choosing the criteria and the time period of restricted weight bearing after surgically treated tibial plateau fractures.Materials and methodsA web-based survey was distributed among members of the Dutch Trauma Society and Dutch Orthopaedic Society to identify the most commonly applied protocols in terms of the post-operative initiation and level of weight bearing in patients with tibial plateau fractures.ResultsOne hundred and eleven surgeons responded to the survey. 72.1% of the respondents recommended starting weight bearing earlier than the 12 weeks recommended by the AO guideline; 11.7% recommended starting weight bearing immediately, 4.5% after 2 weeks and 55.9% after 6 weeks. Moreover, 88.7% of the respondents reported deviating from their own local protocol. There is little consensus about the definition of 100% weight bearing and how to build up weight bearing over time.ConclusionThis study demonstrates that consensus about the weight bearing aftercare for tibial plateau fractures are limited. A large majority of surgeons do not follow the AO guideline or their own local protocol. More transparent criteria and predictors are needed to design optimal weight-bearing regimes for the aftercare of tibial plateau fractures.

Treatment of lateral tibial plateau fractures involving posterolateral condyle with double plate fixation via combined anterolateral and posterolateral approaches

Objective To evaluate the treatment of lateral tibial plateau fractures involving the posterolateral condyle with double plate fixation via the combined anterolateral and posterolateral approaches. Methods From January 2013 to August 2015, 12 patients with lateral tibial plateau fracture involving the posterolateral condyle were treated by double plate fixation via the combined anterolateral and posterolateral approaches. They were 8 males and 4 females, with an average age of 36.9 years (range, from 23 to 58 years). According to the Schatzker classification, we had 8 ones of type Ⅱ, 3 ones of type Ⅴ and one of type Ⅵ. Firstly, the posterolateral condylar fractures were stabilized temporarily by the Kirschner wire after reduction through the posterolateral approach. Secondly, the lateral tibial plateau fractures were dealt with via the anterolateral approach, and fixated with a proximal tibial locking plate. Finally, a T-shaped plate for the distal radius was used to support the posterolateral condyle. The clinical and radiographic results were evaluated using the Hospital for Special Surgery (HSS) knee score and the Rasmussen Score, respectively. Results The average operative time was 143.3 min (range, from 110 to 210 min); the average intraoperative blood loss was 190.0 mL (range, from 100 to 300 mL). The follow-ups for the 12 cases ranged from 12 to 24 months (average, 16.6 months). All the cases obtained clinical healing after 12 to 24 weeks (average, 16 weeks). At the last follow-up, the HSS knee-scores ranged from 65 to 98 points (average, 84.6 points), giving 7 excellent cases, 3 good ones and 2 fair ones. The Rasmussen radiological scores ranged from 13 to 18 points (average, 17.1 points), giving 8 excellent and 4 good cases. Conclusions The combined anterolateral and posterolateral approaches can offer excellent exposure for articular reduction and fixation with double plates, achieving satis-factory radiological and functional results in lateral tibial plateau fractures involving the posterolateral condyle. First reduction of the posterior lateral condylar fractures, followed by reduction and fixation of the anterolateral plateau fractures and finally fixation of the lateral condylar fractures, can lead to effectively improved knee function for the patients. Key words: Tibial fractures; Fracture fixation, internal; Bone plates

Evaluation of functional and radiological outcome of tibial plateau fractures Schatzker type V and VI treated with dual plating

