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Patterson JT, Rusu D, Duong AM, Satish V, Yang M, Mayer L, Allen M, Marecek GS. Subchondral rafting wires reduce tibial plateau fracture subsidence. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2613-2619. [PMID: 38720055 PMCID: PMC11291521 DOI: 10.1007/s00590-024-03963-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/14/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE To determine if subchondral rafting wires retained as adjunctive tibial plateau fracture fixation affect postoperative articular subsidence. METHODS A retrospective cohort study was conducted at one Level 1 trauma center and one academic university hospital. Consecutive adults with closed, displaced OTA/AO 41B/C tibial plateau fractures treated between 2018 and 2023 with open reduction internal fixation were included. Patients who were not ambulatory, with contralateral injuries limiting weight bearing, and without follow-up radiographs of the injured extremity were excluded. The intervention was retention of subchondral rafting wires as definitive fixation. The primary outcome was linear articular surface subsidence between postoperative and follow-up AP knee radiographs. Linear subsidence was compared between groups using Welch's two sample t test. Associations of linear subsidence with patient, injury, and treatment characteristics were assessed by multivariable linear regression. RESULTS We identified 179 patients of a mean age of 44 ± 14 years, of whom 15 (8.4%) received subchondral rafting wires. Median follow-up was 121 days. No patients who received rafting wires as definitive implants experienced linear subsidence ≥ 2 mm, while 22 patients (13.4%) who did not receive rafting wires experienced linear subsidence ≥ 2 mm (p = 0.130). Subchondral rafting wires were associated with less linear subsidence (0.3 mm [95% confidence interval - 0.3-0.9 mm] vsersus 1.0 mm [- 0.9-2.9 mm], p < 0.001). The depth of linear subsidence was significantly associated on multivariable regression with male sex, depressed plateau area, active smoking, and retained rafting wires. CONCLUSION Subchondral rafting wires were associated with a small reduction in articular subsidence after internal fixation of tibial plateau fractures. Routine rafting wires may be useful for patients and fractures at high risk of articular subsidence.
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Affiliation(s)
- Joseph T Patterson
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA.
| | - Daniel Rusu
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA
| | - Andrew M Duong
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA
| | - Vivek Satish
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA
| | - Max Yang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA
| | - Lucas Mayer
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA
| | - Michael Allen
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA
| | - Geoffrey S Marecek
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Dekhne MS, Stenquist D, Suneja N, Weaver MJ, Petersen MM, Singh UM, Von Keudell A. Optimizing Outcomes after Operative Treatment Bicondylar Tibial Plateau Fractures - Time for Innovation? THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:80-91. [PMID: 38420520 PMCID: PMC10898803 DOI: 10.22038/abjs.2023.72836.3378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/30/2023] [Indexed: 03/02/2024]
Abstract
Bicondylar tibial plateau fractures are technically demanding fractures that have a high complication rate. We sought to review the recent literature with the aim to summarize the development of new classification systems that may enhance the surgeon's understanding of the fracture pattern and injury. We highlight the best methods for infection control and touch on new innovative solutions using 3D printer models and augmented mixed reality to provide potentially personalized solutions for each specific fracture configuration.
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Affiliation(s)
- Mihir S. Dekhne
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
| | - Derek Stenquist
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
| | - Nishant Suneja
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J. Weaver
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Moerk Petersen
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Upender Martin Singh
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Arvind Von Keudell
- Harvard Orthopedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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3
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Selçuk E, Erem M, Çopuroğlu C, Özcan M, Çiftdemir M. Comparison of AO, Schatzker, and three-column classification systems in tibial plateau fractures: Impact on functional outcomes. Jt Dis Relat Surg 2024; 35:112-120. [PMID: 38108172 PMCID: PMC10746904 DOI: 10.52312/jdrs.2023.1256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/03/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES This study aimed to compare the AO, Schatzker, and Three-Column classification systems for tibial plateau fractures, focusing on their prognostic and functional outcome prediction and influence on clinical decisions across different trauma types. PATIENTS AND METHODS In this retrospective study, we examined 49 patients (36 males, 11 females; mean age: 40.6±11.8 years; range, 19 to 67 years) with tibial plateau fractures between January 2011 and January 2017. The fractures were classified using the AO, Schatzker, and three-column systems. The main outcome measurements included functional scores (Knee Injury and Osteoarthritis Outcome Score [KOOS], Hospital for Special Surgery [HSS]), range of motion (ROM), duration of hospitalization, thigh atrophy, operation time, and the development of osteoarthritis. The impact of smoking was also assessed. RESULTS According to the AO classification, type B fractures obtained higher KOOS and HSS scores compared to type C fractures (p=0.013 and p=0.007, respectively). According to the Schatzker classification low-energy fractures achieved higher KOOS and HSS scores than high-energy fractures (p=0.013 and p=0.026, respectively). One-column fractures had higher KOOS and HSS scores compared to two-column and three-column fractures (p=0.007 and p=0.001, respectively). Two-column fractures had a lower ROM compared to other column fractures (p=0.022). Shorter hospital stays were recorded for Schatzker low-energy fractures (p=0.016), whereas higher thigh atrophy was found in Schatzker high-energy fractures (p=0.022) and AO type C fractures (p=0.018). Longer operation times were observed in AO type C fractures (p=0.037) and Schatzker high-energy fractures (p=0.017). According to the Kellgren-Lawrence classification, AO type C fractures and three-column fractures yielded worse outcomes (p=0.039 and p=0.001, respectively). Smoking had a negative impact on functional KOOS and HSS scores across all groups (p=0.022 and p=0.001, respectively). CONCLUSION This study highlights the predictive value of the AO, Schatzker, and Three-Column classification systems in determining functional outcomes and clinical data in tibial plateau fractures. Each system provides unique insights into different outcomes, suggesting their concurrent application may yield a more comprehensive prognosis.
