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Jiang J, Xu D, Ji Z, Jia R, Wang F, Tan J, Hong H, Li J. Interfragmentary compression force and fixation stability of lateral tibial plateau fractures in normal and osteoporotic bones. J Orthop Res 2024; 42:1738-1747. [PMID: 38472744 DOI: 10.1002/jor.25832] [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: 11/03/2023] [Revised: 02/12/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
Lateral platform collapse in fixations of lateral tibial plateau fractures (TPFs) using either double-lag screws fixation (DSF) or locking-plate fixation (LPF) is not rare. This study aimed to explore the effect of enhancing the interfragmentary compression force (IFCF) on fixation stability in lateral TPFs in normal and osteoporotic bones using finite element analysis. Finite element models of DSF in normal bone and LPF in normal and osteoporotic bones were established to simulate the fixations of lateral TPF. After model validation, axial compressive forces of 500, 1000, 1500, and 2500 N to the tibial plateau along with an IFCF of 0, 100, 200, and 300 N were applied. The maximum axial micromotion of the lateral fragment (MAM-LF), maximal translational micromotion of the lateral fragment (MTM-LF), peak von Mises stress (VMS), and peak equivalent elastic strain of the lateral fragment (EES-LF) were evaluated. The MAM-LF showed a decreasing trend as the IFCF increased in all models. For DSF models, the peak VMS of implants increased as the IFCF increased when the axial loads were 500 and 1000 N. The peak EES-LF decreased as the IFCF increased under axial loads of 1000, 1500, and 2500 N. For the normal and osteoporotic LPF models, the peak VMS of the implants decreased as the IFCF increased. Peak EES-LF decreased as IFCF increased. In conclusion, enhancing IFCF was beneficial in improving the fixation stability of lateral TPF. The optimal IFCF for DSF and LPF should be as high as reasonably feasible.
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Affiliation(s)
- Jiang Jiang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Daqiang Xu
- Department of Orthopedics, Affiliated Hospital 6 of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - Zhenhua Ji
- Department of Rehabilitation Medicine, Shandong Public Health Clinical Center, Shandong University, Jinan, China
| | - Rui Jia
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Rehabilitation Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Fei Wang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Anatomy, Nanchang Medical College, Nanchang, China
| | - Jinchuan Tan
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hong Hong
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual & Reality Experimental Education Center for Medical Morphology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
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Pizzoli A, Bondi M, Piotto L, Tartaglia N, Saracino M, Vyrva O. Efficacy of Cal-Cemex as bone substitute for tibial plateau fractures. J Orthop Surg Res 2023; 18:836. [PMID: 37932755 PMCID: PMC10626643 DOI: 10.1186/s13018-023-04323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Various factors influence treatment and outcomes in tibial plateau fractures. Bone defects are among them. Many materials have been proposed to address this problem: allograft, bone-cements and various bone substitutes (BSM). Cal-Cemex (β-tricalciophosphate and polymethylmethacrylate) is a new hybrid bi-component BSM. A retrospective multicenter study was conducted based on the clinical experience of three European Hospitals, to demonstrate its clinical effectiveness, versatility and safety. MATERIALS AND METHODS From December 2016 to March 2022, 45 displaced tibial plateau fractures were treated with internal fixation and augmentation using Cal-Cemex. The average age was 55.9 years. According to Schatzker classification, we included 13 type II, 24 type III, 3 type V and 4 type VI fractures. The postoperative follow-up (FU) consisted of clinical and radiological examinations at 6 and 12 weeks and 1 year after surgery. A CT scan was performed preoperatively and 1 year after surgery. Full weight bearing was permitted after less than 6 weeks. Clinical data were collected from patient charts, while functional data were evaluated using the Rasmussen knee function score, the KOOS score and the Hospital for Special Surgery knee rating score (HSS), to evaluate the range of motion, axis and functionality of the knee. RESULTS The average FU was 42.8 months. CT scans taken at 1 year demonstrated a good surface osteointegration without radiolucent lines or osteolysis with good evidence of interdigitation and even bone ingrowth. At 1-year FU, the mean Rasmussen score was 24.7, the mean KOOS score was 90.7 and the mean HSS was 89.9 and the average full weight-bearing period 34.9. No patients had hardware failure or fracture secondary displacement. DISCUSSION Cal-Cemex combines biological features and good mechanical performances. It guarantees biocompatibility and osteoconductivity, although it is not fully reabsorbable; β-tricalciophosphate component gives macro- and microporosity that allow fluids to penetrate inside the material, to stimulate bone ingrowth. CONCLUSIONS The study suggests that Cal-Cemex is an option for tibial plateau fractures, where augmentation and support are necessary for early full weight bearing. The absence of major complications, ease of application, the possibility to cut and perforate this material support its extensive use in bone augmentation for trauma cases.