Objective: High-energy tibial plateau fractures remains a challenge to orthopaedics surgeons, with the bicondylar type (Schatzker type V) and the comminuted type (Schatzker type VI) fractures being the most difficult to treat. Treatment goals of high-energy tibial plateau fractures are to restore the joint stability, congruity, and alignment with minimal soft tissue dissection to allow early joint motion and weight bearing. However, these aims may be difficult to achieve because of the high complication rates and the poor outcomes associated with the surgical treatment in literature, there are multiple modalities of treatment for tibial plateau fractures and the literature has not definitively established a standard for the type of fixation. But there has been a growing support and evidence that dual plating is required in high energy bicondylar tibial plateau fractures. In this study, we evaluated functional and radiological outcomes of 30 patients with high-energy tibial plateau fractures (Schatzker type V and type VI) treated with the double-buttress plate fixation through a medial and a lateral incisions using Rasmussen’s functional & anatomical grading system. Material and mathods: 30 patients (26 males and 4 females) with type V and VI Schatzker tibial plateau fractures (10 case were type V and 20 case were type VI) were treated by double-buttress plate fixation through a medial and a lateral incisions between august 2013 to august 2016 at deen dayal upadhyay hospital, New Delhi. Functional and radiological outcomes evaluated by using Rasmussen’s functional & anatomical grading system. Results: according to Rasmussen’s functional & anatomical grading system results were as follows; functional outcome were excellent in 10 patients(33.33%),good-18 patients (60%), fair-2 patients (6.7%) with mean score 25.17±2.95 and radiological outcome excellent in 19 patients(63.33%),good-11 patients (36.67%) with mean score of 16.80±1.79 Conclusion: double-buttress plate fixation through a medial and a lateral incisions is an excellent treatment option as it provides stable and rigid fixation and restore the joint stability, congruity, and alignment with minimal soft tissue dissection to allow early joint motion and weight bearing stable. These fractures are commonly associated with posteromedial fragment and fixation of fractured fregment during treatment of these fractures has a major role to play to resist rotational forces and prevention of varus deformity and malunion.

Arthroscopic Technique for Treatment of Schatzker Type III Tibia Plateau Fractures Without Fluoroscopy

Accurate reduction and maintenance of the stability with correct implant positioning is critical for surgical treatment of tibial plateau fractures. Our technique includes an arthroscopic reduction and fixation of Schatzker type III tibial plateau fractures with a bulls-eye screw placement without fluoroscopy control. With the arthroscopic guidance, an anterior cruciate ligament drill guide is placed and a K-wire sent to the midpoint of the depressed fragment through the guide at a 40° angle to the coronal axis of the tibia. A tunnel is created with the drill over the K-wire. The depressed fragment is further augmented with gentle impacts over the K-wire. After arthroscopic reduction control, an appropriate-sized iliac graft is pushed until it is below the depressed fragment. The targeting device is adjusted at 130° so that it is parallel to the joint line and a K-wire sent through the device so that it would pass just below the graft. The graft is then supported with cannulated screws sent over the K-wire. This technique provides an arthroscopic reduction of the chondral surface and precise placement of the rafting screws without fluoroscopy.

Tibioplasty, a new technique in the management of tibial plateau fracture: A multicentric experience review

IntroductionThe traditional methods in displaced tibial plateau fractures use metallic instrumentation. “Balloon-tibioplasty” is a novel minimally invasive technique. PurposeUse of the balloon-tibioplasty show an improvement of the reduction compared to traditional methods. Patients and methodsWe enrolled 28 patients who presented with a depression fracture of external tibial plateau divided into two treatment groups: balloon-tibioplasty (group I) and “traditional” reduction technique (group II). ResultsBalloon-tibioplasty is a minimally invasive treatment for tibial plateau fracture. DiscussionBalloon-tibioplasty appears to have several advantages over traditional reduction techniques. ConclusionBalloon-tibioplasty represents an improved and accurate modality for restoration of articular congruence.

