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Zhu B, Chen J, Zhang Y, Song L, Fang J. Revisiting the flexion-valgus type unicondylar posterolateral tibial plateau depression fracture pattern: classification and treatment. J Orthop Surg Res 2023; 18:825. [PMID: 37919777 PMCID: PMC10621237 DOI: 10.1186/s13018-023-04318-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE This study aimed to reclassify posterolateral tibial plateau fractures caused by a flexion-valgus force and describe this fracture pattern to provide a relatively programmed surgical treatment based on morphological characteristics that may improve reduction and stabilization. METHODS We retrospectively reviewed the fracture pattern and injury mechanism of patients with posterolateral tibial plateau fractures who underwent surgery at the First Affiliated Hospital of Nanjing Medical University between January 2014 and April 2020. The cohort was divided into three types. Type I was a depression fracture of the posterolateral platform with an intact posterolateral cortex. Type II was a depression fracture of the posterolateral platform with a disrupted posterolateral cortex. Type III was a depression fracture of the posterolateral platform in combination with anterior cruciate ligament (ACL) rupture or tibial insertion avulsion fracture of the ACL. The lateral window of the modified Frosch approach with an L-type locking plate was used for patients with type I and type III fractures. For patients with type II fractures, both lateral and posterolateral windows of the modified Frosch approach were used for surgery, and a T-plate on the posterior side with an L-plate on the lateral side were used for fixation. The Rasmussen radiology scoring was used to evaluate the quality of surgical reduction and the Rasmussen functional scoring evaluation standard was used to evaluate knee joint function. RESULTS A total of 69 tibial plateau fractures (36 male, 33 female) involving the posterolateral platform were discovered and included in this study. All patients suffered flexion-valgus force at the moment of the accident. There were 32 cases of Type I fracture, 28 cases of Type II fracture, and 9 cases of Type III fracture. The patients were followed up for 12-30 (mean 20.8 ± 9.4) months. The postoperative Rasmussen radiological scores for the three types of fractures were 15-17 (mean 16.31 ± 0.78), 14-17 (mean 15.93 ± 0.94), and 14-17 (mean 16.22 ± 0.97), respectively. The postoperative Rasmussen functional scores for the three types of fractions were 27-30 (mean 27.97 ± 0.90), 27-29 (mean 27.36 ± 0.56), and 27-29 (mean 27.56 ± 0.73), respectively. CONCLUSION Flexion-valgus posterolateral tibial plateau fractures were divided into three types based on the integrity of the posterolateral wall and ACL injuries. We hope the classification can play a certain reference role in recognizing and treating flexion-valgus-type posterolateral tibial plateau fractures.
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Affiliation(s)
- Bin Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Chen
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lijun Song
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiahu Fang
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Ren W, Zhang W, Jiang S, Peng J, She C, Li L, Mao Y, Zhou H, Xu W. The Study of Biomechanics and Clinical Anatomy on a Novel Plate Designed for Posterolateral Tibial Plateau Fractures via Anterolateral Approach. Front Bioeng Biotechnol 2022; 10:818610. [PMID: 35350185 PMCID: PMC8957850 DOI: 10.3389/fbioe.2022.818610] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/17/2022] [Indexed: 12/29/2022] Open
Abstract
There is no consensus about the optimal internal fixation selection for treatment of posterolateral tibial plateau fracture. This study described a novel plate through an anterolateral approach for posterolateral tibial plateau fractures (PTPFs). We evaluated the biomechanical performance of a novel plate and two conventional internal implants and investigated the anatomic feasibility of the novel plate. The fracture models were randomly assigned into six groups: Groups A–C were the model groups of posterolateral split fracture, fixed with the posterior buttress plate, the lateral locking plate, and the novel plate, respectively. Groups D–E were the model groups of posterolateral depression fracture, fixed with the posterior buttress plate, the lateral locking plate, and the novel plate, respectively. We evaluated the biomechanical performance of six model groups by the biomechanical testing and finite element analysis. Progressively increasing axial compressive loads were applied to each synthetic fracture model by using a customized indentor under 250–750 N loads. Meanwhile, we dissected 12 fresh frozen knee specimens and fixed them with the novel plate through the anterolateral approach. We recorded the adjacency of the novel plate to important anatomic structures. Biomechanical testing showed that the novel plate had the least displacement, followed by the posterior buttress plate, and the lateral plate had the most displacement in posterolateral split fracture. There was no significant difference in the displacement between the novel plate and the lateral plate at different loads in posterolateral depression fractures. And the posterior buttress plate showed the most displacement. In the finite element analysis, the maximum stress values of Groups A, B, and C were 383.76, 414.63, and 305.07 MPa under the load of 750 N, respectively. The maximum stress values of Groups D, E, and F were 474.28, 436.31, and 413.4 MPa under the load of 750 N, respectively. In the anatomic study, the placement of the novel plate had a low risk of damage to the important anatomic structures of knee posterolateral corner. The novel plate could be a great choice for the treatment of PTPFs due to better biomechanical performance and easy manipulation.
