1
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Ren X, Xu C, Jiang Y, Teng D, Liu X, Wang J, Zhang W. Effect of structural support size and position on depressed tibial plateau fractures: A finite element analysis. Heliyon 2024; 10:e29453. [PMID: 38628729 PMCID: PMC11019227 DOI: 10.1016/j.heliyon.2024.e29453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
Objective Structural support for depressed tibial plateau fractures is receiving increasing attention. Currently, there has been little biomechanical evaluation of structural support. This work aimed to investigate the effect of structural support size and position on fracture fixation stability. Methods A split-depressed tibial plateau fracture model was created according to the fracture map. Cortical screws combined with structural filler were used for fracture fixation. The filler diameter was set to small, medium and large, and the filler position was set to the center and offset by 1, 2 and 3 mm to study the effect of position and size on stability. Results The maximum stress on the implant in all scenarios occurs at the lower contact surface between the anterior screw and the filler. Increased support size resulted in increased mean maximum screw stress, depressed fragment axial displacement and separated fragment transverse displacement (screw stress: 266.6 ± 37.7 MPa vs. 266.7 ± 51.0 MPa vs. 273.8 ± 41.5 MPa; depressed displacement: 0.123 ± 0.036 mm vs. 0.133 ± 0.049 mm vs. 0.158 ± 0.050 mm; separated displacement: 0.402 ± 0.031 mm VS 0.412 ± 0.047 mm VS 0.437 ± 0.049 mm). The larger the offset of the support position was, the larger the peak screw stress and the larger the reduction loss of depressed and separated fragment reduction, regardless of the support size. The medium support combined with the central position presented the minimum of peak stress and reduction loss. Cortical bone was below 2 % and trabecular strain was below 10 % for all scenarios. Conclusion Central placement of structural support provides superior stability for the treatment of depressed tibial plateau fractures compared to the eccentric placement. When a support is placed centrally, optimal stability is achieved when the diameter matches the diameter of the depressed region. Thus, the utilization of equal-diameter fillers to provide central support appears to be an ideal selection for depressed tibial plateau fractures.
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Affiliation(s)
- Xiaomeng Ren
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
| | - Yu Jiang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
| | - Da Teng
- Senior Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100089, China
| | - Xinmo Liu
- Senior Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100089, China
| | - Junsong Wang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
| | - Wei Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100089, China
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Mehdi B, Fteiti W, Balti W, Hadhri K, Kooli M, Ben Salah M. Initial description of the TEKTONA® technique for tibial plateau depression fractures. Orthop Traumatol Surg Res 2022; 108:103256. [PMID: 35219886 DOI: 10.1016/j.otsr.2022.103256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/21/2021] [Accepted: 04/30/2021] [Indexed: 02/03/2023]
Abstract
Reduction of depressed tibial plateau fractures with TEKTONA® is a percutaneous technique done with fluoroscopy guidance whose aim is to preserve the soft tissues and avoid hemorrhage. The anatomical result is close to that of open reduction with benefits such as reduced pain and early motion. This procedure was first described for vertebral compression fractures but has recently been applied to intra-articular long bone fractures. It consists of reducing depressed fragments with a system of expandable strips mounted on a rigid clamp. Fixation of the reduced fragments is done with cement; percutaneous fixation can be added. This technique is an interesting alternative to standard treatments. Mastery requires good knowledge of the various steps and comprehensive analysis of the depression on CT scan.
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Affiliation(s)
- Bellil Mehdi
- Service d'orthopédie et traumatologie, Hôpital Charles Nicolle de Tunis, boulevard 9-Avril, 1001 Tunis, Tunisia.
| | - Wadhah Fteiti
- Service d'orthopédie et traumatologie, Hôpital Charles Nicolle de Tunis, boulevard 9-Avril, 1001 Tunis, Tunisia
| | - Walid Balti
- Service d'orthopédie et traumatologie, Hôpital Charles Nicolle de Tunis, boulevard 9-Avril, 1001 Tunis, Tunisia
| | - Khaled Hadhri
- Service d'orthopédie et traumatologie, Hôpital Charles Nicolle de Tunis, boulevard 9-Avril, 1001 Tunis, Tunisia
| | - Mondher Kooli
- Service d'orthopédie et traumatologie, Hôpital Charles Nicolle de Tunis, boulevard 9-Avril, 1001 Tunis, Tunisia
| | - Mohamed Ben Salah
- Service d'orthopédie et traumatologie, Hôpital Charles Nicolle de Tunis, boulevard 9-Avril, 1001 Tunis, Tunisia
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3
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Castañeda S, Casas A, González-Del-Alba A, Martínez-Díaz-Guerra G, Nogués X, Ojeda Thies C, Torregrosa Suau Ó, Rodríguez-Lescure Á. Bone loss induced by cancer treatments in breast and prostate cancer patients. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2022; 24:2090-2106. [PMID: 35779210 PMCID: PMC9522722 DOI: 10.1007/s12094-022-02872-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/05/2022] [Indexed: 12/04/2022]
Abstract
Cancer and cancer therapies are a major factor risk for osteoporosis due to bone loss and deterioration of bone microarchitecture. Both factors contribute to a decrease in bone strength and, consequently, increased bone fragility and risk of fracture. Cancer-associated bone loss is a multifactorial process, and optimal interdisciplinary management of skeletal health, accurate assessment of bone density, and early diagnosis are essential when making decisions aimed at reducing bone loss and fracture risk in patients who have received or are receiving treatment for cancer. In this document, a multidisciplinary group of experts collected the latest evidence on the pathophysiology of osteoporosis and its prevention, diagnosis, and treatment with the support of the Spanish scientific society SEOM. The aim was to provide an up-to-date and in-depth view of osteoporotic risk and its consequences, and to present a series of recommendations aimed at optimizing the management of bone health in the context of cancer.