The Effect of Trauma Severity on Clinical and Radiological Results of the Tibial Plateau Fractures Treatment

Background: Tibial plateau fractures, complex injuries, are observed following high- and low-energy traumas. The main goals of the treatment are to restore the extremity alignment and articular surface, and to obtain the early knee motion and rehabilitate the patient. We aimed to evaluate the effect of trauma severity on clinical and radiological results in the treatment of tibial plateau fractures. Methods: Of 49 patients with tibial plateau fractures, 18, 16 and 15 were treated with open reduction-internal fixation, closed reduction-internal fixation, and external fixation, respectively. A total of 53.1% of patients had low-energy fractures while 46.9% of them had high-energy type. Bone union occurred in a mean of 14.4 weeks and the patients’ extremities were allowed to bear full weight after bone union. Clinical and radiological results of the patients were evaluated according to Rasmussen criteria. Results: The knee flexion motion was 128.5o in patients with low-energy fractures, while the knee flexion motion arc in high-energy fractures was detected as 97.5o. There was a statistically significant difference between two groups in terms of knee joint movement. Despite clinical outcomes in the patients with low-energy fractures were better when compared with high-energy fracture, but no statistical significance was detected. Radiological results in the patients with low-energy fractures were statistically significant better when compared with high-energy fractures. Conclusion: Our study results suggest that the type of fracture and severity of trauma in surgical treatment of tibial plateau fractures are the main factors which affect functional and radiological results.

Discussion on the classification and treatment strategies of the lateral condylar tibial plateau fractures

Objective To discuss on the ABC classification of the lateral condylar tibial plateau fractures, and to evaluate its clinical application. Methods From March 2013 to June 2015, 87 patients with lateral condylar tibial plateau fracture were treated in our hospital, including 49 males and 34 females with the mean age of 49.1 years (range, 25-76). A new classification system of the lateral condylar tibial plateau fracture, ABC Classification, was used for all the 83 patients. There were 51 patients for type B, 6 for type C, 9 for type AB, 13 for type BC, 4 for type ABC. Surgery approach and fixation method depended on the type of fracture. Anterior-lateral approach and anterolateral locking plate fixation were used to treat type B and AB, and additional marginal plate were used in type AB. Carlson approach and T-buttress plate fixation were used to treat type C. Frosch approach was used to treat type BC and ABC. The radiographic and clinical results were evaluated by using Rasmussen's radiological and HSS grading at 12 months postoperatively respectively. Results 83 patients underwent surgeries successfully, with average time of 121 mins (range, 90-160 mins). With a follow-up rate of 83.1%, 69 patients were followed up for 12-24 months, the mean follow-up time was 14.6 months. There was no significant difference in fracture healing time of different types. The average time for fracture union were 13.5 weeks (range, 12-16 weeks). The mean score of the Rasmussen's radiological grading was 16.9 (range, 13-18). All the results according to HSS grading are excellent and the mean score of the HSS grading was 94.1 (from 82-98). Conclusion CT-based ABC Classification is worthy of popularization and application in clinics, and it is more reliable and instructive in the treatment of lateral condylar tibial plateau fractures. Key words: Tibia fractures; Fracture fixation, internal; Diagnosis

Therapeutical Management of the Tibial Plateau Fractures

Abstract The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome and complications. Demographic data for the patients and details of current clinical and radiological follow-up findings were obtained to assess range of motion, clinical stability, alignment of the knee, and posttraumatic arthrosis (Kellgren/Lawrence score). 64 cases of tibial plateau fractures treated by different surgical methods and variuos implants type were studied from 2013 to 2015 and followed-up for minimum period of 6 months. The systematisation of the casuitry was made using Schatzker and AO classifications. The treatment methods consist of: percutaneous cannulated cancellous screws, ORIF with buttress plate with or without bone grafting, locking or nonlocking plates, external fixator. As complications we found: redepression 4 case, malunion 2 cases, knee stiffness 9, wound dehiscence in 1 cases and non-union or infection in none of our cases. The average flexion of the injured knee was significantly lower in comparison with the contralateral side (124.9°/135.2°). Knee stability did not differ statistically significantly. There were no signs of posttraumatic arthrosis in 45% of cases, mild signs in 30%, clear signs in 18%, and severe signs in 7%. As conclusion we found that surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion and reduce arthrosis risk and hence to achieve optimal knee function. The choice of optimal surgical methods, proper approach and implant is made in relation to fracture type according Schatzker and AO classification.