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Affiliation(s)
- Andrea Pizzoli
- Department of Orthopaedics and Traumatology, ASST - Mantova, Carlo Poma Hospital, Strada Lago Paiolo 10, 46100, Mantua, Italy
| | - Manuel Bondi
- Department of Orthopaedics and Traumatology, ASST - Mantova, Carlo Poma Hospital, Strada Lago Paiolo 10, 46100, Mantua, Italy.
| | - Laura Piotto
- Department of Orthopaedics and Traumatology, ASST - Mantova, Carlo Poma Hospital, Strada Lago Paiolo 10, 46100, Mantua, Italy
| | - Nicola Tartaglia
- U.O.S.D. Traumatology, Hospital Miulli, Acqua Viva Delle Fonti, Bari, Italy
| | - Michele Saracino
- U.O.S.D. Traumatology, Hospital Miulli, Acqua Viva Delle Fonti, Bari, Italy
| | - Oleg Vyrva
- Bone Tumor Department, Ukrainian National Academy of Medical Sciences, Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
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Sidhu GAS, Hind J, Ashwood N, Kaur H, Bridgwater H, Rajagopalan S. Systematic Review of Current Approaches to Tibia Plateau: Best Clinical Evidence. Cureus 2022; 14:e27183. [PMID: 36039265 PMCID: PMC9395202 DOI: 10.7759/cureus.27183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
If not treated adequately, tibia plateau fractures result in premature osteoarthritis and lifelong disability. The advent of newer implants and techniques to improve outcomes has necessitated the development of different surgical approaches. A Medline and EMBASE search (June 2020) was conducted to identify publications during the last 10 years that focused on surgical approaches for proximal tibia fractures/ tibia plateau management. A total of 2107123 and 2715399 articles were found related to fractures in this area with 133 and 103 review articles looking at the approach on MEDLINE and EMBASE, respectively. This article reviews the continued development of the surgical approaches to aid understanding for surgeons and identify areas for future research to help improve outcomes. Although the anterolateral approach is the most commonly applied surgical technique, having the knowledge of newer approaches (medial, posteromedial, posterolateral, or direct posterior) in the armamentarium is necessary to treat the vast array of fracture patterns. There has been a shift amongst trauma surgeons of using a combination of approaches for complex tibia plateau fractures.
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Zaleski M, Hodel S, Fürnstahl P, Vlachopoulos L, Fucentese SF. Osteochondral Allograft Reconstruction of the Tibia Plateau for Posttraumatic Defects-A Novel Computer-Assisted Method Using 3D Preoperative Planning and Patient-Specific Instrumentation. Surg J (N Y) 2021; 7:e289-e296. [PMID: 34703887 PMCID: PMC8536646 DOI: 10.1055/s-0041-1735602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background
Surgical treatment of posttraumatic defects of the knee joint is challenging. Osteochondral allograft reconstruction (OCAR) is an accepted procedure to restore the joint congruity and for pain relief, particularly in the younger population. Preoperative three-dimensional (3D) planning and patient-specific instrumentation (PSI) are well accepted for the treatment of posttraumatic deformities for several pathologies. The aim of this case report was to provide a guideline and detailed description of the preoperative 3D planning and the intraoperative navigation using PSI in OCAR for posttraumatic defects of the tibia plateau. We present the clinical radiographic results of a patient who was operated with this new technique with a 3.5-year follow-up.
Materials and Methods
3D-triangular surface models are created based on preoperative computer tomography (CT) of the injured side and the contralateral side. We describe the preoperative 3D-analysis and planning for the reconstruction with an osteochondral allograft (OCA) of the tibia plateau. We describe the PSI as well as cutting and reduction techniques to show the intraoperative possibilities in posttraumatic knee reconstructions with OCA.