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Affiliation(s)
- Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Catedra UAM-Roche, EPID-Future, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Casas
- Department of Medical Oncology, Hospital Virgen del Rocío, Seville, Spain
| | | | - Guillermo Martínez-Díaz-Guerra
- Department of Endocrinology and Nutrition, Instituto de Investigación imas12, Universidad Complutense, Hospital 12 de Octubre, Madrid, Spain
| | - Xavier Nogués
- Department of Internal Medicine, Hospital del Mar, Hospital del Mar Research Institute (IMIM), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Universidad Pompeu Fabra, Barcelona, Spain
| | - Cristina Ojeda Thies
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Óscar Torregrosa Suau
- Department of Internal Medicine, Hospital General Universitario de Elche, Alicante, Spain
| | - Álvaro Rodríguez-Lescure
- Department of Medical Oncology, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03202, Alicante, Spain.
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Vendeuvre T, Koneazny C, Brèque C, Rigoard P, Severyns M, Germaneau A. Contribution of Minimally Invasive Bone Augmentation With PMMA Cement in Primary Fixation of Schatzker Type II Tibial Plateau Fractures. Front Bioeng Biotechnol 2022; 10:840052. [PMID: 35299640 PMCID: PMC8921932 DOI: 10.3389/fbioe.2022.840052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The most common type of fracture of the lateral tibial plateau is the Schatzker type II split-depressed fracture. Minimally invasive surgery using balloon reduction appears to be very promising compared to the gold standard using a bone tamp. This surgery aims to have the best reduction and stabilization to benefit from an early passive and active rehabilitation to avoid stiffening and muscle wasting. Using a balloon for fracture reduction has allowed the use of semi-liquid Injectable Bone Cement (IBC) fillers. These fillers can be phosphocalcic or polymethyl methacrylate (PMMA). The latest recommendations on these IBCs in spinal surgery increasingly rule out phosphocalcic fillers because of their low mechanical strength. Questions/purposes: 1) What is the mechanical influence of IBC filling (PMMA) regarding the split and depression components of a Schatzker type II fracture? 2) What is the mechanical influence of osteosynthesis regarding the split and depression components of a Schatzker type II fracture with or without PMMA filing in three different kinds of percutaneous fixations? Methods: This biomechanical study was performed on 36 fresh frozen tibia/fibula specimens. Six groups were formed according to the type of percutaneous osteosynthesis or possible PMMA filling. Mechanical strength tests were carried out using a Unicompartmental Knee prosthesis and displacement components were measured on either side of the separation on the anterolateral facet by optical method. Results: We found a significant difference between cementless and cemented osteosynthesis for depression fracture stabilization (difference −507.56N with 95% confidence interval [−904.17; −110.94] (p-value = 0.026)). The differences between the different types of osteosynthesis were not significant (p-value = 0.58). There was a significant difference between osteosynthesis without cement and osteosynthesis with cement on separation (difference −477.72N [−878.52; −76.93] (p-value = 0.03)). The differences between the different types of fixations were not significant regarding separation (p-value = 0.99). Conclusion: PMMA cement significantly improves primary stability, regardless of the type of osteosynthesis for a Schatzker type II plateau fracture. Filling with PMMA cement during tuberoplasty seems to be a very promising strategy in association with percutaneous osteosynthesis to allow rapid recovery after surgery.
