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Raj M, Singh SK, Rajput AK, Gill SP, Verma SK, Sonarkar SS. The Comparative Analysis of Single Plating Versus Double Plating in the Treatment of Unstable Bicondylar Proximal Tibial Plateau Fractures. Cureus 2023; 15:e46840. [PMID: 37954723 PMCID: PMC10637009 DOI: 10.7759/cureus.46840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction In the present study, we aimed to compare the clinical and radiological results of the single lateral locking plate fixation method to the dual plate (DP) fixation method in cases of unstable bicondylar proximal tibial plateau fractures. Materials and methods Fifty-six patients managed surgically with internal fixation for unstable bicondylar tibial plateau fractures (UBTF) (Schatzker type V and type VI or Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association {AO/OTA} type 41-C) over 36 months from January 2017 to December 2020 were included in this prospective study. All the fractures were fixed surgically either using dual locking plates through double incisions (DP group) or with a single lateral locking plate (single plate {SP} group). All intraoperative and postoperative complications were assessed and recorded. Oxford Knee Score (OKS), Rasmussen's functional grading system, and Rasmussen's radiological scoring system were used to evaluate the functional and radiological outcomes. Result All of the patients were followed for at least 12 months. Twenty-six patients were fixed with a single lateral locking plate, and 30 patients were fixed with a double-incision dual locking plate. The mean Oxford Knee Score (OKS) was 43.24 ± 4.46 in the DP group and 42.7 ± 2.57 in the SP group (P = 0.544). The mean Rasmussen's functional score (RFS) score in the present study was 26.6 ± 2.21 in the DP group and 24.97 ± 3.92 in the SP group (P = 0.056). At the final follow-up, the mean Rasmussen's radiological score (RRS) was 9.06 ± 1.01 in the DP group and 8.1 ± 0.81 in the SP group (P = 0.0003). Conclusion There are no statistically significant differences in the functional outcomes between the two groups, but higher benefits were found in the radiological outcomes in the dual plating group as compared to single lateral locking plate group.
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Affiliation(s)
- Manish Raj
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Deoghar, IND
| | - Santosh Kumar Singh
- Department of Orthopedics, Maa Vindhyavasini Autonomous State Medical College, Mirzapur, IND
| | - Ajay K Rajput
- Department of Orthopedics, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, IND
| | - Simrat Pal Gill
- Department of Orthopedics, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, IND
| | - Satyendra K Verma
- Department of Orthopedics, Rajarshi Dashrath Autonomous State Medical College (RDASMC), Ayodhya, IND
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García Vélez DA, Headford M, Suresh KV, Liberatos PM, Bledsoe G, Revak T. Biomechanical analysis of dual versus lateral locked plating in elderly bicondylar tibial plateau fractures: Does medial comminution matter? Injury 2022; 53:3109-3114. [PMID: 36028376 DOI: 10.1016/j.injury.2022.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess dual plating versus lateral locked plate fixation of bicondylar tibial plateau fractures in an elderly cadaveric model with and without medial bone loss PARTICIPANTS: 10 pairs of elderly (range 78-93 years of age) fresh frozen tibias. INTERVENTION Bicondylar tibial plateau fractures were created reproducing AO/OTA 41 C1 (without medial bone loss) and C2 fractures (with medial bone loss). Cadavers were randomized to 4 different groups. Groups 1 and 2 were 41 C1 fractures and fixated with either dual or lateral plating, respectively. Groups 3 and 4 were fixated in a similar fashion with medial metaphyseal bone loss (41 C2 fracture) with dual plating Group 3 and lateral plating group 4. Lateral plating consisted of a 3.5 mm 5-hole lateral plate (ALPS, ZimmerBiomet) with 6 bicortical locking screws proximally and two diaphyseal screws. Dual plating groups underwent lateral plating and additional 3.5 mm 5-hole posteromedial 1/3 tubular plate (ZimmerBiomet) placed at the apex of the fracture with two shaft screws and one unicortical screw proximally. Specimens were tested in a Mechanical Testing System (MTS) machine loading both condyles. OUTCOME MEASUREMENTS Specimens were loaded to 300 N and coronal alignment obtained. Specimens were then cycled from 100 N to 700 N for 5000 cycles at 2 Hz. Average axial displacement, maximal displacement, average force and coronal alignment after 5000 cycles were recorded. Lastly, force to failure was recorded at 100 N/sec. RESULTS Mean axial displacement was 4.21 mm ranging from 3.12 mm in group 1 to 5.92 mm in group 4 (P = 0.51). Failure force averaged 3340 N ranging from 4342 N in group 1 to 2433 N in group 4 (P = 0.36). Maximal displacement ranged from 3.69 mm in group 1 to 7.37 mm in group 4 (P = 0.21). Change in coronal alignment ranged from 0.98° in group 1 to 1.97° in group 4 (P = 0.45). No statistically significant difference was noted between all four groups for all data points. CONCLUSION The results of this study demonstrate that a lateral locked plate may offer an alternative means of fixation in AO/OTA 41 C1 and C2 fractures.