Results
Our clinical results indicate that 3D-assisted osteotomy and OCAR for posttraumatic defects of the knee may be beneficial and feasible. We illustrate the planning and execution of the osteotomy for the tibia and the allograft using PSI, allowing an accurate anatomical restoration of the joint congruency.
Discussion
With 3D-planning and PSI the OCAR might be more precise compared with conventional methods. It could improve the reproducibility and might allow less experienced surgeons to perform the precise and technically challenging osteotomy cuts of the tibia and the allograft. Further, this technique might shorten operating time because time consuming intraoperative steps such as defining the osteotomy cuts of the tibia and the allograft during surgery are not necessary.
Conclusion
OCAR of the tibia plateau for posttraumatic defects with 3D preoperative planning and PSI might allow for the accurate restoration of anatomical joint congruency, improve the reproducibility of surgical technique, and shorten the surgery time.
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Affiliation(s)
- Martin Zaleski
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro Hodel
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Boluda-Mengod J, Guimerà-García V, Olías-López B, Renovell-Ferrer P, Carrera I, Herrera-Pérez M, Pais-Brito JL. A proposal of a new algorithm for decision-making approaches in open reduction and internal fixation of complex tibial plateau fractures - SOTA algorithm (Spanish Orthopaedic Trauma Association). Injury 2021; 52 Suppl 4:S87-S98. [PMID: 34011441 DOI: 10.1016/j.injury.2021.03.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The correct choice of surgical approaches in complex tibial plateau fractures is essential to achieve adequate reduction and fixation. Detailed fracture morphology and direction of columns displacement, that we have named the Main Deformity Direction (MDD), may aid in selecting the optimal surgical strategy. In this article we present a new algorithm based on MDD and column concepts. The aim of this study was to evaluate the outcomes of a group of tibial plateau fractures treated according to this algorithm. The secondary aim was to evaluate the incidence of the different MDD in our multicolumnar subgroup. PATIENTS AND METHODS Excluding isolated lateral one-column fractures, open fractures and patients not treated following this algorithm, 72 patients with tibial plateau fractures surgically treated with open reduction and internal fixation were collected retrospectively, from three trauma centers, from January 2015 to April 2019. Radiological assessment was performed to establish the columns involved and the MDD. Quality and maintenance of reduction and alignment, complications and functional outcomes were assessed. RESULTS Initial fracture analysis was performed in 72 patients (8 one-column, 35 two-column and 29 multicolumnar fractures). In the multicolumnar group, the posteromedial MDD was the most frequent pattern (17 of 29 patients). Four patients were excluded due to loss of follow-up, resulting 68 patients for final outcome analysis (7 one-column, 34 two-column and 27 multicolumnar). The average follow-up was 18 months (range: 6-52). Excellent/good outcomes were obtained in all one-column, 31 of 34 two-column and 25 of 27 multicolumnar fractures. Incomplete reduction was present in three patients. As complications, we had two loss of reduction, one conversion to knee arthroplasty, one nonunion and one deep infection. No patient presented neurological or vascular problems, knee instability or extension deficit. CONCLUSION Satisfactory results have been obtained following the principles of our algorithm. In addition to the anatomical involvement of columns and segments, we believe that identifying the Main Deformity Direction (MDD) provides useful information for decision-making, especially in multicolumnar fractures. The most frequent MDD in our multicolumnar subgroup was the posteromedial MDD, but more than one-third presented a different MDD, requiring different surgical strategies.
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Affiliation(s)
- Juan Boluda-Mengod
- Hospital Universitario Canarias (HUC), Carretera Ofra s/n., 38320, La Laguna, Tenerife, Spain; School of Medicine, Universidad de La Laguna (ULL), Campus de Ofra, s/n, 38071, La Laguna, Tenerife, Spain; Spanish Orthopaedic Trauma Association - The Orthopaedic Surgery and Traumatology Spanish Society (SOTA-SECOT), Calle Fernández de los Ríos, 108, 28015, Madrid, Spain.
| | - Vicente Guimerà-García
- Hospital Can Misses (HCM), Carrer de Corona s/n., 07800, Ibiza, Spain; Spanish Orthopaedic Trauma Association - The Orthopaedic Surgery and Traumatology Spanish Society (SOTA-SECOT), Calle Fernández de los Ríos, 108, 28015, Madrid, Spain.