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Affiliation(s)
- T. Vendeuvre
- Institut Pprime UPR 3346, CNRS, ISAE-ENSMA, Université de Poitiers, Poitiers, France
- Department of Orthopaedic Surgery and Traumatology, University Hospital, Poitiers, France
| | - C. Koneazny
- Department of Orthopaedic Surgery and Traumatology, University Hospital, Poitiers, France
| | - C. Brèque
- Institut Pprime UPR 3346, CNRS, ISAE-ENSMA, Université de Poitiers, Poitiers, France
| | - P. Rigoard
- Institut Pprime UPR 3346, CNRS, ISAE-ENSMA, Université de Poitiers, Poitiers, France
- PRISMATICS Lab, Department of Spine Surgery and Neuromodulation, University Hospital, Poitiers, France
| | - M. Severyns
- Institut Pprime UPR 3346, CNRS, ISAE-ENSMA, Université de Poitiers, Poitiers, France
- Department of Orthopaedic Surgery and Traumatology, University Hospital, Martinique, France
| | - A. Germaneau
- Institut Pprime UPR 3346, CNRS, ISAE-ENSMA, Université de Poitiers, Poitiers, France
- *Correspondence: A. Germaneau,
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Sabatini L, Aprato A, Camazzola D, Bistolfi A, Capella M, Massè A. Primary total knee arthroplasty in tibial plateau fractures: Literature review and our institutional experience. Injury 2021; 54 Suppl 1:S15-S23. [PMID: 33583591 DOI: 10.1016/j.injury.2021.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/16/2020] [Accepted: 02/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Displaced proximal tibia fractures in the elderly may be very difficult to manage. If osteosynthesis represents the standard of care in the younger patients, in the aged population this solution is controversial because a significant failure rate has been reported after internal fixation. Moreover, osteoarthritis progression following tibial plateau fractures is common, often requiring a subsequent total knee arthroplasty (TKA). In recent years, in order to overcome the fracture healing problems and to allow immediate full weight bearing, primary TKA after tibial plateau fractures in elderly patients has gained popularity. MATERIAL AND METHODS from 2015 to 2019, 11 tibial plateau fractures in elderly patients with pre-existing osteoarthritis were treated with a primary TKA. Age, gender, mechanism of trauma, pre-operative autonomy level, fractures classification, degree of osteoarthritis and intraoperative data (ligamentous stability and type of implant) were collected. After a mean follow-up of 28 months, Knee Society Score (KSS), post-operative autonomy level and Forgotten Joint Score (FJS) were evaluated. The radiological assessment (signs of loosening, limb axis and patellar height indices) and complications were also recorded. RESULTS according to fracture type and ligamentous competence, 6 cases of posterior-stabilized (PS) design and 5 cases of semi-constrained TKA were implanted. At the final follow up, mean KSS knee score was 83±16 and mean KSS functional score was 74±15. Mean pre-operative autonomy level assessed with the Parker scale, was significantly higher than the post-operative one (7.5±1.4 vs 5.6 ± 1.3). Mean FJS was 66 ± 14. No lines of radiolucency or limb malalignment were found at the final radiological follow-up. One major complication was recorded: one acute periprosthetic infection. One patient reported a periprosthetic femoral fracture after 26 months. CONCLUSION Based on our and results and those reported on literature, primary TKA is a suitable option in case of tibial plateau fractures in elderly patients with pre-existing osteoarthritis and poor bone quality, in which osteosynthesis outcome may be poor. Unlike ORIF, primary TKA may allow immediate weightbearing and a faster recovery. Nevertheless, it is a demanding surgery with a significant complications rate and should be reserved for selected patients and experienced surgeons.
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Affiliation(s)
- Luigi Sabatini
- University of Turin, Viale 25 aprile 137 int 6, Torino 10133, Italy
| | - Alessandro Aprato
- University of Turin, Viale 25 aprile 137 int 6, Torino 10133, Italy.
| | | | | | - Marcello Capella
- University of Turin, Viale 25 aprile 137 int 6, Torino 10133, Italy
| | - Alessandro Massè
- University of Turin, Viale 25 aprile 137 int 6, Torino 10133, Italy
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6
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Injection of Calcium Phosphate Apatitic Cement/Blood Composites in Intervertebral Fusion Cages: A Simple and Efficient Alternative to Autograft Leading to Enhanced Spine Fusion. Spine (Phila Pa 1976) 2020; 45:E1288-E1295. [PMID: 32694485 DOI: 10.1097/brs.0000000000003598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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7
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Sinha A, Maffulli N. Balloon tibioplasty for tibial plateau fractures. Surgeon 2020; 19:297-309. [PMID: 32958409 DOI: 10.1016/j.surge.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/26/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tibial plateau fractures are complex intra-articular injuries. The aim of treatment is to restore joint congruity and alignment. Balloon tibioplasty is a novel, minimally invasive technique to reduce the fracture and restore the continuity of the articular surface. A systematic review was performed according to the PRISMA guidelines in order to assess the outcomes from this procedure. SOURCES OF DATA The online databases of Pubmed, Google scholar, the Cochrane Library, EMBASE and CINAHL were searched. Articles of interest were retrieved and evaluated, including case series, randomised controlled trials and cadaver studies. AREAS OF AGREEMENT Eight studies (one randomised controlled trial, four case series and three cadaver studies) were included in the final review. The studies demonstrated adequate fracture reduction with favourable clinical and imaging outcomes from balloon tibioplasty. Very few complications were described. AREAS OF CONTROVERSY There is a small volume of literature currently available on balloon tibioplasty with an overall low level of evidence. The overall number of reported cases is also small. GROWING POINTS Further research is necessary, with adequately powered randomised controlled trials. Further areas of research include type of bone substitute and the use of arthroscopically assisted surgery.
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Affiliation(s)
- Amit Sinha
- Department of Orthopaedics, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, UK; Wales Deanery, Ty Dysgu, Cefn Coed, Nantgarw, CF15 7QQ, UK
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
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8
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Sareen A, Lal H, Kareem SA. Innovative Use of Posterior Vertebral Wall Impactor in Tibial Plateau Depressed Fractures. Indian J Orthop 2020; 54:336-342. [PMID: 33194110 PMCID: PMC7609769 DOI: 10.1007/s43465-020-00257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/07/2020] [Indexed: 02/04/2023]
Abstract
Depressed articular fractures of tibial plateau are treated by elevation of the fracture fragments to maintain the articular congruity and filling the void with any bone substitutes, followed by screw or plate fixation. This elevation of the fragments to maintain articular congruity poses a surgical challenge even in experienced hands. Many techniques have been described for the same, as the use of the metallic-bone-tamps, elevators and more recently inflatable-balloon-tamps. But due to the lesser cross-section area, these often led to comminution of the fragile articular bone fragments. The inflatable-balloon-tamp caused extrusion of contrast-dye or unintentional posterior-wall displacement. We treated a series of 25 patients with tibial plateau depressed fractures by a novel technique using posterior-vertebral-body-wall-impactor. This helped in a uniform dissipation of force over a large cross-sectional area under the fracture fragment, leading to minimal comminution of the depressed fragment, maintaining the articular congruency. Rest of the fixation was done in the standard manner. There were no intra-operative or post-operative complications. All patients had good knee function according to Rasmussen Knee Function Grading System and achieved radiological union of fracture at follow-up (with a range of 12-18 months). Hence, this technique may be a safer and effective alternative for the elevation of depressed articular fractures of tibia.