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Affiliation(s)
- Weizhi Ren
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wen Zhang
- Orthopedic Institute, Soochow University, Suzhou, China
| | - Shijie Jiang
- Department of Orthopedics, Changzhou No. 2 People’s Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Jian Peng
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Haibin Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Wei Xu, ; Haibin Zhou,
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Wei Xu, ; Haibin Zhou,
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Gencer B, Doğan Ö, Çalışkan E, İğdir V, Biçimoğlu A. Single versus double plating for bicondylar tibia plateau fractures: Comparison of range of motion, muscle strength, clinical outcomes and accelerometer-measured physical activity levels. Knee 2022; 34:187-194. [PMID: 34959135 DOI: 10.1016/j.knee.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 10/30/2021] [Accepted: 12/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Optimal treatment of bicondylar plateau fractures is still a matter of debate. Accelerometer-measured physical activity levels may help us to obtain objective information regarding the quality of life of patients. The aim of this study was to compare the physical activity levels, objective and subjective functional results and stabilities of fixations of patients with treated bicondylar plateau fractures. METHODS In this cross-sectional study of 23 patients, accelerometer-measured physical activity levels, daily energy consumption and measurements of knee joint range of motion (ROM) and muscle strength were measured. While Knee Injury and Osteoarthritis Outcome Score (KOOS) was used as a patient-reported outcome measurement, Rasmussen Radiological Score was used for radiological evaluation. RESULTS There was no significant difference between the groups in terms of physical activity levels and daily energy consumption (P = 0.667). While Total KOOS, Symptom and Stiffness and Sports Activities scores were higher in patients with a single plate (P = 0.034, P = 0.003 and P = 0.014, respectively), knee flexion and extension ROM and flexor and extensor muscle strength were similar between groups (P = 0.405, P = 0.095, P = 0.982 and P = 0.988, respectively). CONCLUSIONS While patient-reported outcome measurements were better with single plating, there was no difference between the groups in terms of physical activity levels, ROM, muscle strength and radiological results. Although it should be kept in mind that the choice of the primary surgeon, the condition of the soft tissue and the fracture geometry are also effective in the decision-making process, single plating seems to be a valid surgical option in the treatment of bicondylar plateau fractures.
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Affiliation(s)
- Batuhan Gencer
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Ankara, Turkey.
| | - Özgür Doğan
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Ankara, Turkey
| | - Emrah Çalışkan
- Koç University Medical Faculty, Orthopaedics and Traumatology Department, İstanbul, Turkey
| | - Volkan İğdir
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Ankara, Turkey
| | - Ali Biçimoğlu
- Ankara City Hospital, Orthopaedics and Traumatology Clinic, Ankara, Turkey
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"Out-in" position in the surgical treatment of three-column tibial plateau fractures: A technical note. Injury 2021; 52:1074-1078. [PMID: 33131792 DOI: 10.1016/j.injury.2020.10.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023]
Abstract
Three-column classification of tibial plateau fractures is based on computerized tomography (CT) images, and the patients with three-column fractures can be treated with posteromedial combined with anterolateral approach in the floating position. However, there are certain disadvantages to operating in a "floating position". Therefore, we proposed an "out-in" position for those fractures. The patient is placed in supine position on the operating table, and the healthy hip is elevated. For the posteromedial approach, the affected limb should be placed on a rectangular fluoroscopy table and kept in abduction and external rotation (out); for the anterolateral approach, the affected limb is retracted into the operating bed and kept in neutral position (in).This position has been shown to be highly effective for easy operation as well as intraoperative image monitoring. Furthermore, it highlights the advantage of anterior-posterior joint fracture reduction.