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Affiliation(s)
- Eşref Selçuk
- Trakya Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 22030 Edirne, Türkiye.
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Castano Betancourt MC, Maia CR, Munhoz M, Morais CL, Machado EG. A review of Risk Factors for Post-traumatic hip and knee osteoarthritis following musculoskeletal injuries other than anterior cruciate ligament rupture. Orthop Rev (Pavia) 2022; 14:38747. [DOI: 10.52965/001c.38747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Post-traumatic osteoarthritis (PTOA) is a common form of osteoarthritis that might occur after any joint trauma. Most PTOA publications mainly focus on anterior cruciate ligament (ACL) injuries. However, many other traumatic injuries are associated with PTOA, not only for the knee but also for the hip joint. We aim to identify and summarize the existing literature on the musculoskeletal injuries associated with knee and hip PTOA and their risk factors in determining those with a worse prognosis, excluding ACL injuries. Despite the narrative nature of this review, a systematic search for published studies in the last twenty years regarding the most relevant injuries associated with a higher risk of PTOA and associated risk factors for OA was conducted. This review identified the six more relevant injuries associated with knee or hip PTOA. We describe the incidence, risk factors for the injury and risk factors for PTOA of each. Meniscal injury, proximal tibial fracture, patellar dislocation, acetabular, femoral fractures and hip dislocations are all discussed in this review.
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Zeng C, Ren X, Xu C, Hu M, Li J, Zhang W. Stability of internal fixation systems based on different subtypes of Schatzker II fracture of the tibial plateau: A finite element analysis. Front Bioeng Biotechnol 2022; 10:973389. [PMID: 36159683 PMCID: PMC9490054 DOI: 10.3389/fbioe.2022.973389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Schaztker II fracture is the most common type of the tibial plateau fractures (TPF). There has been a large number of cadaveric biomechanical studies and finite element simulation studies to explore the most stable fixation methods for this type of fracture, which were based on a single fracture morphology. But differences among fracture morphologies could directly affect the stability of internal fixation systems. In this sense, we verified the stability of existing internal fixation modalities by simulating Schatzker II fractures with different fracture morphologies. Objectives: To compare the stability of different filler types combined with locked compression plate/screw in different subtypes of Schatzker II TPF. Methods: Four subtypes of Schatzker II were created based on 3D map of TPF. Each of the subtypes was fixed with LCP/screw or LCP/screw combined with different fill types. Stress distribution, displacement distribution, and the load sharing capacity of the filler were assessed by applying the maximum load during gait. In addition, repeated fracture risks of depressed fragment were evaluated regarding to the ultimate strain of bone. Results: The stress concentration of the implant in each scenario was located on the screw at the contact site between the plate and the screw, and the filler of the defect site significantly reduced the stress concentration of the implant (Subtype A: Blank group 402.0 MPa vs. Experimental group 315.2 ± 5.5 MPa; Subtype C: Blank group 385.0 MPa vs. Experimental group 322.7 ± 12.1 MPa). Displacement field analysis showed that filler significantly reduced the reduction loss of the depressed fragment (Subtype A: Blank group 0.1949 mm vs. Experimental group 0.174 ± 0.001 mm; Subtype C: 0.264 mm vs. 0.253 ± 0.002 mm). Maximum strain was in subtype C with the value of 2.3% ± 0.1% indicating the greatest possibility of failure risk. And with the increase of its modulus, the bearing capacity of filler increased. Conclusion: The existence of filler at the defect site can effectively reduce the stress concentration of the implant and the reduction loss of the collapsed block, thus providing good stability for Schatzker II fracture. In subtype A fracture, the modulus of filler presented the slightest influence on the stability, followed by subtype C, while the stability of subtype B was most influenced by the modulus of filler. Therefore, it is necessary to evaluate the preoperative patient imaging data adequately to select the appropriate stiffness of the filler.