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Affiliation(s)
- Atul Sareen
- grid.416888.b0000 0004 1803 7549Orthopaedics Department, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Hitesh Lal
- grid.416888.b0000 0004 1803 7549Orthopaedics Department, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Shaffaf Abdul Kareem
- grid.416888.b0000 0004 1803 7549Orthopaedics Department, VMMC and Safdarjung Hospital, New Delhi, 110029 India ,A-5, White Field, Jewel Homes, SRM Road, Ernakulam, Kerala 682018 India
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9
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Wang Z, Tian S, Zhao K, Zhang R, Yin Y, Zhu Y, Hou Z, Zhang Y. Neutrophil to lymphocyte ratio and fracture severity in young and middle-aged patients with tibial plateau fractures. INTERNATIONAL ORTHOPAEDICS 2020; 44:2769-2777. [PMID: 32897401 DOI: 10.1007/s00264-020-04793-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/01/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The neutrophil-to-lymphocyte ratio (NLR) has recently been found to be closely associated with the severity of trauma. This study aimed to analyze the correlation between the imaging severity of isolated tibial plateau fractures (TPFs) and the NLR in the blood. METHODS A total of 223 patients with isolated TPFs were enrolled in this retrospective study over five years. The data at hospital admission were extracted from an electronic database. Schatzker classification was performed according to the imaging data by two experienced orthopaedic surgeons. All patients were divided into two groups: group 1 included patients with mild-to-moderate fractures (Schatzker types I-IV), and group 2 included patients with severe fractures (Schatzker types V-VI). The NLR levels at hospital admission were statistically compared between the two groups. RESULTS The blood NLR, hemoglobin level, red blood cell count, neutrophil count, platelet count, time from injury to admission, total protein, and Na+ levels were significantly different among the two groups. According to the receiver operating characteristic (ROC) curve, the cutoff for the NLR was 5.8. ROC curve analysis showed that the sensitivity of an NLR ≥ 5.8 to predict severe TPFs was 53.4%, and the specificity was 70.7%. In the multivariate analysis, NLR ≥ 5.8 and haemoglobin < lower limit appeared to be independent predictors of severe TPFs. CONCLUSIONS Our study is the first to demonstrate that the NLR level appears to be a useful biomarker for predicting the severity of isolated TPFs in young and middle-aged adults.
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Affiliation(s)
- Zhongzheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China
| | - Siyu Tian
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China
| | - Ruipeng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China.
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10
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Comparison of cannulated lag screws and lateral locking plate in the treatment of Schatzker type II tibial plateau fractures. Jt Dis Relat Surg 2020; 31:130-6. [PMID: 32160506 PMCID: PMC7489126 DOI: 10.5606/ehc.2020.66654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objectives
This study aims to compare the clinical and radiological outcomes of the two fixation methods frequently used in the treatment of Schatzker type II fractures: lag screw fixation and lateral anatomic plate fixation. Patients and methods
This retrospective study, which was conducted between January 2005 and December 2014, included 61 patients (41 males, 20 females; mean age 43.4±13.1 years; range, 20 to 76 years) with Schatzker type II (Orthopaedic Trauma Association (OTA)/Arbeitsgemeinschaft für Osteosynthesefragen (AO) 41-B3) fractures. Patients were divided into two groups according to the type of surgery as cannulated lag screw fixation group (group 1, n=24, 39.4%) and lateral locking plate fixation group (group 2, n=37, 60.6%). Intraoperative mediolateral and anteroposterior instability were measured. Final knee flexion- extention range of motion (ROM), single-leg hop test, Knee Society Score (KSS), Hospital for Special Surgery (HSS) and short form 36 (SF36) scores were obtained at the last follow-up. Results
The mean age of patients was 42.1±13.8 years in group 2 and 45.5±12.2 years in group 1. The mean follow-up period was 34±4 months. Minimal or no arthritis was detected in 75% (n=18) of patients in group 1 and 78% (n=29) of patients in group 2 (p=0.27). Single leg-hop test results (p=0.55), final follow-up knee ROM (p=0.40), KSS (p=0.21), HSS (p=0.15), and SF36 scores of group 1 were similar to group 2. In group 1, the duration of surgery was shorter (p<0.001) and the cost of treatment was lower (p<0.001). Conclusion Treatment of Schatzker type II tibial plateau fractures with lag screws seems to provide less invasive, cheaper, and faster surgical treatment as compared with lateral locking plate fixation. In addition, patients who underwent internal fixation with lag screws had similar clinical and radiological outcomes with those who underwent lateral locking plate fixation.