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Affiliation(s)
| | | | | | | | - Gary Bledsoe
- Department of Biomechanical Engineering, United States
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Biomechanical Evaluation of a Fin-type Implant Compared to Traditional Buttress Plate for the Stabilization of the Posteromedial Fragment in Tibial Plateau Split Fractures. J Med Biol Eng 2021. [DOI: 10.1007/s40846-021-00648-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rajamanthrilage A, Arifuzzaman M, Millhouse P, Pace T, Behrend C, DesJardins J, Anker J. Measuring Orthopedic Plate Strain to Track Bone Healing Using a Fluidic Sensor Read via Plain Radiography. IEEE Trans Biomed Eng 2021; 69:278-285. [PMID: 34181532 DOI: 10.1109/tbme.2021.3092291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We describe a fluidic X-ray visualized strain indicator under applied load (X-VISUAL) to quantify orthopedic plate strain and inform rehabilitative care. METHODS The sensor comprises a polymeric device with a fluidic reservoir filled with a radio-dense fluid (cesium acetate) and an adjoining capillary wherein the liquid level is measured. A stainless-steel lever attaches to the plate and presses upon the acrylic bulb with a displacement proportional to plate bending strain. The sensor was attached to a plate in a Sawbones composite tibia mimic and a human cadaveric tibia. An osteotomy model (5 mm gap) was used to simulate an unstable fracture, and allograft repair to simulate a stiffer healed fracture. The cadaveric and Sawbones tibia were cyclically loaded five times (0-400 N) using a mechanical test stand, and fluid displacement was measured from plain radiographs. RESULTS The sensor displayed reversible and repeatable behavior with a slope of 0.096 mm/kg and fluid level noise of 50-80 micrometer (equivalent to 5-10 N). The allograft-repaired composite fracture was 13 times stiffer than the unstable fracture. CONCLUSION An analysis of prior external fracture fixation studies and fatigue curves for internal plates indicates that the threshold for safe weight bearing should be 1/5th-1/10th of the initial bending for an unstable fracture. The precision of our device (<2% body weight) should thus be sufficient to track fracture healing from unstable through safe weight bearing. SIGNIFICANCE The X-VISUAL fluidic sensor enables orthopedic plate strain quantification to monitor facture healing via X-ray imaging.
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Lee AK, Cooper SA, Collinge C. Bicondylar Tibial Plateau Fractures: A Critical Analysis Review. JBJS Rev 2019; 6:e4. [PMID: 29461986 DOI: 10.2106/jbjs.rvw.17.00050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Adam K Lee
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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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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Advantages of external hybrid fixators for treating Schatzker V-VI tibial plateau fractures: A retrospective study of 40 cases. Orthop Traumatol Surg Res 2017; 103:965-970. [PMID: 28760373 DOI: 10.1016/j.otsr.2017.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 05/15/2017] [Accepted: 05/17/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Proximal tibia fractures make up 1% of all fractures in adults. The fractures classified as Schatzker V and VI fractures can compromise knee structure and function. They are challenging to treat and often have complications. While plate fixation is the gold standard, the resulting infection rate has led us to favor external hybrid fixation. The aims of this study were to assess the radiographic and functional outcomes along with the complication rate when using this method and to compare them to historical plate fixation data. MATERIAL AND METHODS This was a retrospective study of 40 patients. The complications, quality of reduction, IKS, Lysholm and Rasmussen functional scores at the latest follow-up and factors affecting the functional outcome were evaluated. These parameters were compared to published results from plate fixation studies. RESULTS The deep infection rate was 2.5%. The union rate was 80%. Satisfactory reduction was obtained in 70% of cases; however, 52% of patients had malunion. The mean IKS score was 73.74, the mean Rasmussen score was 22.85 and the mean Lysholm score was 75.53. Age, reduction at latest follow-up, mechanical axis and anteroposterior laxity had a significant effect on the functional outcome. DISCUSSION Despite the malunion rate being higher than other studies, the functional outcomes were nearly identical based on the variables measured. There are several advantages associated with using a hybrid external fixator: shorter operative time, less bleeding, shorter hospital stays and lower infection rate. CONCLUSION Hybrid external fixation is a reliable fracture fixation method that leads to satisfactory functional outcomes, while reducing the infection rate and allowing arthroplasty to be performed in the future if needed.