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Affiliation(s)
- Chuyang Zeng
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaomeng Ren
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Cheng Xu
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Mengmeng Hu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Jiantao Li
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- *Correspondence: Jiantao Li, ; Wei Zhang,
| | - Wei Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Jiantao Li, ; Wei Zhang,
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Prall WC, Rieger M, Fürmetz J, Haasters F, Mayr HO, Böcker W, Kusmenkov T. Schatzker II tibial plateau fractures: Anatomically precontoured locking compression plates seem to improve radiological and clinical outcomes. Injury 2020; 51:2295-2301. [PMID: 32650982 DOI: 10.1016/j.injury.2020.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/01/2020] [Accepted: 07/05/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The design of anatomically precontoured locking compression plates (LCP) allows the placement of angular stable screws right underneath the reduced joint surface fragments. To date, there is a lack of evidence supporting the broad utilization of these implants in split depression fractures to the lateral tibial plateau. Thus, aim of the present matched pair retrospective cohort study was to investigate the radiological and clinical outcomes of anatomically precontoured LCP compared to conventional plate and screw osteosynthesis in Schatzker II fractures. MATERIAL AND METHODS The institutional databank was searched for Schatzker II fractures from 2010 to 2016. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm LCP or conventional 4.5 mm l-shaped plates and screws were included. CT scans and radiographs were analyzed. Details of the operative procedures and secondary events were collected. A matched pair analyses was conducted in a best fit manner. The primary outcome parameter was the Rasmussen Radiological Score approximately one year postoperatively. Secondary outcome parameters were the medial proximal tibial angle (MPTA), the Rasmussen Clinical Score and the WOMAC Score after a follow up of at least three years. RESULTS A total of 50 patients was included. Patient age, gender distribution, size and depression depth of the lateral joint surface fragments, frequency of utilizing bone grafts or substitutes and lateral meniscus repair as well as subsequent implant removal were comparable across the groups. Immediately postoperatively, the Rasmussen Radiological Score revealed no differences. After a mean of 64.2 weeks, the radiological outcome was significantly better in the LCP 3.5 group (RRS 8.2 vs. 6.3 points, p<0.001; MPTA 89.5 vs. 92.0°, p = 0.001). After a mean clinical follow-up of 4.5 years, the Rasmussen Clinical Score (22.9 vs. 27.8 points, p<0.001) and the WOMAC score (24.3 vs. 16.0 points, p = 0.04) revealed significantly impaired results in the conventional group. CONCLUSION Anatomically precontoured LCP prevent the subsidence of the reduced joint surface fragments more sufficiently and allow for improved patient outcomes compared to conventional plates and screws. The utilization of anatomically precontoured LCP should therefore closely be considered for internal fixation of any split depression fractures to the lateral tibial plateau.
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Affiliation(s)
- W C Prall
- FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany.
| | - M Rieger
- FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria
| | - J Fürmetz
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - F Haasters
- FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - H O Mayr
- FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of Orthopaedics and Trauma Surgery, Freiburg University Hospital, Albert-Ludwigs-University, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - W Böcker
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - T Kusmenkov
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
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Gonzalez LJ, Hildebrandt K, Carlock K, Konda SR, Egol KA. Patient function continues to improve over the first five years following tibial plateau fracture managed by open reduction and internal fixation. Bone Joint J 2020; 102-B:632-637. [DOI: 10.1302/0301-620x.102b5.bjj-2019-1385.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. Methods In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired t-test. Results Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA). Conclusion Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: Bone Joint J 2020;102-B(5):632–637.
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Affiliation(s)
- L. J. Gonzalez
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - K. Hildebrandt
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - K. Carlock
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - S. R. Konda
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
- Jamaica Hospital Medical Center, New York, New York, USA
| | - K. A. Egol
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
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8
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Elsoe R, Motahar I, Mahdi F, Larsen P. Presence of magnetic resonance imaging verified soft tissue injuries did not significantly affect the patient-reported outcome 12 months following a lateral tibial plateau fracture: A 12-month prospective cohort study of 56 patients. Knee 2020; 27:420-427. [PMID: 32035704 DOI: 10.1016/j.knee.2020.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/26/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Soft tissue injuries following lateral tibial plateau fracture affect more than half of patients. Regardless of the type of soft tissue injured, it is still unclear how different treatment strategies influence postoperative outcome. The aim of this study was to report the 12-month Knee Injury and Osteoarthritis Outcome Score (KOOS5) of patients with surgically managed lateral tibial plateau fractures divided into groups with and without conservatively managed magnetic resonance imaging (MRI)-verified soft tissue injuries. METHODS Prospective cohort study. Patients treated surgically following a lateral tibial plateau fracture (AO-41B) between December 2013 and November 2016 were included. Soft tissue injuries were evaluated with preoperative MRI scans. The primary outcome score was the 12-month KOOS5 score divided into groups with and without soft tissue injuries. RESULTS A total of 56 patients were included. Average patient age was 56 years (range 22-86). Thirty-three patients (59%) were female. Fifty percent of patients presented with MRI-verified soft tissue injuries. At 12 months postoperatively, the mean KOOS5 score for patients with soft tissue injuries was 53.5 (95% confidence interval (CI): 44.8-62.1) and the KOOS5 score for patients without soft tissue injuries was 59.6 (95% CI: 50.7-68.6). No significant difference in the KOOS5 score between patients with and without soft tissue injuries was observed (P = .31). CONCLUSIONS At 12-month follow-up the presence of MRI-verified soft tissue injuries did not significantly affect the patient-reported KOOS5 score. More research is needed to investigate the effects of surgical vs. non-surgical treatment strategies of associated soft tissue injuries following lateral tibial plateau fractures.