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11
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Cuzzocrea F, Jannelli E, Ivone A, Perelli S, Fioruzzi A, Ghiara M, Zanon G, Benazzo F. Arthroscopic-Guided Balloon Tibioplasty in Schatzker III Tibial Plateau Fracture. JOINTS 2019; 6:220-227. [PMID: 31879718 PMCID: PMC6930121 DOI: 10.1055/s-0039-1697607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 08/06/2019] [Indexed: 02/08/2023]
Abstract
Purpose
The study aims to present the results at a mean 28-months follow-up of arthroscopic-guided balloon tibioplasty and to spot some technical tricks and some practice using tools and materials.
Methods
The study relates to six patients with tibial plateau fractures type Schatzker III with tibial plateau depression more than 4 mm at preoperative computed tomography scan (CT-scan). The follow-up period ranged from 22 to 33 months, with a mean of 28 months. No patients were lost to follow-up. The patients were evaluated clinically using the Rasmussen score system and Lysholm score systems at 6 to 12 and 24 months, postoperatively. Radiographic evaluations (standard X-rays) were done preoperatively at 1, 3, and 12 months postoperatively while a CT-scan with 3D reconstruction was performed preoperatively, at the first day and 6 months, postoperatively.
Results
The mean Rasmussen clinical score at 6 months postoperatively was 26.3 while at 1-year postoperatively the mean Rasmussen clinical score was 28.33. At 2-year postoperatively the mean Rasmussen clinical score was 28.83. Statistically significant difference was found in 6-months and 2-years results (
p
< 0.05). CT-scan achieved the first postoperative day showed the recovery of approximately 70% of the area of the interested tibial plateau, restoring of the joint surface without articular bone free fragments.
Conclusion
The described surgical procedure, if correctly performed with proper indications (Schatzker III), respect the principles mentioned above and the clinical and radiological results confirm our purpose.
Level of Evidence
This is a therapeutic case series, level IV study.
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Affiliation(s)
- Fabrizio Cuzzocrea
- Department of Orthopaedics and Traumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Eugenio Jannelli
- Department of Orthopaedics and Traumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Alessandro Ivone
- Department of Orthopaedics and Traumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Simone Perelli
- Department of Orthopaedics and Traumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Alberto Fioruzzi
- Department of Orthopaedics and Traumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Matteo Ghiara
- Department of Orthopaedics and Traumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Giacomo Zanon
- Department of Orthopaedics and Traumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Francesco Benazzo
- Department of Orthopaedics and Traumatology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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12
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Vendeuvre T, Monlezun O, Brandet C, Ingrand P, Durand-Zaleski I, Gayet LE, Germaneau A, Khiami F, Roulaud M, Herpe G, Rigoard P. Comparative evaluation of minimally invasive 'tibial tuberoplasty' surgical technique versus conventional open surgery for Schatzker II-III tibial plateau fractures: design of a multicentre, randomised, controlled and blinded trial (TUBERIMPACT study). BMJ Open 2019; 9:e026962. [PMID: 31481365 PMCID: PMC6731842 DOI: 10.1136/bmjopen-2018-026962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Fractures of the tibial plateau are in constant progression. They affect an elderly population suffering from a number of comorbidities, but also a young population increasingly practicing high-risk sports. The conventional open surgical technique used for tibial plateau fractures has several pitfalls: bone and skin devascularisation, increased risks of infection and functional rehabilitation difficulties. Since 2011, Poitiers University Hospital is offering to its patients a new minimally invasive technique for the reduction and stabilisation of tibial plateau fractures, named 'tibial tuberoplasty'. This technique involves expansion of the tibial plateau through inflation using a kyphoplasty balloon, filling of the fracture cavity with cement and percutaneous screw fixation. We designed a study to evaluate the quality of fracture reduction offered by percutaneous tuberoplasty versus conventional open surgery for tibial plateau fracture and its impact on clinical outcome. METHODS AND ANALYSIS This is a multicentre randomised controlled trial comparing two surgical techniques in the treatment of tibial plateau fractures. 140 patients with a Schatzker II or III tibial plateau fracture will be recruited in France. They will be randomised either in tibial tuberoplasty arm or in conventional surgery arm. The primary outcome is the postoperative radiological step-off reduction blindly measured on CT scan (within 48 hours post-op). Additional outcomes include other radiological endpoints, pain, functional abilities, quality of life assessment and health-economic endpoints. Outcomes assessment will be performed at baseline (before surgery), at day 0 (surgery), at 2, 21, 45 days, 3, 6, 12 and 24 months postsurgery. ETHICS AND DISSEMINATION This study has been approved by the ethics committee Ile-De-France X and will be conducted in accordance with current Good Clinical Practice (GCP) guidelines, Declaration of Helsinki and standard operating procedures. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER Clinicaltrial.gov:NCT03444779.