| | - Beatriz Olías-López
- Hospital Universitario Canarias (HUC), Carretera Ofra s/n., 38320, La Laguna, Tenerife, Spain; Spanish Orthopaedic Trauma Association - The Orthopaedic Surgery and Traumatology Spanish Society (SOTA-SECOT), Calle Fernández de los Ríos, 108, 28015, Madrid, Spain.
| | - Pablo Renovell-Ferrer
- Consorcio Hospital General Universitario de Valencia (CHGUV), Avenida Tres Cruces, 2, 46014, Valencia, Spain; Spanish Orthopaedic Trauma Association - The Orthopaedic Surgery and Traumatology Spanish Society (SOTA-SECOT), Calle Fernández de los Ríos, 108, 28015, Madrid, Spain.
| | - Ion Carrera
- Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Carrer de Sant Quintí, 89, 08041, Barcelona, Spain; Spanish Orthopaedic Trauma Association - The Orthopaedic Surgery and Traumatology Spanish Society (SOTA-SECOT), Calle Fernández de los Ríos, 108, 28015, Madrid, Spain.
| | - Mario Herrera-Pérez
- Hospital Universitario Canarias (HUC), Carretera Ofra s/n., 38320, La Laguna, Tenerife, Spain; School of Medicine, Universidad de La Laguna (ULL), Campus de Ofra, s/n, 38071, La Laguna, Tenerife, Spain; Spanish Orthopaedic Trauma Association - The Orthopaedic Surgery and Traumatology Spanish Society (SOTA-SECOT), Calle Fernández de los Ríos, 108, 28015, Madrid, Spain.
| | - José Luis Pais-Brito
- Hospital Universitario Canarias (HUC), Carretera Ofra s/n., 38320, La Laguna, Tenerife, Spain; School of Medicine, Universidad de La Laguna (ULL), Campus de Ofra, s/n, 38071, La Laguna, Tenerife, Spain; Spanish Orthopaedic Trauma Association - The Orthopaedic Surgery and Traumatology Spanish Society (SOTA-SECOT), Calle Fernández de los Ríos, 108, 28015, Madrid, Spain.
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Metwaly RG, Zakaria ZM, Elgebeily MA, El Zahlawy H. Solving the enigma of posterolateral tibial plateau fractures, the clue protocol. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The study aim is to evaluate functional and radio- logical outcomes following a suggested protocol based on the four-column classification for management of posterolateral column tibial plateau fractures.
A prospective cohort study was performed in level I academic center on 42 patients with mean age of 36 years (22-59). Eleven patients had isolated posterolateral column fractures whereas 31 patients had associated columns fractures. According to the suggested protocol, all cases of isolated posterolateral column fracture started treatment via arthroscopic evaluation of soft tissue injuries (menisci and liga- ments), arthroscopically assisted reduction and inter- nal fixation by rafting screws followed by ORIF if plating was needed. If associated with other columns fractures, columns were fixed sequentially in an anti-clockwise direction starting from anteromedial column.
Average follow up was 26 months. Mean time to union was 16.3 (12-22) weeks. No radiological evidence of loss of coronal or sagittal alignment was detected at final follow up. Five patients had an average depression of 5 millimeters that did not need further intervention at this short-term follow up. Mean KOOS was 81 (72- 88). The average knee range of motion was (0° - 127°). One patient had temporary common peroneal nerve injury, one patient had deep infection and two had superficial wound infection.
implementing the suggested protocol gives good to excellent radiological and functional results as regard posterolateral tibial plateau fracture. A larger study group with longer follow up is needed.
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Koëter S, Van Tienen TG, Rijk PC, Vincken PWJ, Segers MJM, Van Essen B, Van Melick N, Stegeman BH, Van Arkel ERA. Dutch Guideline on Knee Arthroscopy Part 2: non-meniscus intra-articular knee injury: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop 2021; 92:81-84. [PMID: 33228429 PMCID: PMC7924887 DOI: 10.1080/17453674.2020.1850081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - A guideline committee of medical specialists and a physiotherapist was formed on the initiative of the Dutch Orthopedic Association (NOV) to update the Guideline Arthroscopy of the Knee: Indications and Treatment 2010. This next Guideline was developed between June 2017 and December 2019. In part 1 we focused on the meniscus; this part 2 addresses all other aspects of knee arthroscopy.Methods - The guideline was developed in accordance with the criteria of the AGREE instrument (AGREE II: Appraisal of Guidelines for Research and Evaluation II) with support of a professional methodologist from the Dutch Knowledge Institute of Medical Specialists. The scientific literature was searched and systematically analyzed. Conclusions and recommendations were formulated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Recommendations were developed considering the balance of benefits and harms, the type and quality of evidence, the values and preferences of the people involved, and the costs.