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Affiliation(s)
- Rasmus Elsoe
- Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark.
| | - Isa Motahar
- Department of Radiology, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark
| | - Firaz Mahdi
- Department of Radiology, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark
| | - Peter Larsen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark; Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark
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9
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Schröder E Souza BG, Leite TA, Silva TABD, Candido COFDF, de Almeida FF, de Oliveira VM. Comparative Study of Function and Quality of Life in Patients with Fracture of the Tibial Plateau Operated with Locked or Conventional Plates. Rev Bras Ortop 2019; 54:37-44. [PMID: 31363241 PMCID: PMC6424804 DOI: 10.1016/j.rbo.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/19/2017] [Indexed: 11/16/2022] Open
Abstract
Objective To compare clinical, functional, and quality of life outcomes between patients with tibial plateau fractures operated with locked or conventional plates, and to compare the costs of these implants. Methods This was a comparative cross-sectional study of a consecutive series of patients with tibial plateau fractures treated surgically from August 2015 to June 2016. Patients < 18 years old, 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. The present study compared the costs of the implants for the hospital, quality of life (with the 12-Item Short Form Health Survey [SF-12]), Lysholm score, pain scale, and clinical and radiological parameters. Results
A total of 45 patients with tibial plateau fractures were admitted, and 11 cases were excluded. Two cases were lost to follow-up; therefore, 32 remained for the analysis (94%). The mean follow-up time was of 15.1 months (standard deviation [SD] = 4.8 months). In group A (locked plates), there were 22 patients (69%), at an average hospital cost of BRL 4,125.39/patient (SD = 1,634.79/patient) for the implants. In group B (conventional plates) there were 10 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 (2.7 mm ± 3.3 mm versus 0.5 mm ± 1.6 mm;
p
= 0.02; TE = 0.90).
Conclusion The costs of locked implants for the treatment of tibial plateau fractures are significantly higher than those of conventional implants, without any clinical, quality of life, radiological, or functional advantages of the locked implants demonstrated in the present series.
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Affiliation(s)
| | - Thiago Avelino Leite
- Serviço de Ortopedia e Traumatologia, Hospital e Maternidade Therezinha de Jesus (HMTJ), Juiz de Fora, MG, Brasil
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Quintens L, Herteleer M, Vancleef S, Carette Y, Duflou J, Nijs S, Sloten JV, Hoekstra H. Anatomical Variation of the Tibia - a Principal Component Analysis. Sci Rep 2019; 9:7649. [PMID: 31114000 PMCID: PMC6529455 DOI: 10.1038/s41598-019-44092-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/07/2019] [Indexed: 12/17/2022] Open
Abstract
Conventional anatomically contoured plates do not adequately fit most tibiae. This emphasizes the need for a more thorough morphological study. Statistical shape models are promising tools to display anatomical variations within a population. Herein, we aim to provide a better insight into the anatomical variations of the tibia and tibia plateau. Seventy-nine CT scans of tibiae were segmented, and a principal component analysis was performed. Five morphologically important parameters were measured on the 3D models of the mean tibial shapes as well as the −3SD and +3 SD tibial shapes of the first five components. Longer, wider tibiae are related to a more rounded course of the posterior column, a less prominent tip of the medial malleolus, and a more posteriorly directed fibular notch. Varus/valgus deformations and the angulation of the posterior tibia plateau represent only a small percentage of the total variation. Right and left tibiae are not always perfectly symmetrical, especially not at the level of the tibia plateau. The largest degree of anatomical variation of the tibia is found in its length and around the tibia plateau. Because of the large variation in the anatomy, a more patient-specific approach could improve implant fit, anatomical reduction, biomechanical stability and hardware-related complications.
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Affiliation(s)
- Liselore Quintens
- KU Leuven - University of Leuven, Faculty of Medicine, Leuven, Belgium
| | - Michiel Herteleer
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.,Biomedical Science Group, Organ Systems, KU Leuven - University of Leuven, Leuven, Belgium
| | - Sanne Vancleef
- Department of Mechanical Engineering, KU Leuven - University of Leuven, Leuven, Belgium
| | - Yannick Carette
- Department of Mechanical Engineering, KU Leuven - University of Leuven, Leuven, Belgium
| | - Joost Duflou
- Department of Mechanical Engineering, KU Leuven - University of Leuven, Leuven, Belgium
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, KU Leuven - University of Leuven, Leuven, Belgium
| | - Harm Hoekstra
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium. .,Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.
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11
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Buckley RE, Schneider P, Duffy PJ, Puloski S, Korley R, Martin CR. A sub-meniscal arthrotomy improves the medium-term patient outcome of tibial plateau fractures. Knee Surg Sports Traumatol Arthrosc 2019; 27:837-844. [PMID: 30159740 DOI: 10.1007/s00167-018-5122-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE This trial was conducted to determine the medium-term functional outcome of displaced tibial plateau fracture patients treated with closed fluoroscopic assisted reduction and internal fixation (CRIF) versus patients treated with standard open reduction with sub-meniscal arthrotomy and internal fixation (ORIF). METHODS A prospective trial was conducted in adult patients with displaced AO/OTA 41 B and 41 C tibial plateau fractures. Patients were assigned to treatment based upon the standard treatment of the surgeon involved following the call schedule for the day, either CRIF or ORIF. Postoperative radiographs and CT were performed on all patients and patients were followed for a minimum of 2 years. Primary outcome measures were the KOOS, SMFA and SF-36. RESULTS Seventy patients were recruited with 2 year follow-up on 35 patients in the CRIF group and 27 patients in the ORIF group. Postoperative CT scans showed that reductions were better with the ORIF group especially in the posterolateral quadrant as compared to the CRIF group. The frequency of mal-reductions was higher in the CRIF group. The KOOS, at two years, showed that the CRIF had significantly less good outcomes in the subcategories of SPORT (p = 0.03) and QOL (p = 0.01) measurements. CONCLUSIONS ORIF with a sub-meniscal arthrotomy provides better quality reductions and better medium-term results as compared to CRIF for tibial plateau fractures. This may provide more long-term benefit from osteoarthritic symptoms in this patient group. LEVEL OF EVIDENCE Therapeutic, Level 2.
