Treatment Of Complex Tibial Fractures Research Articles

Outcomes Following Treatment of Complex Tibial Fractures with Circular External Fixation: A Comparison between the Taylor Spatial Frame and TrueLok-Hex.

ABSTRACTAimThe purpose of this study was to compare the functional and radiological outcomes of complex tibia fractures treated with two different hexapod fixators.Material and methodsThis is a retrospective comparative study of patients treated for complex tibial fractures between 2010 and 2015. Inclusion criteria was patients between 18 years and 60 years of age, who sustained a complex comminuted open or closed tibial fracture with or without bone loss, who had a minimum of 12 months’ follow-up, and who have been treated definitively using either Taylor Spatial Frame (TSF) or TrueLok-Hexapod System (TL-HEX). The outcome measures were Association for the Study and Application of the Method of Ilizarov (ASAMI) score, foot function index (FFI), EQ5-D, four-step square test (FSST), and timed up and go (TUG) test. Descriptive statistics were used to assess patient demographic information. Categorical variables (ASAMI and EQ5D-5L) were analysed using the χ2 test. Continuous variables (FFI, functional tests, and radiographic outcomes) were analysed with two-tailed Student’s t tests.ResultsIn all, 24 patients were treated with the TL-HEX and 21 with the TSF. The mean time for external fixation was 219 ± 107 days (TL-HEX) and 222 ± 98 days (TSF). Union occurred in 92% (TL-HEX) and 100% (TSF). The mean follow-up was 777 ± 278 days (TL-HEX) and 1211 ± 388 days (TSF). Using the ASAMI scores, there were 17 excellent and 6 good results for the TL-HEX and 10 excellent and 11 good results for the TSF (p = 0.33). The FFI was 30 ± 28.7 (TL-HEX) and 26.1+23.9 (TSF) (p = 0.55). The EQ5D was 0.67 ± 0.3 (TL-HEX) and 0.73 ± 0.2 (TSF) (p = 0.43). The mean TUG and FSST were 9.2 ± 3.2 and 10 ± 2.9 seconds (TL-HEX) and 8.4 ± 2.3 and 9.6 ± 3.1 seconds (TSF) (p = 0.34 and 0.69).ConclusionThe results of this study suggest that both hexapod external fixation devices have comparable clinical, functional, and radiographic outcomes. Either fixator can be used for the treatment of complex tibial fractures, anticipating good and excellent clinical outcomes in approximately 80% patients.Level of evidenceTherapeutic level IIIHow to cite this articleNaude J, Manjra M, Birkholtz FF, et al. Outcomes Following Treatment of Complex Tibial Fractures with Circular External Fixation: A Comparison between the Taylor Spatial Frame and TrueLok-Hex. Strategies Trauma Limb Reconstr 2019;14(3):142–147.

Minimally invasive plate oseosynthesis assisted by a self-designed lower limb axial tractor for treatment of complex tibial plateau fractures

Objective To investigate the clinical efficacy of minimally invasive plate oseoynthesis (MIPO) assisted by a self-designed lower limb axial tractor in the treatment of complex tibial plateau fractures. Methods The data were retrospectively analyzed of the 31 patients who had undergone surgical treatment for complex tibial plateau fractures from June 2015 to April 2018 at Department of Orthopeadics, Hospital Affiliated to Binzhou Medical College. MIPO was conducted with the assistance of the axial tractor in 17 of them. They were 12 men and 5 women with an age of 50.8±14.7 years, with 8 cases of Schatzker type Ⅴ and 9 ones of Schatzker type Ⅵ. MIPO was conducted without the assistance of the axial tractor but with the assistance of manipulation reduction in the other 14 patients. They were 9 men and 5 women with an age of 48.9±9.5 years, with 6 cases of Schatzker type Ⅴ and 8 ones of Schatzker type Ⅵ. The 2 groups were compared in terms of operation time, intraoperative bleeding, and Rasmussen scores for knee function and medial angle of the proximal tibia at the last follow-up. Results The 2 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The tractor and manipulation groups were followed up for a mean of 9.8 months and 10.9 months respectively. Bone healing was achieved in all patients. For the tractor and manipulation groups, respectively, the operation time was127.8±40.8 min and 174.1±66.8 min, and the intraoperative bleeding 115.6±41.7 mL and 184.3±91.4 mL, showing significant differences between them (P 0.05). Loss of force line was observed in none of the patients at the last follow-up. Conclusion Compared with conventional manipulation reduction, use of our self-designed lower limb axial tractor can shorten operation time, reduce bleeding and facilitate reduction of fracture fragments in the treatment of tibial plateau fractures of Schatzker types Ⅴ and Ⅵ. Key words: Knee joint; Fracture fixation, internal; Surgerical procedures, minimally invasive; Traction; Tibial plateau fracture