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den Berg JV, Reul M, Vinckier O, Derksen RJ, Nijs S, Verhofstad M, Hoekstra H. Posterior tibial plateau fracture treatment with the new WAVE posterior proximal tibia plate: feasibility and first results. Eur J Trauma Emerg Surg 2021; 48:1285-1294. [PMID: 33710401 DOI: 10.1007/s00068-021-01639-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Operative management of posterior tibial plateau fractures (PTPF) remains challenging. The treatment goal is to restore the alignment and articular congruence, and providing sufficient stability which allows early mobilization. The purpose of this study was to assess the feasibility and safety of the newly developed WAVE posterior proximal tibia plate. METHODS Between Oct 2017 and Jun 2020, 30 adult patients with a tibial plateau fracture and posterior involvement were selected for treatment with a WAVE posterior proximal tibia plate. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at time of injury (pre-injury) and at 1-year follow-up. Radiological outcome was evaluated with CT-imaging. RESULTS Twenty-eight patients were eligible for treatment with the new implant (3 'one-column', 10 'two column' and 15 'three-column' fractures), whereas in 2 patients anatomical fit was insufficient. KOOS results showed fair outcome scores at 1 year, with a large negative impact compared to pre-injury levels; however, a trend towards better results compared to a previous PTPF reference cohort. Radiological follow-up showed insufficient posterolateral buttress in two cases and residual articular step-off (> 2 mm) in seven patients, of which five were classified as three column fractures. CONCLUSION Management of PTPF using the WAVE posterior proximal tibia plate is feasible and safe with satisfactory clinical and radiological results after 1 year. Nevertheless, there is a learning curve regarding optimal implant positioning to achieve the maximum benefit of the implant. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - Maike Reul
- Department of Orthopedics and Traumatology, VU Brussel-Free University of Brussels, Brussels, Belgium
| | - Olivier Vinckier
- Department of Trauma Surgery, University Hospitals 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
| | - Michiel Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - 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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Wang Z, Zheng B, Jin Y, Yang G, Chen G, Liang J, Zhou X, Yang X. Arthroscopy-assisted surgery: The management of posterolateral tibial plateau depression fracture accompanying ligament injury: A case series and review of the literature. J Orthop Surg (Hong Kong) 2020; 28:2309499019891208. [PMID: 31876260 DOI: 10.1177/2309499019891208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Tibial plateau fractures are multiple fracture patterns associated with soft-tissue injuries. Among which, the combined existence of posterolateral tibial plateau depression fracture with anterior cruciate ligament (ACL) rupture has been reported rarely. Meanwhile, surgical method for the treatment of depression fracture is fairly complex. The aim of this article is to show a case series of this unusual injury pattern and the therapy of posterolateral tibial plateau depression fracture accompanying ACL rupture. In our treatment, arthroscopy assisted reduction of depression fracture and ACL reconstruction reduces surgical trauma and leads to good functional recovery. We also review the current literature.