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Affiliation(s)
- Tanguy Vendeuvre
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Spine and Neuromodulation Functional Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Poitiers University, Poitiers, France
- Institut Pprime, Futuroscope, Poitou-Charentes, France
| | - Olivier Monlezun
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Claire Brandet
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Pierre Ingrand
- UFR Medecine et Pharmacie, Universite de Poitiers, Poitiers, France
| | | | - Louis-Etienne Gayet
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - Frederic Khiami
- Department of Orthopaedic Surgery and Traumatology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Manuel Roulaud
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Guillaume Herpe
- Department of Radiology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Philippe Rigoard
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Spine and Neuromodulation Functional Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Poitiers University, Poitiers, France
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13
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Le Ferrec M, Mellier C, Lefèvre FX, Boukhechba F, Janvier P, Montavon G, Bouler JM, Gauthier O, Bujoli B. In vivo resorption of injectable apatitic calcium phosphate cements: Critical role of the intergranular microstructure. J Biomed Mater Res B Appl Biomater 2019; 108:367-376. [PMID: 31033211 DOI: 10.1002/jbm.b.34395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 12/21/2022]
Abstract
The in vivo resorption rate of two injectable apatitic calcium phosphate cements used in clinics (Graftys® HBS and NORIAN®) was compared, using a good laboratory practice (GLP) study based on an animal model of critical-sized bone defect. To rationalize the markedly different biological properties observed for both cements, key physical features were investigated, including permeability and water-accessible porosity, total porosity measured by mercury intrusion and gravimetry, and microstructure. Due to a different concept for creating porosity between the two cements investigated in this study, a markedly different microstructural arrangement of apatite crystals was observed in the intergranular space, which was found to significantly influence both the mechanical strength and in vivo degradation of the two calcium phosphate cements.
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Affiliation(s)
- Myriam Le Ferrec
- Graftys SA, Pôle d'activités d'Aix en Provence, Aix en Provence, France.,SUBATECH, UMR CNRS 6457, IMT Atlantique Bretagne-Pays de la Loire, Nantes, France
| | - Charlotte Mellier
- Graftys SA, Pôle d'activités d'Aix en Provence, Aix en Provence, France
| | | | | | - Pascal Janvier
- CEISAM, Université de Nantes, CNRS, UMR 6230, Nantes, France
| | - Gilles Montavon
- SUBATECH, UMR CNRS 6457, IMT Atlantique Bretagne-Pays de la Loire, Nantes, France
| | | | - Olivier Gauthier
- RMeS, UMR 1229, Université de Nantes, INSERM, Nantes, France.,ONIRIS, Nantes Atlantic College of Veterinary Medicine, Nantes, France
| | - Bruno Bujoli
- CEISAM, Université de Nantes, CNRS, UMR 6230, Nantes, France
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14
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Percutaneous injection of calcium phosphate composite in pediatric unicameral bone cysts: a minimum 5-year follow-up study. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-018-0513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Wang JQ, Jiang BJ, Guo WJ, Zhang WJ, Li AB, Zhao YM. Arthroscopic-assisted balloon tibioplasty versus open reduction internal fixation (ORIF) for treatment of Schatzker II-IV tibial plateau fractures: study protocol of a randomised controlled trial. BMJ Open 2018; 8:e021667. [PMID: 30093519 PMCID: PMC6089321 DOI: 10.1136/bmjopen-2018-021667] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Arthroscopic-assisted balloon tibioplasty is an emerging technology that has shown advantages in recovering depression of the articular surface. However, studies evaluating clinical outcomes between arthroscopic-assisted balloon tibioplasty and traditional open reduction internal fixation (ORIF) are sparse. This is the first randomised study to compare arthroscopic-assisted balloon tibioplasty with ORIF, and will provide guidance for treating patients with Schatzker types II, III and IV with depression of the medial tibial plateau only. METHODS AND ANALYSIS A blinded randomised controlled trial will be conducted and a total of 80 participants will be randomly divided into either the arthroscopic-assisted balloon tibioplasty group or the ORIF group, at a ratio of 1:1. The primary clinical outcome measures are the knee functional scores, Rasmussen radiological evaluation scores and the quality of reduction based on postoperative CT scan. Secondary clinical outcome measures are intraoperative blood loss, surgical duration, visual analogue scale score after surgery, hospital duration after surgery, complications and 36-Item Short-Form Health Survey score. ETHICS AND DISSEMINATION This study has been reviewed and approved by the Institutional Review Board of the Second Affiliated Hospital of Wenzhou Medical University (batch: 2017-12). The results will be presented in peer-reviewed journals after completion of the study. TRIAL REGISTRATION NUMBER NCT03327337, Pre-results.
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Affiliation(s)
- Ji-Qi Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bing-Jie Jiang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei-Jun Guo
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei-Jiang Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - A-Bing Li
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - You-Ming Zhao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
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16
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Belaid D, Vendeuvre T, Bouchoucha A, Brémand F, Brèque C, Rigoard P, Germaneau A. Utility of cement injection to stabilize split-depression tibial plateau fracture by minimally invasive methods: A finite element analysis. Clin Biomech (Bristol, Avon) 2018; 56:27-35. [PMID: 29777960 DOI: 10.1016/j.clinbiomech.2018.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/16/2018] [Accepted: 05/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment for fractures of the tibial plateau is in most cases carried out by stable fixation in order to allow early mobilization. Minimally invasive technologies such as tibioplasty or stabilization by locking plate, bone augmentation and cement filling (CF) have recently been used to treat this type of fracture. The aim of this paper was to determine the mechanical behavior of the tibial plateau by numerically modeling and by quantifying the mechanical effects on the tibia mechanical properties from injury healing. METHODS A personalized Finite Element (FE) model of the tibial plateau from a clinical case has been developed to analyze stress distribution in the tibial plateau stabilized by balloon osteoplasty and to determine the influence of the cement injected. Stress analysis was performed for different stages after surgery. FINDINGS Just after surgery, the maximum von Mises stresses obtained for the fractured tibia treated with and without CF were 134.9 MPa and 289.9 MPa respectively on the plate. Stress distribution showed an increase of values in the trabecular bone in the treated model with locking plate and CF and stress reduction in the cortical bone in the model treated with locking plate only. INTERPRETATION The computed results of stresses or displacements of the fractured models show that the cement filling of the tibial depression fracture may increase implant stability, and decrease the loss of depression reduction, while the presence of the cement in the healed model renders the load distribution uniform.