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Affiliation(s)
- Richard E Buckley
- 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Medical Center, University of Calgary, Calgary, AB, T2N 5A1, Canada.
| | - Prism Schneider
- 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Medical Center, University of Calgary, Calgary, AB, T2N 5A1, Canada
| | - Paul J Duffy
- 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Medical Center, University of Calgary, Calgary, AB, T2N 5A1, Canada
| | - Shannon Puloski
- 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Medical Center, University of Calgary, Calgary, AB, T2N 5A1, Canada
| | - Robert Korley
- 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Medical Center, University of Calgary, Calgary, AB, T2N 5A1, Canada.,, Suite 335 401-9th Ave SW, Calgary, AB T2P 3C5, Canada
| | - C Ryan Martin
- 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Medical Center, University of Calgary, Calgary, AB, T2N 5A1, Canada
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12
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Gebel PJ, Tryzna M, Beck T, Wilhelm B. Tibial plateau fractures: Fracture patterns and computed tomography evaluation of tibial plateau fractures in winter sports. Orthop Rev (Pavia) 2018; 10:7517. [PMID: 29770177 PMCID: PMC5937364 DOI: 10.4081/or.2018.7517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/28/2018] [Accepted: 01/28/2018] [Indexed: 11/25/2022] Open
Abstract
The purpose was to analyze tibial plateau fractures (TPF) by computed tomography (CT) by creating a frequency map (FM). We hypothesized that a FM shows clinically important aspects of involvement that are not expressed in classic classifications. 185 TPF were retrospectively evaluated in this single center study. We created a FM onto an axial template of an intact subarticular tibial plateau and separated the joint surface in 9 areas, counted the frequency of involvement. The FM gives information of location and grade of damage and expressed three major fracture areas in 76%. 5 specific fracture types add up to 51%. The dorsal parts of the tibial plateau are involved in a higher percentage (+8%). True lateral fractures are less often than plane radiographs suggest. An impression was found in 50%. The complexity of TPFs is high, but 5 specific types could be identified in >50%. The complexity is not sufficiently covered in common classifications, especially the dorsal involvement. The FM is a simple and useful tool that complements common classifications and can be used as guideline for surgical treatment.
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Affiliation(s)
- Philipp Jan Gebel
- Department of Orthopedic Surgery and Traumatology, Spital Thun-Simmental AG, Thun
| | - Malte Tryzna
- Department of General Surgery and Traumatology, Kantonsspital Graubünden, Chur
| | - Thomas Beck
- Department of General Surgery and Traumatology, Spital Wallis, Visp, Switzerland
| | - Bernd Wilhelm
- Department of General Surgery and Traumatology, Spital Wallis, Visp, Switzerland
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13
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Abstract
OBJECTIVE To determine if ligamentous and meniscal injuries as determined by initial magnetic resonance imaging altered clinical outcomes after the fixation of tibial plateau fractures. DESIGN Comparative cohort study. SETTING Academic level I trauma center. PATIENTS/PARTICIPANTS Eighty-two patients from a prospective database of operatively treated tibial plateau fractures met the inclusion criteria, which consisted of injury radiographs, preoperative knee magnetic resonance imaging (MRI), and a minimum of 12 months of clinical outcomes. INTERVENTION In addition to radiographs and computed tomography scans for fracture assessment, an MRI was performed to detect tears in the medial and lateral menisci and complete ruptures of the cruciate ligaments (anterior cruciate ligament and posterior cruciate ligament) and collateral ligaments [lateral collateral ligament and medial collateral ligament (MCL)]. Surgical fixation of tibial plateau fractures was performed by a single surgeon based on injury patterns. MAIN OUTCOME MEASUREMENTS Clinical outcomes included the Knee Outcome Survey Activities of Daily Living Scale, the Lower Extremity Functional Scale, the Short-Form 36, and knee range of motion. Secondary soft tissue surgeries and conversion to arthroplasty were also noted. RESULTS On injury MRI, 60 patients (73%) had injuries to at least one soft tissue structure. At final follow-up, 2 patients (2%) had a secondary soft tissue surgery and 1 patient (1%) underwent total knee arthroplasty. Patient-reported outcomes and range of motion assessments were not significantly different in patients with and without medial meniscal tears, lateral meniscal tears, and complete MCL ruptures. CONCLUSIONS In this cohort of patients with operative tibial plateau fractures, sutured lateral meniscal tears, untreated medial meniscus tears, and complete MCL ruptures did not significantly affect clinical outcomes. In addition, these data suggest that obtaining a preoperative MRI in patients with tibial plateau fractures to diagnose soft tissue injuries may not alter the surgical treatment or alter patient prognosis for midterm outcomes. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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14