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Affiliation(s)
- Zhangfu Wang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Binbin Zheng
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Yanjun Jin
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Guangyong Yang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Guofu Chen
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Junbo Liang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Xiaobo Zhou
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Xiangdong Yang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
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Ren D, Liu Y, Chen Y, Lu J, Song Z, Zhou B, Wang P. A Novel Method of the Treatment for Posterolateral Tibial Plateau Fractures. J Knee Surg 2020; 33:1010-1019. [PMID: 31127602 DOI: 10.1055/s-0039-1688918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Reduction and fixation of posterolateral tibial plateau fracture via a posterolateral approach is challenging, and the posterolateral approach itself may injure the posterolateral ligament complex of the knee and can result in knee instability. We developed a new curved support plate (CSP) that can pass, via traditional anterolateral approach, through the superior tibiofibular interval and effectively support the posterolateral fragments. The purpose of our study was to determine the biomechanical reliability of the new plate and report the preliminary efficacy of the CSP for posterolateral tibial plateau fracture. In the biomechanical experiment, 40 synthetic tibias were used to create posterolateral shearing tibial fracture models, which were randomly assigned to groups A to D. Vertical displacement of the posterolateral fragments was measured under axial loads of 500 to 1,500 N. The new plate and 3.5-mm lateral locking plate exhibited similar control over fragment displacement. From June 2016 to August 2017, eight patients with posterolateral tibial plateau fracture underwent treatment with the CSP. Hospital for Special Surgery (HSS) knee score, knee flexion and extension ranges of motion, and complications were recorded to evaluate treatment effects. Eight patients (five men and three women, mean age 44 years [range, 23-66 years]) were enrolled in the study. Mean follow-up time was 13 months (range, 7-19 months). All patients achieved radiographic bone union by 3.3 months (range, 3-4 months) postoperatively. There were no complications of neurovascular injury, deep vein thrombosis, infection, and implant loosening throughout the follow-up period. At final follow-up, mean HSS score was 92.6 (88-96), with a mean knee flexion of 131.25 degrees (120-135 degrees) and a mean knee extension of 1 degree (0-5 degrees). Fixation of posterolateral tibial plateau fracture was easily and successfully achieved using our newly designed CSP, which may provide a new choice for posterolateral tibial plateau fractures.
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Affiliation(s)
- Dong Ren
- Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
| | - Yueju Liu
- Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
| | - Yanxi Chen
- Department of Orthopedic Trauma, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jian Lu
- Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
| | - Zhaohui Song
- Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
| | - Bing Zhou
- Department of Orthopaedic Surgery, Gaoyou Hospital, Soochow University, Gaoyou, Jiangsu, China
| | - Pengcheng Wang
- Orthopaedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, China
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Zhang BB, Sun H, Zhan Y, He QF, Zhu Y, Wang YK, Luo CF. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res 2019; 8:357-366. [PMID: 31537993 PMCID: PMC6719528 DOI: 10.1302/2046-3758.88.bjr-2018-0331.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives CT-based three-column classification (TCC) has been widely used in the treatment of tibial plateau fractures (TPFs). In its updated version (updated three-column concept, uTCC), a fracture morphology-based injury mechanism was proposed for effective treatment guidance. In this study, the injury mechanism of TPFs is further explained, and its inter- and intraobserver reliability is evaluated to perfect the uTCC. Methods The radiological images of 90 consecutive TPF patients were collected. A total of 47 men (52.2%) and 43 women (47.8%) with a mean age of 49.8 years (sd 12.4; 17 to 77) were enrolled in our study. Among them, 57 fractures were on the left side (63.3%) and 33 were on the right side (36.7%); no bilateral fracture existed. Four observers were chosen to classify or estimate independently these randomized cases according to the Schatzker classification, TCC, and injury mechanism. With two rounds of evaluation, the kappa values were calculated to estimate the inter- and intrareliability. Results The overall inter- and intraobserver agreements of the injury mechanism were substantial (κinter = 0.699, κintra = 0.749, respectively). The initial position and the force direction, which are two components of the injury mechanism, had substantial agreement for both inter-reliability or intrareliability. The inter- and intraobserver agreements were lower in high-energy fractures (Schatzker types IV to VI; κinter = 0.605, κintra = 0.721) compared with low-energy fractures (Schatzker types I to III; κinter = 0.81, κintra = 0.832). The inter- and intraobserver agreements were relatively higher in one-column fractures (κinter = 0.759, κintra = 0.801) compared with two-column and three-column fractures. Conclusion The complete theory of injury mechanism of TPFs was first put forward to make the TCC consummate. It demonstrates substantial inter- and intraobserver agreement generally. Furthermore, the injury mechanism can be promoted clinically. Cite this article: B-B. Zhang, H. Sun, Y. Zhan, Q-F. He, Y. Zhu, Y-K. Wang, C-F. Luo. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res 2019;8:357–366. DOI: 10.1302/2046-3758.88.BJR-2018-0331.R1.