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Affiliation(s)
- D Belaid
- Department of Mechanical Engineering, Faculty of Technology Sciences, University of Mentouri Brothers - Constantine, P.O. Box 325, Ain-El-Bey Way, Constantine 25017, Algeria; Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France
| | - T Vendeuvre
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; Department of Orthopaedic Surgery and Traumatology, CHU Poitiers, Poitiers, France; Spine & neuromodulation functional unit, Department of neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
| | - A Bouchoucha
- Department of Mechanical Engineering, Faculty of Technology Sciences, University of Mentouri Brothers - Constantine, P.O. Box 325, Ain-El-Bey Way, Constantine 25017, Algeria
| | - F Brémand
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France
| | - C Brèque
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; ABS Lab, Université de Poitiers, France
| | - P Rigoard
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; Spine & neuromodulation functional unit, Department of neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
| | - A Germaneau
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.
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17
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Chang HR, Yu YY, Ju LL, Zheng ZL, Chen W, Zhang YZ. Percutaneous Reduction and Internal Fixation for Monocondylar Fractures of Tibial Plateau: A Systematic Review. Orthop Surg 2018; 10:77-83. [PMID: 29770577 DOI: 10.1111/os.12372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 01/15/2023] Open
Abstract
Instead of extensive dissection of soft tissue around the fracture site, percutaneous techniques have unique advantages in managing displaced fragments, including preservation of soft tissues, less blood loss, lower risk of complications, and earlier functional rehabilitation. However, there are few systematic reviews on the effects of percutaneous reduction and internal fixation (PRIF) for tibial plateau fractures. A systematic search of Cochrane, EMBASE, and MEDLINE databases was performed for all publicly available data in March 2017 regarding the use of PRIF in treating monocondylar tibial plateau fractures. Basic information of included articles, surgical information, clinical outcomes, and concomitant soft tissue injuries were collected for analysis. Finally, a total of 20 articles including 561 patients were retrieved. Traffic accident was the most common cause of injury. Percutaneous techniques using bone tamp reduction were described in all studies. The majority (≥85%) of patients were classified as excellent or good according to clinical and radiological Rasmussen scores. The overall complication rate was 6.6%, with loss of reduction the most frequent complication with an incidence of 2.4%. This systematic review indicated that PRIF was an optimal alternative that physicians should consider for the treatment of monocondylar tibial plateau fractures.
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Affiliation(s)
- Heng-Rui Chang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Yi-Yang Yu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Lin-Lin Ju
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhan-le Zheng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| | - Ying-Ze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
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18
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Sun DH, Zhao Y, Zhang JT, Zhu D, Qi BC. Anterolateral tibial plateau osteotomy as a new approach for the treatment of posterolateral tibial plateau fracture: A case report. Medicine (Baltimore) 2018; 97:e9669. [PMID: 29505010 PMCID: PMC5779779 DOI: 10.1097/md.0000000000009669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
RATIONALE It is challenging to visualize and reduce a posterolateral tibial plateau fracture through an anterolateral approach as the tibial plateau fragments are often covered by the fibular head and ligamentous structures. PATIENT CONCERNS In this case report, we describe a patient with a depression fracture of the posterolateral quadrant combined with a split fracture of the posteromedial quadrant and an avulsion fracture of the tibial intercondylar eminence. DIAGNOSES Tibial plateau fracture(AO type 41-B3). INTERVENTIONS A posteromedial approach combined with an anterolateral approach and an osteotomy involving the proximal tibiofibular joint of the tibial plateau was used to expose, reduce, and fix the fracture. OUTCOMES There was no risk of injury to the common peroneal nerve or ligaments. The patient is recovering well and is satisfied with the function of the injured knee. LESSONS We recommend anterolateral tibial plateau osteotomy for the treatment of posterolateral tibial plateau fractures in clinical practice.
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19
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Le Ferrec M, Mellier C, Boukhechba F, Le Corroller T, Guenoun D, Fayon F, Montouillout V, Despas C, Walcarius A, Massiot D, Lefèvre FX, Robic C, Scimeca JC, Bouler JM, Bujoli B. Design and properties of a novel radiopaque injectable apatitic calcium phosphate cement, suitable for image-guided implantation. J Biomed Mater Res B Appl Biomater 2017; 106:2786-2795. [PMID: 29226553 DOI: 10.1002/jbm.b.34059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/09/2017] [Accepted: 11/18/2017] [Indexed: 12/12/2022]
Abstract
An injectable purely apatitic calcium phosphate cement (CPC) was successfully combined to a water-soluble radiopaque agent (i.e., Xenetix® ), to result in an optimized composition that was found to be as satisfactory as poly(methyl methacrylate) (PMMA) formulations used for vertebroplasty, in terms of radiopacity, texture and injectability. For that purpose, the Xenetix dosage in the cement paste was optimized by injection of the radiopaque CPC in human cadaveric vertebrae under classical PMMA vertebroplasty conditions, performed by interventional radiologists familiar with this surgical procedure. When present in the cement paste up to 70 mg I mL-1 , Xenetix did not influence the injectability, cohesion, and setting time of the resulting composite. After hardening of the material, the same observation was made regarding the microstructure, mechanical strength and alpha-tricalcium phosphate to calcium deficient apatite transformation rate. Upon implantation in bone in a small animal model (rat), the biocompatibility of the Xenetix-containing CPC was evidenced. Moreover, an almost quantitative release of the contrast agent was found to occur rapidly, on the basis of in vitro static and dynamic quantitative studies simulating in vivo implantation. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2786-2795, 2018.
