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Christodoulidis A, Giardini P, Menna CR, Pagliari M, Molinari M. Treatment of Schatzker Type III Tibial Plateau Fractures: Report of an Alternative, Percutaneous Technique and Brief Review of the Literature. J Long Term Eff Med Implants 2024; 34:23-26. [PMID: 38505890 DOI: 10.1615/jlongtermeffmedimplants.2023048152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Schatzker III tibial plateau fractures (TPF) reduction and stabilization still represents a challenging procedure. We present an alternative, percutaneous surgical technique. With an antero-medial transverse incision at the level of the tibial metaphysis, under fluoroscopic control, an osteotome is advanced from medial to lateral, under the depressed fragments, reducing the articular surface of the lateral TP anatomically, without creating a significant void and preserving the lateral wall. Final fixation is achieved with screws placed from lateral to medial in a percutaneous fashion, parallel to the articular surface to hold fragments in a rafting way. Open surgical techniques hide many pitfalls and several new reduction options have been described; some simple but invasive, using bone tamps and bone graft that increase surgical trauma; others reliable and safe, but demanding and difficult to reproduce, needing good arthroscopic skills or special and expensive instrumentation, therefore not always available in the operating theater. We prefer a medially based percutaneous metaphyseal bone access using two simple flat low profile instruments such as osteotomes, that preserve bone and vascularization during the reduction maneuvers, minimizing the above-mentioned risks, for the treatment of Schatzker type III TPF.
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Affiliation(s)
| | - Piero Giardini
- Department of Trauma and Orthopaedics, Cavalese Hospital, via dei Dossi 17, Cavalese, Trento, 38033, Italy
| | - Carlo Raimondo Menna
- Department of Trauma and Orthopaedics, Cavalese Hospital, via dei Dossi 17, Cavalese, Trento, 38033, Italy
| | - Micaela Pagliari
- Department of Trauma and Orthopaedics, Cavalese Hospital, via dei Dossi 17, Cavalese, Trento, 38033, Italy
| | - Marco Molinari
- Department of Orthopeadics and Traumatology, Cavalese Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
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Wang Z, Zheng Z, Ye P, Tian S, Zhu Y, Chen W, Hou Z, Zhang Q, Zhang Y. Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up. J Orthop Translat 2022; 36:1-7. [PMID: 35891925 PMCID: PMC9284320 DOI: 10.1016/j.jot.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/13/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background The objective of this study was to compare the clinical and radiological outcomes of two surgical methods for tibial plateau fractures (TPFs): minimally invasive surgery (MIS) using a double reverse traction repositor and traditional open reduction internal fixation (ORIF). Methods From our prospectively collated database, 187 consecutive adult patients with 189 operatively treated TPFs in our level I trauma center were included from January 2015 to March 2018 who had a minimum of three years’ follow-up. All cases were performed by the senior surgeon using either MIS (group 1, 84 patients with 84 TPFs) or ORIF (group 2, 103 patients with 105 TPFs). Details of the demographics, injury mechanism, pre- and postoperative follow-up imaging, operative procedures and complications were collected. The final results from the 36-Item Short-Form Health Survey (SF-36), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Hospital for Special Surgery (HSS) were obtained at the final follow-up. Results Clinically, significant differences were observed in the WOMAC (pain, P = 0.001; stiffness, P < 0.001), HSS (P = 0.003) and SF-36 (P = 0.001). Radiologically, significant intergroup differences were observed in the loss of immediate postoperative reduction rates, secondary loss of reduction rates and signs of osteoarthritis (Kellgren–Lawrence). Two and ten superficial infections in group 1 (2.4%) and group 2 (9.5%), respectively, and 6 lateral popliteal nerve palsy cases occurred (0 MIS, 6 ORIF), with significant intergroup differences. Conclusion Our study shows that the MIS using a double reverse traction repositor is promising and safe technique for the TPFs when used for the correct indications. The translational potential of this article The current status of using a minimally invasive surgery for the treatment of TPFs have been analyzed and a new method of using a double reverse traction repositor for the treatment of TPFs have been proposed in this study, which updated treatment concept of TPFs.