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Affiliation(s)
- B-B Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - H Sun
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Y Zhan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Q-F He
- Department of Orthopaedic Surgery, Zhejiang University School of Medicine Affiliated Hangzhou First People's Hospital, Shanghai, China
| | - Y Zhu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Y-K Wang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - C-F Luo
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Ren D, Liu Y, Zhou B, Lu J, Wang P. A Novel Design of a Plate for Posterolateral Tibial Plateau Fractures Based on Computed Tomography Mapping of the Proximal Tibiofibular Joint. Med Sci Monit 2018; 24:9300-9306. [PMID: 30574954 PMCID: PMC6320643 DOI: 10.12659/msm.911738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background We designed a novel plate for the treatment of posterolateral tibial plateau fractures. We first gathered radiological data of the proximal tibiofibular joint to verify the feasibility of the novel plate and provide an anatomical basis. Material/Methods Tomographic images of 98 healthy human tibias were obtained retrospectively. The width of the lateral tibial plateau, width of the posterolateral tibial plateau to the sagittal plane of the tibial plateau and width of the proximal tibiofibular joint to the sagittal plane of tibial plateau were measured. The proximal posterolateral tibial bone cortex angle and posterolateral slope-diaphysis angle were also calculated. Paired sample t-test was used for comparing men and women, and left and right sides. We used 2 variables for Pearson correlation analysis between the width of the lateral tibial plateau and other length indices. Results There were no statistically significant differences between left and right knees (P>0.05). However, there were statistically significant differences of the 3 length indices between men and women (P<0.05). The length indices were all correlated to the width of the lateral tibial plateau (P<0.01). Conclusions This study of the lateral tibial plateau has a high accuracy in anatomical measurement, and our novel plate design is feasible based on the data. The study provided anatomical basis for the novel plate.
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Affiliation(s)
- Dong Ren
- Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Yueju Liu
- Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Bing Zhou
- Department of Orthopedic Surgery, Gaoyou Hospital of Soochow University, Gaoyou, Jiangsu, China (mainland)
| | - Jian Lu
- Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei, China (mainland)
| | - Pengcheng Wang
- Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei, China (mainland)
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10
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A Novel Design of a Plate for Posterolateral Tibial Plateau Fractures Through Traditional Anterolateral Approach. Sci Rep 2018; 8:16418. [PMID: 30401952 PMCID: PMC6219608 DOI: 10.1038/s41598-018-34818-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/26/2018] [Indexed: 11/18/2022] Open
Abstract
Biomechanical performance of a newly designed plate for treating posterolateral tibial plateau fractures was compared with three traditional internal fixation devices using finite element analysis (FEA) and biomechanical experiments. Forty synthetic tibias were used to create posterolateral shearing tibial fracture models, which were randomly assigned to groups A–D. The fragments were fixed with two 6.5-mm lag screws (group A), the newly designed plate (group B), a 3.5-mm lateral locking plate (group C), and a posterolateral buttress plate (group D). In the biomechanical experiment, vertical displacement of the posterolateral fragments was measured under axial loads of 500–1500 N. In the FEA, vertical displacement of the posterolateral fragments and stress distribution and maximum stress of each internal fixation were measured under axial loads of 250–750 N. Biomechanically, collective ranges of vertical displacements in the four groups were 0.356 ± 0.089–1.055 ± 0.023 mm at 500 N axial load, 0.651 ± 0.062–1.525 ± 0.03 mm at 1000 N, and 0.903 ± 0.077–1.796 ± 0.04 mm at 1500 N. Differences between the four groups were statistically significant (P < 0.05), except for groups B and C at 1500 N. FEA showed that collective ranges of vertical displacements in the four groups were 0.290–1.425 mm at of 250 N axial load, 0.580–1.680 mm at 500 N, 1.067–1.818 mm at 750 N. Maximum stress of groups A–D were, respectively, 321.940, 132.660, 100.383, and 321.940 MPa under 250 N axial load. Maximum stress of all four internal fixations increased, and the overall trends at 500 and 750 N were consistent with that at 250 N. Posterior, straight fixation was the most reliable. Fixation with the lag screw was least reliable. The new plate and 3.5-mm lateral locking plate exhibited similar control over fragment displacement. The newly designed plate was stable and reliable, indicating its suitability for clinical application.