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Kateros K, Galanakos SP, Kyriakopoulos G, Papadakis SA, Macheras GA. Complex Tibial Plateau Fractures Treated by Hybrid External Fixation System: A correlation of followup computed tomography derived quality of reduction with clinical results. Indian J Orthop 2018; 52:161-169. [PMID: 29576644 PMCID: PMC5858210 DOI: 10.4103/ortho.ijortho_300_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tibial plateau fractures are common due to high energy injuries. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Recognition of the particular fracture pattern is important, as this guides the surgical approach required in order to adequately stabilize the fracture. This study evaluates the results of the combined treatment of external fixator and limited internal fixation along with the advantages using postoperative computed tomography (CT) scan after implant removal. Materials and. METHODS 55 patients with a mean age of 42 years (range 17-65 years) with tibial plateau fracture, were managed in our institution between October 2010 and September 2013., Twenty fractures were classified as Schatzker VI and 35 as Schatzker V. There were 8 open fractures (2 Gustilo Anderson 3A and 6 Gustilo Anderson 2). All fractures were treated with closed reduction and hybrid external fixation (n = 21/38.2%) or with minimal open reduction internal fixation and a hybrid system (n = 34/61.8%). After the removal of the fixators, CT-scan was programmed for all the cases, for correlation with the results. At final followup, the American Knee Society Score (AKSS) was administered. RESULTS All patients were evaluated with a minimum of 12 months (range 12-21 months) followup. Average time to union was 15.5 weeks (range 13-19 weeks). The postoperative joint congruity as evaluated in the postoperative CT-scan was <2 mm of articular step-off in 8 patients (14.5%), between 2 and 4 mm in 18 patients (32.7%) and over 4 mm in 29 (52.7%). The injured limb mechanical axis was restored within 5° compared to the contralateral limb in 36 cases (65%) and with an angulation >5° in 19 cases (35%). Patients with residual joint depression <3.5 mm had a 95% chance of having excellent AKSS knee score results and 80% chance of having excellent AKSS function scores. On the other hand, residual joint depression of >4.5 mm displayed a 100% chance of getting poor-fair scores both in AKSS knee and AKSS function score. The association of a postoperative mechanical axis within 5° of the contralateral limb and improved knee scores was statistically significant for the AKSS function and total scores but not for the AKSS knee score. The AKSS was negatively correlated with postoperative joint depression magnitude which was statistically significant. Only the amount of joint collapse was verified as a prognostic factor in a multivariate logistic regression analysis. CONCLUSIONS The postoperative CT-scan shows important information about bone healing, and an exact image of the reduction and the shaft alignment. Postoperative radiographs may have led to an underestimation of the degree of residual displacement. On the contrary, CT-scan demonstrates the exact grade of articular displacement and depending on CT-scan results one can better manage the postoperative rehabilitation.
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Affiliation(s)
- Konstantinos Kateros
- First Orthopaedic Department, Gennimatas General Hospital, Cholargos, Athens, Greece
| | - Spyridon P Galanakos
- Fourth Department of Orthopaedics and Traumatology, KAT Hospital, Kifissia, 2 Nikis Street, 145 61, Athens, Greece,Address for correspondence: Dr. Spyridon P Galanakos, Fourth Department of Orthopaedics and Traumatology, KAT Hospital, 2 Nikis Street, 145 61 Athens, Greece. E-mail:
| | | | - Stamatios A Papadakis
- Fourth Department of Orthopaedics and Traumatology, KAT Hospital, Kifissia, 2 Nikis Street, 145 61, Athens, Greece
| | - George A Macheras
- Fourth Department of Orthopaedics and Traumatology, KAT Hospital, Kifissia, 2 Nikis Street, 145 61, Athens, Greece
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15
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Arnold JB, Tu CG, Phan TM, Rickman M, Varghese VD, Thewlis D, Solomon LB. Characteristics of postoperative weight bearing and management protocols for tibial plateau fractures: Findings from a scoping review. Injury 2017; 48:2634-2642. [PMID: 29102370 DOI: 10.1016/j.injury.2017.10.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/10/2017] [Accepted: 10/28/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify and describe the characteristics of existing practices for postoperative weight bearing and management of tibial plateau fractures (TPFs), identify gaps in the literature, and inform the design of future research. METHODS Seven electronic databases and clinical trial registers were searched from inception until November 17th 2016. Studies were included if they reported on the surgical management of TPFs, had a mean follow-up time of ≥1year and provided data on postoperative management protocols. Data were extracted and synthesized according to study demographics, patient characteristics and postoperative management (weight bearing regimes, immobilisation devices, exercises and complications). RESULTS 124 studies were included involving 5156 patients with TPFs. The mean age across studies was 45.1 years (range 20.8-72; 60% male), with a mean follow-up of 34.9 months (range 12-264). The most frequent fracture types were AO/OTA classification 41-B3 (29.5%) and C3 (25%). The most commonly reported non-weight bearing time after surgery was 4-6 weeks (39% of studies), with a further 4-6 weeks of partial weight bearing (51% of studies), resulting in 9-12 weeks before full weight bearing status was recommended (55% of studies). Loading recommendations for initial weight bearing were most commonly toe-touch/<10kg (28%), 10kg-20kg (33%) and progressive (39%). Time to full weight bearing was positively correlated with the proportion of fractures of AO/OTA type C (r=0.465, p=0.029) and Schatzker type IV-VI (r=0.614, p<0.001). Similar rates of rigid (47%) and hinged braces were reported (58%), most frequently for 3-6 weeks (43% of studies). Complication rates averaged 2% of patients (range 0-26%) for abnormal varus/valgus and 1% (range 0-22%) for non-union or delayed union. CONCLUSIONS Postoperative rehabilitation for TPFs most commonly involves significant non-weight bearing time before full weight bearing is recommended at 9-12 weeks. Partial weight bearing protocols and brace use were varied. Type of rehabilitation may be an important factor influencing recovery, with future high quality prospective studies required to determine the impact of different protocols on clinical and radiological outcomes.