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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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Affiliation(s)
- William M Ricci
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110
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Ehlinger M, Adamczewski B, Rahmé M, Adam P, Bonnomet F. Comparison of the pre-shaped anatomical locking plate of 3.5 mm versus 4.5 mm for the treatment of tibial plateau fractures. INTERNATIONAL ORTHOPAEDICS 2015; 39:2465-71. [PMID: 25750131 DOI: 10.1007/s00264-015-2713-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/13/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Treatment of tibial plateau fractures is discussed. A retrospective comparative study of fractures treated with an anatomical locking plate of 4.5 mm or 3.5 mm. Our hypothesis is that the 3.5 mm plates give an equivalent hold of fractures with comparable results and better clinical tolerance. METHODS From May 2010 to October 2011, 18 patients were operated on using a 4.5-mm LCP™ anatomical plate (group A) and 20 patients received a3.5-mm LCP™ anatomical plate (group B). Groups were comparable. One fracture was open. RESULTS For the Group A, 14 patients had a follow up of 35.3 months and for the Group B, 16 patients had a follow up of 27 months. Mobility was comparable in both groups. The Hospital for Special Surgery (HSS) score was 86.4 versus 80.6, the Lysholm score was 83.6 versus 77 for groups A and B respectively. Consolidation was 3.25 months versus 3.35 months and mean axis was 183.1° versus 181.6° for groups A and B. Mechanical axes during revision were statistically different to the controlateral axes. One secondary displacement was noted in group A and one secondary displacement in group B. Group A had eight patients reporting discomfort with the material versus three in group B (p < 0.05). CONCLUSION The hypothesis is proven. In regards to the results, there is no significant difference between the two groups but the clinical tolerance was better in group B. More time is needed in the long term to better evaluate these severe fractures.
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Affiliation(s)
| | | | - Michel Rahmé
- Orthopedics, Hopital de Hautepierre, Strasbourg, France
| | - Philippe Adam
- Orthopedics, Hopital de Hautepierre, Strasbourg, France
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Sferopoulos NK. Autograft transfer from the ipsilateral femoral condyle in depressed tibial plateau fractures. Open Orthop J 2014; 8:310-5. [PMID: 25317215 PMCID: PMC4192835 DOI: 10.2174/1874325001408010310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/31/2014] [Accepted: 09/03/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction : The rationale for operative treatment of depressed tibial plateau fractures is anatomic reduction, stable fixation and grafting. Grafting options include autogenous bone graft or bone substitutes. Methods : The autograft group included 18 patients with depressed tibial plateau fractures treated with autogenous bone grafting from the ipsilateral femoral condyle following open reduction and internal fixation. According to Schatzker classification, there were 9 type II, 4 type III, 2 type IV and 3 type V lesions. The average time to union and the hospital charges were compared with the bone substitute group. The latter included 17 patients who had an excellent outcome following treatment of split and/or depressed lateral plateau fractures, using a similar surgical technique but grafting with bone substitutes (allografts). Results : Excellent clinical and radiological results were detected in the autograft group after an average follow-up of 28 months (range 12-37). The average time to union in the autograft group was 14 weeks (range 12-16), while in the bone substitute group it was 18 weeks (range 16-20). The mean total cost was 1276 Euros for the autograft group and 2978 Euros for the bone substitute group. Discussion : The use of autogenous graft from the ipsilateral femoral condyle following open reduction and internal fixation of depressed tibial plateau fractures provided enough bone to maintain the height of the tibial plateau and was not associated with any donor site morbidity. Using this method, the surgical time was not significantly elongated and the rehabilitation was not affected. It also exhibited faster fracture healing without postoperative loss of reduction and it was less expensive than the use of bone substitutes.
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Affiliation(s)
- N K Sferopoulos
- 2 Department of Orthopaedic Surgery, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, 54635 Thessaloniki, Greece
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High-energy tibial plateau fractures: external fixation versus plate fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:411-23. [DOI: 10.1007/s00590-014-1528-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 08/08/2014] [Indexed: 11/26/2022]
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Jain JK, Asif N, Ahmad S, Qureshi O, Siddiqui YS, Rana A. Locked compression plating for peri- and intra-articular fractures around the knee. Orthop Surg 2014; 5:255-60. [PMID: 24254448 DOI: 10.1111/os.12069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 08/05/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the role of locked compression plates (LCPs) in management of peri- and intra-articular fractures around the knee. METHODS Twenty distal femoral and 20 proximal tibial fractures were fixed with LCPs. The types of femoral fractures were A1 (four), A2 (three), A3 (two), C1 (one), C2 (seven) and C3 (three). The types of tibial fractures were A2 (one), A3 (two), B2 (two), C1 (four), C2 (five) and C3 (six). All patients were followed up for up to 18 months (mean, 12 months). Fourteen patients with distal femoral fractures and 19 with proximal tibial fractures underwent surgery using a minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. The others were treated by open reduction. The average time of fixation was 8 days after injury (0-31 days). Knee Society scores were used for clinical and functional assessment. RESULTS All fractures, except one of the distal femur and one of the proximal tibia, united. The mean union times for distal femoral and proximal tibial fractures were 15.2 and 14.9 weeks, respectively. One patient with a distal femoral fracture had implant failure. One patient was quadriplegic and did not recover the ability to walk. The average Knee Society scores of the remaining 18 patients were 82.66 (excellent) and 77.77 (functional score, good). There was one case of implant failure and one of screw breakage in distal femoral fractures. One case of nonunion occurred in a proximal tibial fracture. CONCLUSION Provided it is applied with proper understanding of biomechanics, LCP is one of the best available options for management of challenging peri- and intra-articular fractures.
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Affiliation(s)
- Jitesh Kumar Jain
- Department of Orthopaedics, Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, India
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