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Affiliation(s)
- Sander Koëter
- Department of Orthopedic Surgery Canisius Wilhelmina Ziekenhuis, Nijmegen;
| | | | - Paul C Rijk
- Department of Orthopedic Surgery Medisch Centrum Leeuwarden, Leeuwarden;
| | | | | | - Bert Van Essen
- Department of Sports Medicine Maxima Medisch Centrum, Veldhoven;
| | | | | | - Ewoud R A Van Arkel
- FocusKliniek Orthopedie Haaglanden Medisch Centrum, Den Haag, The Netherlands
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Prall WC, Rieger M, Fürmetz J, Haasters F, Mayr HO, Böcker W, Kusmenkov T. Schatzker II tibial plateau fractures: Anatomically precontoured locking compression plates seem to improve radiological and clinical outcomes. Injury 2020; 51:2295-2301. [PMID: 32650982 DOI: 10.1016/j.injury.2020.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/01/2020] [Accepted: 07/05/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The design of anatomically precontoured locking compression plates (LCP) allows the placement of angular stable screws right underneath the reduced joint surface fragments. To date, there is a lack of evidence supporting the broad utilization of these implants in split depression fractures to the lateral tibial plateau. Thus, aim of the present matched pair retrospective cohort study was to investigate the radiological and clinical outcomes of anatomically precontoured LCP compared to conventional plate and screw osteosynthesis in Schatzker II fractures. MATERIAL AND METHODS The institutional databank was searched for Schatzker II fractures from 2010 to 2016. Patients that underwent open reduction and internal fixation with anatomically precontoured 3.5 mm LCP or conventional 4.5 mm l-shaped plates and screws were included. CT scans and radiographs were analyzed. Details of the operative procedures and secondary events were collected. A matched pair analyses was conducted in a best fit manner. The primary outcome parameter was the Rasmussen Radiological Score approximately one year postoperatively. Secondary outcome parameters were the medial proximal tibial angle (MPTA), the Rasmussen Clinical Score and the WOMAC Score after a follow up of at least three years. RESULTS A total of 50 patients was included. Patient age, gender distribution, size and depression depth of the lateral joint surface fragments, frequency of utilizing bone grafts or substitutes and lateral meniscus repair as well as subsequent implant removal were comparable across the groups. Immediately postoperatively, the Rasmussen Radiological Score revealed no differences. After a mean of 64.2 weeks, the radiological outcome was significantly better in the LCP 3.5 group (RRS 8.2 vs. 6.3 points, p<0.001; MPTA 89.5 vs. 92.0°, p = 0.001). After a mean clinical follow-up of 4.5 years, the Rasmussen Clinical Score (22.9 vs. 27.8 points, p<0.001) and the WOMAC score (24.3 vs. 16.0 points, p = 0.04) revealed significantly impaired results in the conventional group. CONCLUSION Anatomically precontoured LCP prevent the subsidence of the reduced joint surface fragments more sufficiently and allow for improved patient outcomes compared to conventional plates and screws. The utilization of anatomically precontoured LCP should therefore closely be considered for internal fixation of any split depression fractures to the lateral tibial plateau.
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Affiliation(s)
- W C Prall
- FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany.