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Affiliation(s)
- Myriam Le Ferrec
- Graftys SA, Eiffel Park, Bâtiment D, Pôle d'activités d'Aix en Provence, 13854 Aix en Provence CEDEX 3, France
| | - Charlotte Mellier
- Graftys SA, Eiffel Park, Bâtiment D, Pôle d'activités d'Aix en Provence, 13854 Aix en Provence CEDEX 3, France
| | - Florian Boukhechba
- Graftys SA, Eiffel Park, Bâtiment D, Pôle d'activités d'Aix en Provence, 13854 Aix en Provence CEDEX 3, France
| | - Thomas Le Corroller
- Hôpitaux Sud - Hôpital Sainte-Marguerite, CHU APHM, 13274, Marseille Cedex 9, France
| | - Daphné Guenoun
- Hôpitaux Sud - Hôpital Sainte-Marguerite, CHU APHM, 13274, Marseille Cedex 9, France
| | - Franck Fayon
- CNRS, UPR 3079, CEMHTI, 45071, Orléans Cedex 02, France
| | | | - Christelle Despas
- Université de Lorraine, CNRS, UMR 7564, LCPME, 54600, Villers-lès-Nancy, France
| | - Alain Walcarius
- Université de Lorraine, CNRS, UMR 7564, LCPME, 54600, Villers-lès-Nancy, France
| | | | - François-Xavier Lefèvre
- Université de Nantes, CNRS, UMR 6230, CEISAM, UFR Sciences et Techniques, BP 92208, 44322, NANTES Cedex 3, France
| | | | - Jean-Claude Scimeca
- Université Côte d'Azur, CNRS, Inserm, iBV, UMR 7277, Tour Pasteur, UFR Médecine, 06107, Nice Cedex 02, France
| | - Jean-Michel Bouler
- Université de Nantes, CNRS, UMR 6230, CEISAM, UFR Sciences et Techniques, BP 92208, 44322, NANTES Cedex 3, France
| | - Bruno Bujoli
- Université de Nantes, CNRS, UMR 6230, CEISAM, UFR Sciences et Techniques, BP 92208, 44322, NANTES Cedex 3, France
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20
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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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21
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Abstract
The effective management of articular impacted fractures requires the successful elevation of the osteochondral fragment to eliminate joint incongruency and the stable fixation of the fragments providing structural support to the articular surface.The anatomical restoration of the joint can be performed either with elevation through a cortical window, through balloon-guided osteoplasty or direct visualisation of the articular surface.Structural support of the void created in the subchondral area can be achieved through the use of bone graft materials (autologous tricortical bone), or synthetic bone graft substitutes.In the present study, we describe the available techniques and materials that can be used in treating impacted osteochondral fragments with special consideration of their epidemiology and treatment options. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160072. Originally published online at www.efortopenreviews.org.
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Affiliation(s)
- Ippokratis Pountos
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK
| | - Peter V. Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, and NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, Leeds, UK
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22
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Miquel J, Santana F, Torrens C. A vast majority of preliminary reports published in the shoulder literature are not followed by long-time follow-up studies - a literature review. INTERNATIONAL ORTHOPAEDICS 2016; 41:869-875. [PMID: 27194160 DOI: 10.1007/s00264-016-3228-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/05/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of paper is to check how many preliminary reports (PR) reach a long-term publication (LT), and analyse differences in outcomes and complications between them. METHODS A literature search was performed to identify shoulder preliminary or early reports. Fifty one papers fulfilled criteria and were categorized for paper topic. Bibliographic searches were undertaken to find LT on the topic from the same author or research group. Outcomes and complications reported in PR were recorded and compared to those reported in LT. RESULTS Ten out of 51 PR (19.61 %) were followed by a LT with minimum follow-up of five years, by the same authors. Complication and reintervention rate were higher in the LT compared to PR (p < 0.05). Results published on PR were better than results published on LT even though these differences did not reach significance (p = 0.08). DISCUSSION PR may represent the fastest way to spread new findings. However, concerns regarding short-term follow-up, small sample size bias and decrease in outcomes over time can discourage promising preliminary results. CONCLUSIONS The vast majority of preliminary reports never reached a LT follow-up paper. Preliminary reports underestimate complications and tend to overestimate outcomes.
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Affiliation(s)
- Joan Miquel
- Orthopaedics & Trauma Department, Consorci Sanitari de l'Anoia, Avinguda Catalunya, 11, (08700), Igualada, Spain.
| | - Fernando Santana
- Orthopaedics & Trauma Department, Parc de Salut Mar. Barcelona, Passeig Marítim, 25-29, (08003), Barcelona, Spain
| | - Carlos Torrens
- Orthopaedics & Trauma Department, Parc de Salut Mar. Barcelona, Passeig Marítim, 25-29, (08003), Barcelona, Spain
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