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Affiliation(s)
- Zhongzheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Zhanle Zheng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Pengyu Ye
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Siyu Tian
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Qi Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.,NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, 050051, People's Republic of China.,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China
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Vendeuvre T, Ferrière V, Bouget P, Billot M, Germaneau A, Severyns M, Roulaud M, Rigoard P, Pries P. Percutaneous surgery with balloon for tibial plateau fractures, results with a minimum of 5 years of follow-up. Injury 2022; 53:2650-2656. [PMID: 35643555 DOI: 10.1016/j.injury.2022.05.033] [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: 12/21/2021] [Revised: 04/22/2022] [Accepted: 05/14/2022] [Indexed: 02/02/2023]
Abstract
Tibial plateau fracture is a frequent entity for which surgical management is difficult both surgically and postoperatively, with multiple complications and often delayed recovery. The challenge lies in the anatomical reduction of the joint, the limitation of complications and the rapid functional recovery. Tuberoplasty appears to be an innovative technique that meets current expectations. The objective is to evaluate the reliability of tuberoplasty in reducing surgical risks and improving postoperative clinical results. This single-centre retrospective study included 30 patients with depressed tibial plateau fractures who underwent tuberoplasty from September 2011 to March 2014. Reduction analysis was performed by comparing pre-operative and post-operative depression from computed tomography (CT) data. Clinical outcomes were assessed by measuring flexion joint ranges, time to weight-bearing, KOOS questionnaire and a pangonogram. The mean depression was 7.4mm pre-operatively and 2.6mm [0;9] post-operatively, with 47% (14/30) having a residual depression of 2mm or less. Mean flexion at 6 weeks was 103° [30; 130]. Partial and total weight-bearing were allowed on day 47 [3; 150] and day 58 [20; 150], respectively. The mean KOOS score was 25.43 [1.15; 62.30] at a minimum of 5 years after surgery and the mean axis was 176.54° [172; 180]. There was one case of thrombophlebitis and one sensory-motor deficit in the common fibular nerve territory. The reduction of the tibial plateau observed in our study from tuberoplasty is in line with the literature results obtained from a conventional approach. Our results indicate that tuberoplasty is stable in the long term, has good functional results and early recovery with few complications. This preliminary study presents results that need to be investigated in a prospective randomised double-blind study.
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Affiliation(s)
- Tanguy Vendeuvre
- CHU de Poitiers, 2 rue de la Milétrie, Service d'Orthopédie-Traumatologie et Chirurgie de la Colonne, 86021 Poitiers, France; Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - Victor Ferrière
- CHU de Poitiers, 2 rue de la Milétrie, Service d'Orthopédie-Traumatologie et Chirurgie de la Colonne, 86021 Poitiers, France.
| | - Pierre Bouget
- CHU de Poitiers, 2 rue de la Milétrie, Service d'Orthopédie-Traumatologie et Chirurgie de la Colonne, 86021 Poitiers, France
| | - Maxime Billot
- CHU de Poitiers, 2 rue de la Milétrie, PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), 86021 Poitiers, France
| | - Arnaud Germaneau
- CHU de Poitiers, 2 rue de la Milétrie, PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), 86021 Poitiers, France
| | - Mathieu Severyns
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - Manuel Roulaud
- CHU de Poitiers, 2 rue de la Milétrie, PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), 86021 Poitiers, France
| | - Philippe Rigoard
- CHU de Poitiers, 2 rue de la Milétrie, PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), 86021 Poitiers, France
| | - Pierre Pries
- CHU de Poitiers, 2 rue de la Milétrie, Service d'Orthopédie-Traumatologie et Chirurgie de la Colonne, 86021 Poitiers, France
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4
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Aubert K, Germaneau A, Rochette M, Ye W, Severyns M, Billot M, Rigoard P, Vendeuvre T. Development of Digital Twins to Optimize Trauma Surgery and Postoperative Management. A Case Study Focusing on Tibial Plateau Fracture. Front Bioeng Biotechnol 2021; 9:722275. [PMID: 34692655 PMCID: PMC8529153 DOI: 10.3389/fbioe.2021.722275] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background and context: Surgical procedures are evolving toward less invasive and more tailored approaches to consider the specific pathology, morphology, and life habits of a patient. However, these new surgical methods require thorough preoperative planning and an advanced understanding of biomechanical behaviors. In this sense, patient-specific modeling is developing in the form of digital twins to help personalized clinical decision-making. Purpose: This study presents a patient-specific finite element model approach, focusing on tibial