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

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

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

Treatment of 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

Staged treatment of complex tibial plateau fractures with temporary transarticular external fixation and delayed plate fixation

Objective To evaluate the clinical efficacy of staged treatment of complex tibial plateau fractures with temporary transarticular external fixation and delayed plate fixation. Methods Enrolled in this study were 44 cases of complex tibial plateau fracture who had been treated from January 2011 to January 2014. Temporary transarticular external fixation and delayed plate fixation was adopted in 22 patients (observation group) , involving 14 men and 8 women with an average age of 45.5±11.4 years, and 10 left sides and 12 right sides. By the Schatzker classification, 13 cases were type Ⅴ and 9 type Ⅵ. Calcaneal traction and plate fixation was adopted in the other 22 patients (control group) , involving 13 men and 9 women with an average age of 43.8±10.4 years, and 8 left sides and 14 right sides. By the Schatzker classification, 12 cases were type Ⅴ and 10 type Ⅵ. The 2 groups were evaluated by the time from hospitalization to plate fixation, operation time, intra-operative bleeding volume, hospitalization time, healing time, complications and Hospital for Special Surgery (HSS) scoring at the final follow-ups. The 2 groups were compatible with no significant differences regarding the preoperative general data (P>0.05). Results The 44 patients were followed up for 12 to 30 months (mean, 18.6 months). There were significant differences between the 2 groups in the time from hospitalization to plate fixation, operation time, intra-operative bleeding volume and hospitalization time (P 0.05). Conclusions Although both methods can treat complex tibial plateau fractures, temporary transarticular external fixation and delayed plate fixation may be preferable because it can lead to decreased hospitalization time, less intra-operative bleeding volume, fewer surgical complications and good functional recovery of the knee. Key words: External fixation; Tibial fracture; Fracture fixation, internal; Knee joint

Clinical study of combined TCM and WM in the treatment of complex tibial plateau fractures

PurposeTo analyze the effect of integrated traditional Chinese and Western medicine on complex tibial plateau fractures.MethodChoose Our Hospital2014Years2Month ~2014yearTenpatients with complex tibial plateau fractures treated in the monthAThecases were randomly divided into control group and observation group, eachexample.compares the conditions of total weight bearing time, fracture healing time, and internal fixation time of two groups of patients treated with different regimens andDifference.ResultsThe total weight-bearing time of the observation group was (8.1±0.3) Week; Fracture healing time6.0±0.5) Month; （7.1±0.5) month, both significantly shorter than the control group, the difference was statistically significant (PThe0.05）.ConclusionApplication of integrated Chinese and Western medicine in treatment of complexityThe value of Tibial plateau fracture is prominent, which can promote the postoperative recovery of patients.

Reduction and fixation via posteromedial and anterolateral approaches for complex tibial fractures associated with collapse of posterolateral articular surface