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11
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Sun H, He QF, Zhang BB, Zhu Y, Zhang W, Chai YM. A biomechanical evaluation of different fixation strategies for posterolateral fragments in tibial plateau fractures and introduction of the 'magic screw'. Knee 2018; 25:417-426. [PMID: 29678367 DOI: 10.1016/j.knee.2018.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 02/28/2018] [Accepted: 03/26/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Posterior plate fixation is biomechanically the strongest fixation method for posterolateral column fracture (PLCF) of the tibial plateau; however, there are inherent deficiencies and risks of a posterior approach. Thus, the 'magic screw' was proposed to enhance fixation stability of the lateral rafting plate used for PLCF. The purpose of this study was to re-examine and compare the stability of different fixation methods for PLCF. METHODS Synthetic tibiae models were used to simulate posterolateral split fractures. The fracture models were randomly assigned into three groups: Group A, fixed with posterolateral buttress plates; Group B, with lateral locking compression plates (LCP); and Group C fixed with lateral LCPs and one 'magic screw'. Gradually increased axial compressive loads were applied to each specimen. RESULTS There was a mean subsidence hierarchy of the posterolateral fragment at different load levels: Group A had the least subsidence, followed by Group C, and Group B had the most. There were no significant differences in the mean loads at different displacements between Group A and Group C. Group A had the highest axial stiffness. Additionally, there was a significant difference in axial stiffness between Group B and Group C. CONCLUSION Biomechanical stability of the combined fixation of the posteriorly positioned lateral rafting plate with the 'magic screw' was much closer to that of posterior plate fixation for split-type PLCF. The necessity of posterior fixation through a posterior approach may be reduced for selected patients.
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Affiliation(s)
- Hui Sun
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qi-Fang He
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bin-Bin Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Zhu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Yi-Min Chai
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Sun H, Zhu Y, He QF, Shu LY, Zhang W, Chai YM. Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau: The magic screw technique. Injury 2017; 48:2814-2826. [PMID: 29096929 DOI: 10.1016/j.injury.2017.10.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/22/2017] [Accepted: 10/25/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND A posterolateral column fracture of the tibial plateau (PLCF) is not uncommon, especially lateral and bicondylar tibial plateau fractures. Currently, there is no consensus on the methods of surgical treatment for PLCF, including the surgical approach or the fixation strategy. Though various posterior approaches have been explored and can allow posterior buttress plate fixation, the necessity of a posterior approach with fixation for PLCFs is increasingly questioned. Meanwhile, there is no literature to analyse the morphological features of PLCFs. None of the available surgical techniques can solve all of the problems of PLCFs. METHODS From February 2016 to June 2016, an inconsecutive series of 16 patients who suffered Schatzker type II tibial plateau fractures involving the posterolateral column were selected based on an analysis of the morphological characteristics of PLCFs. The patients were all treated by lateral rafting plate fixation with magic screw implantation through the extended lateral approach. RESULTS According to PLCF morphology, 4 patients had mild slope-type depression fractures (MSDF) of the articular surface, and the other 12 patients had block-type splitting fractures (BSF). After a 12-month follow-up period, there were no complications related to the fixation technique and no significant changes in limb alignment. At the final follow-up, the average range of motion (ROM) of the affected knees was 2.3°-125°, and the average HSS score was 94.2. CONCLUSIONS The selected patients who suffered Schatzker type II fractures involving the posterolateral column could be successfully treated via lateral rafting plate fixation with the magic screw technique. For PLCF treatment, magic screw fixation is a valuable technique that may reduce the utilization of posterior approaches and posterior fixations.