plateau fractures, to enhance biomechanical knowledge to optimize surgical trauma procedures and improve decision-making in postoperative management. Study design: This is a level 5 study. Methods: We used a postoperative 3D X-ray image of a patient who suffered from depression and separation of the lateral tibial plateau. The surgeon stabilized the fracture with polymethyl methacrylate cement injection and bi-cortical screw osteosynthesis. A digital twin of the patient’s fracture was created by segmentation. From the digital twin, four stabilization methods were modeled including two screw lengths, whether or not, to inject PMMA cement. The four stabilization methods were associated with three bone healing conditions resulting in twelve scenarios. Mechanical strength, stress distribution, interfragmentary strains, and fragment kinematics were assessed by applying the maximum load during gait. Repeated fracture risks were evaluated regarding to the volume of bone with stress above the local yield strength and regarding to the interfragmentary strains. Results: Stress distribution analysis highlighted the mechanical contribution of cement injection and the favorable mechanical response of uni-cortical screw compared to bi-cortical screw. Evaluation of repeated fracture risks for this clinical case showed fracture instability for two of the twelve simulated scenarios. Conclusion: This study presents a patient-specific finite element modeling workflow to assess the biomechanical behaviors associated with different stabilization methods of tibial plateau fractures. Strength and interfragmentary strains were evaluated to quantify the mechanical effects of surgical procedures. We evaluate repeated fracture risks and provide data for postoperative management.
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Affiliation(s)
- Kévin Aubert
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.,Ansys France, Villeurbanne, France
| | - Arnaud Germaneau
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France
| | | | | | - Mathieu Severyns
- Department of Orthopedic and Trauma Surgery at the University Hospital Center of Fort-de-France, Fort-de-France, France
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Philippe Rigoard
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.,PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France.,Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France
| | - Tanguy Vendeuvre
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France.,PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France.,Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France.,Department of Orthopedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France
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5
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Bokam P, Germaneau A, Breque C, Rigoard P, Vendeuvre T, Valle V. Fracture behavior of cancellous bone and cancellous bone-PMMA bone cement interface: An experimental study using an integrated methodology (wedge splitting test and Heaviside-based digital image correlation). J Mech Behav Biomed Mater 2021; 122:104663. [PMID: 34246077 DOI: 10.1016/j.jmbbm.2021.104663] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
Minimally invasive methods, such as balloon kyphoplasty (BKP) and percutaneous sacroplasty (PS), which are now widely used for the surgical treatment of compression fractures, involve injection of a bolus of poly (methyl methacrylate) bone cement (hereafter, "bone cement") into the fractured tissue. Many of the common complications following these surgeries, such as cement leakage and adjacent-level fractures (in the case of BKP), have been postulated to be related to the quality of the cancellous bone-bone cement interface, which, in turn, is a function of its fracture resistance. It is common to use bovine cancellous bone or polyurethane foam (PF) as a substitute for human cancellous bone in biomechanical studies of these surgical methods. The literature is lacking in studies of determination of fracture properties of human cancellous bone-bone cement interface, bovine cancellous bone-bone cement interface, and PF-bone cement interface. In the present work, an integrated methodology (combination of wedge splitting test and Heaviside-based digital image correlation) was used to make these determinations as well as those for the bone cement, bones and the PF alone. The fracture properties determined were maximum fracture load (Fmax), fracture toughness (Kc), and specific fracture energy (Gf). For example, Gf values for human cancellous bone and human cancellous bone-bone interface were 0.48±0.14 N/mm and 0.38±0.05 N/mm, respectively, whereas in the case of bovine cancellous bone and bovine cancellous bone-bone cement interface, they were 1.08±0.11 N/mm and 0.22±0.05 N/mm, respectively, and for PF (Grades 12.5 and 15.0) and PF-bone cement interface, they were 0.81±0.12 and 0.55±0.06 N/mm, respectively. The same trends were seen in the Fmax and Kc results. These results suggest that it may not be justified to use either bovine cancellous bone or either of the PF grades as a substitute for human cadaveric cancellous bone in biomechanical studies of BKP, PS, and similar surgical methods.