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Affiliation(s)
- John B Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Chen Gang Tu
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Port Road, Adelaide, SA, Australia
| | - Tri M Phan
- Hospital for Trauma and Orthopaedics, Ho Chi Minh, Vietnam
| | - Mark Rickman
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Port Road, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, Australia
| | - Viju Daniel Varghese
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Port Road, Adelaide, SA, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, Australia
| | - Lucian B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Port Road, Adelaide, SA, Australia; Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, Australia.
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16
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Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures. INTERNATIONAL ORTHOPAEDICS 2017; 41:1865-1873. [PMID: 28721498 DOI: 10.1007/s00264-017-3566-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 06/30/2017] [Indexed: 12/12/2022]
Abstract
ABASTRACT INTRODUCTION: Although regularly ignored, there is growing evidence that posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of posterior column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. METHODS A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of posterior column fractures was 61.9%. Posterior column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of posterior column fracture fixation, due to a limited patient size. CONCLUSION Our data indicates that implementation of the updated three-column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize posterior column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of posterior column fractures with restoration of the sagittal alignment. LEVEL OF EVIDENCE 3.
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17
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Abstract
Tibial plateau fractures are complex injuries produced by high- or low-energy trauma. They principally affect young adults or the 'third age' population.These fractures usually have associated soft-tissue lesions that will affect their treatment. Sequential (staged) treatment (external fixation followed by definitive osteosynthesis) is recommended in more complex fracture patterns. But one should remember that any type of tibial plateau fracture can present with soft-tissue complications.Typically the Schatzker or AO/OTA classification is used, but the concept of the proximal tibia as a three-column structure and the detailed study of the posteromedial and posterolateral fragment morphology has changed its treatment strategy.Limb alignment and articular surface restoration, allowing early knee motion, are the main goals of surgical treatment. Partially articular factures can be treated by minimally-invasive methods and arthroscopy is useful to assist and control the fracture reduction and to treat intra-articular soft-tissue injuries.Open reduction and internal fixation (ORIF) is the gold standard treatment for these fractures. Complex articular fractures can be treated by ring external fixators and minimally-invasive osteosynthesis (EFMO) or by ORIF. EFMO can be related to suboptimal articular reduction; however, outcome analysis shows results that are equal to, or even superior to, ORIF. The ORIF strategy should also include the optimal reduction of the articular surface.Anterolateral and anteromedial surgical approaches do not permit adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is necessary to reduce and fix them through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement.Some authors have also suggested that primary total knee arthroplasty could be an option in specific patients and with specific fracture patterns. Cite this article: Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev 2016;1:225-232. DOI: 10.1302/2058-5241.1.000031.
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18
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Chang H, Zhu Y, Zheng Z, Chen W, Zhao S, Zhang Y, Zhang Y. Meta-analysis shows that highly comminuted bicondylar tibial plateau fractures treated by single lateral locking plate give similar outcomes as dual plate fixation. INTERNATIONAL ORTHOPAEDICS 2016; 40:2129-2141. [DOI: 10.1007/s00264-016-3157-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
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Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures. Injury 2015; 46:1608-12. [PMID: 26071324 DOI: 10.1016/j.injury.2015.05.035] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibial plateau fractures account for approximately 1% of all fractures. They usually occur after a direct high-energy trauma. Despite adequate treatment, these fractures can result in malalignment and secondary osteoarthritis (OA). Research concerning long-term functional outcome is limited. The primary aim of this study was to evaluate mid- to long-term functional outcome of surgically treated tibial plateau fractures. The secondary aim was to investigate whether radiological characteristics of OA one year after surgery are predictive of functional outcome at follow-up. METHODS All consecutive patients with fractures of the proximal tibia, which were surgically treated in our level-2 trauma centre between 2004 and 2010, were included in this study. Initial trauma radiographs were analysed for fracture classification, using both the Schatzker and AO/OTA classification systems, by three different raters. Immediate postoperative and 1-year postoperative radiographs were analysed for osteoarthritis by an experienced radiologist, using the Kellgren and Lawrence scale. Functional outcome of the included patients was measured using the Dutch version of the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. RESULTS Seventy one patients out of a group of 96 included patients completed the survey. Median KOOS scores are 89.8% for pain, 91.1% for 'other symptoms', 89.7% for daily function, 72.5% for sports and recreation and 75.0% for quality of life. Median KOOS overall score is 82.99%. We did not find a correlation between the KOOS scores and the absolute age for any of the subscales. There was no significant relationship between radiological characteristics of osteoarthritis and functional outcome. CONCLUSIONS This is the first study to describe mid- to long-term functional outcome after ORIF for all types of tibial plateau fractures, with the use of the KOOS. Patients should be informed about the likelihood of lower functional outcome in the long-term. This study shows that radiological characteristics of osteoarthritis are not related with lower functional outcomes in the mid- to long-term.