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Affiliation(s)
- Hui Sun
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
| | - Yi Zhu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
| | - Qi-Fang He
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
| | - Lin-Yuan Shu
- Department of Emergency, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
| | - Wei Zhang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
| | - Yi-Min Chai
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, 600 YiShan Road, Shanghai, 200233, China.
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13
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Tomás-Hernández J, Monyart JM, Serra JT, Vinaixa MR, Farfan EG, García VM, Feliu EC. Large fracture of the anteromedial tibial plateau with isolated posterolateral knee corner injury: case series of an often missed unusual injury pattern. Injury 2016; 47 Suppl 3:S35-S40. [PMID: 27692105 DOI: 10.1016/s0020-1383(16)30604-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tibial plateau fractures are a heterogeneous group of lesions with multiple fracture patterns. They are often associated with soft tissue injuries, the lateral meniscus and the anterior cruciate ligament (ACL) being the most common structures affected. The purpose of this article is to present a case series of an often missed unusual injury pattern that consists on the association of a large anteromedial tibial plateau fracture with a posterolateral (PL) knee corner injury without involvement of the cruciate ligaments. The diagnosis of PL complex injury may go unrecognized in a considerable number of cases and delay on the treatment decreases the success rate of soft tissue repairing. The importance of a high index of suspicion and a proper early diagnosis with an MRI is of paramount importance. We also describe the current surgical management used by the authors and review of the current literature.
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Affiliation(s)
- Jordi Tomás-Hernández
- Department of Orthopaedic and Trauma Surgery, Trauma Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain.
| | - Joan Minguell Monyart
- Department of Orthopaedic and Trauma Surgery, Knee Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Jordi Teixidor Serra
- Department of Orthopaedic and Trauma Surgery, Trauma Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Merce Reverté Vinaixa
- Department of Orthopaedic and Trauma Surgery, Knee Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Ernesto Guerra Farfan
- Department of Orthopaedic and Trauma Surgery, Trauma Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Vicente Molero García
- Department of Orthopaedic and Trauma Surgery, Trauma Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
| | - Enric Castellet Feliu
- Department of Orthopaedic and Trauma Surgery, Knee Unit, Hospital Vall d'Hebron - Universitat Autonoma de Barcelona (UAB), Passeig Vall d'Hebron, Barcelona, Spain
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14
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Kokkalis ZT, Iliopoulos ID, Pantazis C, Panagiotopoulos E. What's new in the management of complex tibial plateau fractures? Injury 2016; 47:1162-9. [PMID: 26989043 DOI: 10.1016/j.injury.2016.03.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The management of complex tibial plateau fractures is ever evolving. The severity of the injury to the surrounding soft tissues influences the timing and the method of fixation. Minimal invasive techniques continue to dominate our philosophy of reduction and reconstruction whereas augmentation of depressed intra-articular fragments remains an accepted strategy to maintain reduction and prevent secondary collapse. Locking plates, conventional plates and fine wire fixators all have been used successfully with satisfactory outcomes. In this article we report on the latest advances made in the management of these complex injuries.
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Affiliation(s)
- Zinon T Kokkalis
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Papanikolaou 1, 26504 Rio-Patras, Greece.
| | - Ilias D Iliopoulos
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Papanikolaou 1, 26504 Rio-Patras, Greece
| | - Constantinos Pantazis
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Papanikolaou 1, 26504 Rio-Patras, Greece
| | - Elias Panagiotopoulos
- University of Patras, School of Medicine, University Hospital of Patras, Department of Orthopaedics, Papanikolaou 1, 26504 Rio-Patras, Greece.
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15
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Tosounidis TH, Giannoudis PV. Letter to the Editor: "A combined posterior reversed L-shaped and anterolateral approach for two column tibial plateau fractures in Caucasians: A technical note". Injury 2016; 47:983. [PMID: 26916411 DOI: 10.1016/j.injury.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Theodoros H Tosounidis
- Academic Department of Trauma & Orthopaedic Surgery, Leeds General Infirmary, Leeds LS1 3EX, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, Leeds General Infirmary, Leeds LS1 3EX, UK; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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