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Affiliation(s)
- P Bokam
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à vocation régionale Pierre Deniker, Centre Hospitalier Henri Laborit, Poitiers, France; Institut Pprime, CNRS, Université de Poitiers, ISAE-ENSMA, F-86962, Futuroscope, Chasseneuil, France.
| | - A Germaneau
- Institut Pprime, CNRS, Université de Poitiers, ISAE-ENSMA, F-86962, Futuroscope, Chasseneuil, France
| | - C Breque
- Institut Pprime, CNRS, Université de Poitiers, ISAE-ENSMA, F-86962, Futuroscope, Chasseneuil, France; Laboratoire d'anatomie et de simulation de universite de Poitiers, ABS Lab-Bat D1, 6, rue de la miletrie TSA-51115, 86073 Poitiers cedex 9, France
| | - P Rigoard
- Institut Pprime, CNRS, Université de Poitiers, ISAE-ENSMA, F-86962, Futuroscope, Chasseneuil, France; Department of Neurosurgery, Spine and Neuromodulation Function Unit. Prismatics Lab. CHU. Poitiers., France
| | - T Vendeuvre
- Institut Pprime, CNRS, Université de Poitiers, ISAE-ENSMA, F-86962, Futuroscope, Chasseneuil, France; Department of Neurosurgery, Spine and Neuromodulation Function Unit. Prismatics Lab. CHU. Poitiers., France
| | - V Valle
- Institut Pprime, CNRS, Université de Poitiers, ISAE-ENSMA, F-86962, Futuroscope, Chasseneuil, France
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Vendeuvre T, Gayet LÉ. Percutaneous treatment of tibial plateau fractures. Orthop Traumatol Surg Res 2021; 107:102753. [PMID: 33316447 DOI: 10.1016/j.otsr.2020.102753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/28/2020] [Indexed: 02/03/2023]
Abstract
In France, 11,294 proximal tibia fractures occurred in 2018 and 6880 surgical procedures were done to treat them. Most of these were tibial plateau fractures, although fractures can occur in the metaphysis only or in the intercondylar eminence. The proximal tibia's poor vascularization justifies sparing it by doing a percutaneous treatment, setting the stage for bone union. The treatment must be based on rigorous planning with 3D imaging to determine the type of fracture accurately. The goals of treatment are first to realign the lower limb and then to reduce the articular surface, while addressing any associated injuries. Percutaneous reduction is based on ligamentotaxis and the use of spatulas or balloons that spare the vascularization. Surgical navigation and arthroscopy are precious tools for verifying the reduction. There are several options for stabilization, ranging from using polymethylmethacrylate cement for a Schatzker III fracture to applying a cannulated screw or doing MIPPO (Minimal Invasive Percutaneous Plate Osteosynthesis) with an anatomical plate and adjustable locking screws placed under the depression in complex fractures. Percutaneous surgery is not about the size of the incisions; the focus is on sparing the metaphysis and its vascularization to ensure high-quality and long-lasting stability. It appears to yield better functional outcomes than open reduction and internal fixation, not only for Schatzker type I, II and III fractures, but also for complex fractures where open fixation is more damaging and the source of complications.
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Affiliation(s)
- Tanguy Vendeuvre
- Service de chirurgie orthopédique et traumatologique, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - Louis-Étienne Gayet
- Service de chirurgie orthopédique et traumatologique, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
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