Treatment of tibial plateau fractures with posterolateral collapse and posteromedial spilt

Objective To explore the treatment of tibial plateau fractures with posterolateral collapse and posteromedial spilt. Methods During the period from January 2009 to January 2015, 17 tibial plateau fractures with posterolateral collapse and posteromedial spilt were surgically treated. They were 12 males and 5 females, with an average age of 32.4 years (from 21 to 52 years). Anteroposterior and lateral radiographs as well as computed tomography (CT) images were obtained in the course of preoperative radio-logical evaluation to determine the collapse and displacement. After the posteromedial bone spilt fragments were reduced and fixated via the posteromedial approach, the posterolateral collapse fragments were exposed via the fibular osteotomy approach and stabilized by lateral buttress following reduction. Hospital for Special Surgery (HSS) functional score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used at the final follow-ups to evaluate functional outcomes. Results Follow-ups with a mean duration of 18.3 months (range, from 12 to 24 months) were carried out in all the patients. All fractures healed within an average of 13.2 weeks (range, from 12 to 16 weeks). The HSS functional scores ranged from 60 to 100 points, averaging 89.6 points, giving 15 excellent cases, one good case and one fair case. The AOFAS functional scores ranged from 86 to 98 points, averaging 95.2 points. No loosening or breakage of the implants, or traumatic arthritis occurred in this series. Conclusion For tibial plateau fractures with posterolateral collapse and posteromedial spilt, a special type, it is an effective treatment to carry out open reduction and internal fixation of the posterolateral collapse fragments via the fibular osteotomy approach after reduction and stabilization of the posteromedial bone spilt fragments. Key words: Tibial fractures; Knee joint; Fracture fixation, internal; Osteotomy

Total solution for improving the diagnosis and treatment of tibial plateau fractures

Total solution for improving the diagnosis and treatment of tibial plateau fractures

Locking compression plate plus small locking plate with short screws through limited posteromedial approach for complex tibial plateau fractures

Objective To explore locking compression plate plus small locking plate with short screws through limited posteromedial approach for complex tibial plateau fractures. Methods We re-viewed 36 patients with complex tibial plateau fracture who had been treated from January 2010 to January 2015 and fully followed up at our department. They were 21 men and 15 women, 23 to 62 years of age (average, 42.3 years). By Schatzker classification, 21 cases were type Ⅴ and 15 type Ⅵ. The fractures were fixated by lateral locking compression plate plus small locking plate with short screws (3.5 mm) through limited posteromedial approach. The internal fixation was assessed by measuring the tibial plateau angle (TPA) and posterior slope angle (PA) on the X-ray films at immediate postoperation and 12 months after operation. At the final follow-ups, the knee flexion and extension were measured and functional recovery of the knee assessed using the Hospital for Special Surgery (HSS) score. Results The follow-up lasted from 12 to 33 months (mean, 15.8 months) in the 36 patients. No implant loosening or breakage or incision infection was observed. Fracture healing time ranged from 4.0 to 6.5 months (average, 4.6 months). No fracture failed to unite; the fracture alignment was fine without loss of reduction. The average TPA and PA at imme-diate postoperation (86.5°±1.3° and 9.5°±1.4°) were not significantly different from those at 12 months postoperation (85.8°±1.5° and 10.6°±1.2°) (P >0.05). According to the HSS scores at final follow-ups, 23 cases were rated as excellent, 8 as good, 4 as fair and one as poor, giving an excellent to good rate of 86.1%. At final follow-ups, the range of motion of the affected knee averaged 126.5° (from 95° to 140°). Conclusion Locking compression plate plus small locking plate with short screws through limited posteromedial approach is a fine treatment for complex tibial plateau fractures, resulting in reliable fixation, satisfactory functional recovery and limited complications. Key words: Tibial fractures; Knee joint; Fracture fixation, internal; Bone plates