Objective To explore the treatment of complex tibial fractures associated with collapse of posterolateral articular surface (Schatzker types Ⅵ and Ⅴ) using reduction via posteromedial and antero-lateral approaches. Methods From July 2010 to September 2012, 19 patients with complex tibial frac-ture were treated and followed up by our department. They were 11 males and 8 females, with an average age of 49.5 years (range, from 30 to 65 years). Their fractures were classified as Schatzker type V in 14 cases and Schatzker type Ⅵ in 5. All fractures involved the posterolateral tibial plateau. They were all reduced via the posteromedial and anterolateral approaches. The posterolateral cortical fragments were pushed anteriorly and a curved reconstruction plate was used to maintain the reduction via the posteromedial approach. An anatomically designed plate was lastly placed on the anterolateral side of the proximal tibia to fix the lateral articular surface of the proximal tibia. The knee function was evaluated by The Hospital fou Special Surgery Score(HSS) at the last follow-ups. Results The mean operation time was 164.7 min (range, from 120 to 280 min). All fractures united clinically and radiographically after an average time of 15.2 weeks (range, from 12 to 18 weeks). No nonunion, injury to the common peroneal nerve, varus deformity, implant failure, or no deep wound infection occurred. At immediate postoperation and one year postoperation, the mean tibial plateau angle (TPA) was 87.2°±1.0° and 87.1°±1.1° , and the mean posterior slope angle (PSA) was 7.0°±1.1° and 7.0°±1.0° , respectively, showing no significant difference between the 2 time points (P>0.05). At one year postoperation, the average motion of the affected knee was 128.7° (range, from 0 to 135°). The posterolateral tibial articular malreduction (≥2 mm step-off) was seen in 2 patients. The mean HSS score at the last follow-ups was 92.6 (range, from 88 to 97). Conclusions Posterolateral fragments in complex tibial plateau fractures can be reduced and fixed via the posteromedial and anterolateral ap-proaches, and can be fixed by a posterolateral buttress plate through the posteromedial approach and by an anterolateral locking plate. This is a safe and effective treatment for posterolateral tibial plateau fractures al-ternatively. Key words: Knee joint; Froctures, bone; Fracture fixation, internal; Bone plates

The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan.

We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation.

Three kinds of internal fixations for treatment of complex tibial plateau fractures: a comparative biomechanical study

Objective To evaluate the biomechanism of three kinds of internal fixations in treatment of complex tibial plateau fractures. Methods Eighteen human antiseptic cadaver tibial plateau specimens were used to make models of complex tibial plateau fracture (type Ⅵ fractures of Schatzker classification). The models were fixated with a lateral Golf-buttress plate (GP), modified dual plate (a lateral Golf-buttress plate plus a medial five-hole one-third tubular antiglide plate) (DP) or a lateral locking compression plate (LCP) respectively to compare strength, rigidity and stability of different fixation methods. Results The biomechanical strength, rigidity and stability in DP group and LCP group were better than those in GP group (P 0.05). Conclusions Locking compression plate and modified dual plate are fairly ideal internal fixators for treatment of complex tibial plateau fractures. In the meantime, locking compression plate emphasizes conservation of soft tissues and blood supply, can better meet the requirement of the biological fixation of fracture and is the most ideal internal fixator at present. Key words: Tibial fractures; Fracture fixation; internal; Biomechanics

Multiaxial locking plates for treatment of complex tibiai plateau fractures

Objective To report clinical effects of multiaxial locking plates in the treatment of the complex tibial plateau fractures. Methods From July 2006 to June 2007, 25 cases of complex tibial plateau fractures, 18 males and 7 females, were treated with surgical reduction and internal fixation using multiaxial locking plates. The mean age of the patients was 32.8(20 to 56) years. There were 21 closed fractures and 4 open ones. According to Schatzker classification, 6 cases were of type Ⅳ, 16 of type Ⅴ, and 3 of type Ⅵ. The follow-up period lasted 10.5(7 to 15) months on average. The knee functions in all the patients were assessed according to radiological manifestations and HSS scoring. Results All fractures united at 4 to 6 months postoperatively and the average HSS score after half a year was 88.4 (78 to 96). Skin flap necrosis was found in 1 case and incision infection in another. No loosening or rupture of the fixator, or reduction failure was observed. Conclusions The multiaxial locking plate is an effective fixator for complex tibial plateau fractures due to its convenience and stability. The locking screws can be implanted in various directions and the primary and secondary reduction failures can be avoided. Key words: Tibia; Fractures; Fracture fixation, internal; Internal fixator

Treatment of Complex Tibial Fractures in Children with the Taylor Spatial Frame

Most tibial shaft fractures in children can be treated with closed reduction and cast fixation, but some fractures need external or internal fixation. The Taylor spatial frame (Smith & Nephew, Memphis, Tennessee) is a relatively new external fixator that can correct 6-axis deformities with computer accuracy. This article reports our experience using the Taylor spatial frame as a rewarding treatment modality for complex tibial fractures in children and adolescents.