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Mattiassich G, Foltin E, Pietsch M, Djahani O, Kröpfl A, Fischmeister M, Scheurecker G. Magnetic resonance evaluation in long term follow up of operated lateral tibial plateau fractures. BMC Musculoskelet Disord 2015. [PMID: 26210789 PMCID: PMC4515000 DOI: 10.1186/s12891-015-0633-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background A lack of data exists on the long-term magnetic resonance imaging (MRI) findings after surgical repair of tibial plateau fractures (TPFs). We evaluated the MRI findings 13 to 31 years after surgical repair of TPFs, focusing especially on the pathological changes in the ligaments, menisci, and cartilage. Methods Twenty-three patients with 24 TPFs underwent open reduction and internal fixation with the same fork-shaped surgical plate that was used in our institution until 1999. No patient underwent preoperative or immediately postoperative MRI. The knees of all patients who underwent plate removal were examined by axial, coronal, and sagittal MRI. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and whole-organ magnetic resonance score (WORMS) were determined in all patients. Results All 24 knees exhibited MRI abnormalities. An unexpectedly high number of pathological changes in the menisci and ligaments were observed. No meniscal or ligamentous injuries were documented at the time of the injury or initial surgery, but meniscal injuries manifested in the long term. MRI in almost all cases showed a damage to the lateral meniscal, the severity of which was related to the degree of tibial plateau widening, but not to the severity of the lateral joint surface impression. The overall condition of the knee joint was satisfactory as measured by the WORMS, and there was a weak correlation between WORMS and KOOS.
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Affiliation(s)
- Georg Mattiassich
- Trauma Center Unfallkrankenhaus Linz - Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, Linz, 4010, Austria. .,Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
| | - Ernst Foltin
- Private Practice for Trauma Surgery, Schlierbach, Austria.
| | - Martin Pietsch
- Department of Orthopaedic Surgery, General and Orthopaedic Hospital Stolzalpe, Stolzalpe, Austria.
| | - Oliver Djahani
- Department of Orthopaedic Surgery, General and Orthopaedic Hospital Stolzalpe, Stolzalpe, Austria.
| | - Albert Kröpfl
- Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria. .,Department of Trauma Surgery, Diakonissen Clinic Schladming, Schladming, Austria.
| | - Martin Fischmeister
- Trauma Center Unfallkrankenhaus Linz - Teaching Hospital of the Paracelsus Medical University Salzburg, Garnisonstrasse 7, Linz, 4010, Austria.
| | - Georg Scheurecker
- Institute for CT- and MRI-Diagnostic at Schillerpark, Linz, Austria.
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Ehlinger M, Adamczewski B, Rahmé M, Adam P, Bonnomet F. Comparison of the pre-shaped anatomical locking plate of 3.5 mm versus 4.5 mm for the treatment of tibial plateau fractures. INTERNATIONAL ORTHOPAEDICS 2015; 39:2465-71. [PMID: 25750131 DOI: 10.1007/s00264-015-2713-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/13/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Treatment of tibial plateau fractures is discussed. A retrospective comparative study of fractures treated with an anatomical locking plate of 4.5 mm or 3.5 mm. Our hypothesis is that the 3.5 mm plates give an equivalent hold of fractures with comparable results and better clinical tolerance. METHODS From May 2010 to October 2011, 18 patients were operated on using a 4.5-mm LCP™ anatomical plate (group A) and 20 patients received a3.5-mm LCP™ anatomical plate (group B). Groups were comparable. One fracture was open. RESULTS For the Group A, 14 patients had a follow up of 35.3 months and for the Group B, 16 patients had a follow up of 27 months. Mobility was comparable in both groups. The Hospital for Special Surgery (HSS) score was 86.4 versus 80.6, the Lysholm score was 83.6 versus 77 for groups A and B respectively. Consolidation was 3.25 months versus 3.35 months and mean axis was 183.1° versus 181.6° for groups A and B. Mechanical axes during revision were statistically different to the controlateral axes. One secondary displacement was noted in group A and one secondary displacement in group B. Group A had eight patients reporting discomfort with the material versus three in group B (p < 0.05). CONCLUSION The hypothesis is proven. In regards to the results, there is no significant difference between the two groups but the clinical tolerance was better in group B. More time is needed in the long term to better evaluate these severe fractures.
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Affiliation(s)
| | | | - Michel Rahmé
- Orthopedics, Hopital de Hautepierre, Strasbourg, France
| | - Philippe Adam
- Orthopedics, Hopital de Hautepierre, Strasbourg, France
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