| | - M Rieger
- FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria
| | - J Fürmetz
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - F Haasters
- FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - H O Mayr
- FIFA Medical Centre of Excellence, Division of Knee Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Harlachinger Str. 51, 81547 Munich, Germany; Academic Teaching Hospital of the Paracelsus Medical University (PMU), Strubergasse 21, 5020 Salzburg, Austria; Department of Orthopaedics and Trauma Surgery, Freiburg University Hospital, Albert-Ludwigs-University, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - W Böcker
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
| | - T Kusmenkov
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Nussbaumstr. 20, 80336 Munich, Germany
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Giordano V, Belangero WD, Sá BDEA, Rivas D, Souto D, Portnoi E, Mariolani JR, Koch HA. Plate-screw and screw-washer stability in a Schatzker type-I lateral tibial plateau fracture: a comparative biomechanical study. Rev Col Bras Cir 2020; 47:e20202546. [PMID: 32520134 DOI: 10.1590/0100-6991e-20202546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/22/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the biomechanical role of both a non-locking two-hole small fragment dynamic compression plate with 3.5-mm screws and a 4.5-mm cortical screw with a washer applied to a Schatzker type-I tibial plateau fracture. Sixteen right synthetic tibiae were used to create an anterolateral shear tibial plateau fracture (Schatzker type-I fracture). Eight models were fixed with a small fragment non-locked straight dynamic compression plate with one 3.5-mm bicortical screw (plate-screw construction) and eight models were fixed with a 4.5-mm cortical screw and a washer (screw-washer construction), both inserted at 1.0 mm distal to the apex of the fracture. Specimens were tested up to the onset of yielding at a constant strain rate of 5.0-mm/min. Stiffness ranged from 311.83 N/mm to 199.54 N/mm, with a mean + SD of 260.32 + 33.8 N/mm in the plate-screw construction, and from 290.34 N/mm to 99.16 N/mm, with a mean + SD of 220.46 + 63.12 N/mm in screw-washer construction. There was no significant difference (p=0.172). Use of a two-hole small-fragment non-locked plate with one 3.5-mm cortical screw or a 4.5-mm cortical screw with a washer applied at 1.0 mm distal to the apex of the fracture as buttressing present similar stiffness in terms of preventing axial displacement in synthetic tibiae models tested up to the onset of yielding.
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Affiliation(s)
- Vincenzo Giordano
- - Miguel Couto Municipal Hospital, Orthopedics and Traumatology Service Nova Monteiro - Rio de Janeiro - RJ - Brazil.,- Clínica São Vicente, Rede D'or São Luiz, Orthopedics - Rio de Janeiro - RJ - Brazil
| | - William Dias Belangero
- - Faculty of Medical Sciences, University of Campinas (UNICAMP), Department of Orthopedics - Campinas - SP - Brazil.,- Faculty of Medical Sciences, University of Campinas (UNICAMP), Biomaterials Laboratory in Orthopedics (LABIMO) - Campinas - SP - Brazil
| | - Brenno DE Araújo Sá
- - Miguel Couto Municipal Hospital, Orthopedics and Traumatology Service Nova Monteiro - Rio de Janeiro - RJ - Brazil
| | - Daniela Rivas
- - Miguel Couto Municipal Hospital, Orthopedics and Traumatology Service Nova Monteiro - Rio de Janeiro - RJ - Brazil
| | - Danilo Souto
- - Miguel Couto Municipal Hospital, Orthopedics and Traumatology Service Nova Monteiro - Rio de Janeiro - RJ - Brazil
| | - Eduardo Portnoi
- - Miguel Couto Municipal Hospital, Orthopedics and Traumatology Service Nova Monteiro - Rio de Janeiro - RJ - Brazil
| | - José Ricardo Mariolani
- - Faculty of Medical Sciences, University of Campinas (UNICAMP), Biomaterials Laboratory in Orthopedics (LABIMO) - Campinas - SP - Brazil
| | - Hilton Augusto Koch
- - Federal University of Rio de Janeiro (UFRJ), Department of Radiology - Rio de Janeiro - RJ- Brazil
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An Easy Positioning Technique for Complex Proximal Tibia Fractures. Tech Orthop 2020. [DOI: 10.1097/bto.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register]
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11
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Strategies to minimize soft tissues and septic complications in staged management of high-energy proximal tibia fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:671-680. [PMID: 31893294 DOI: 10.1007/s00590-019-02619-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Soft tissues (wound dehiscence, skin necrosis) and septic (wound infection, osteomyelitis) complications have been historically recognized as the most frequent complications in surgical treatment of high-energy proximal tibia fractures (PTFs). Staged management with a temporary external fixator is a commonly accepted strategy to prevent these complications. Nonetheless, there is a lack of evidence about when and how definitive external or internal definitive fixation should be chosen, and which variables are more relevant in determining soft tissues and septic complications risk. The aim of the present study is to retrospectively evaluate at midterm follow-up the results of a staged management protocol applied in a single trauma center for selective PTFs. METHODS The study population included 24 cases of high-energy PTFs treated with spanning external fixation followed by delayed internal fixation. Severity of soft tissues damage and fracture type, timing of definitive treatment, clinical (ROM, knee stability, WOMAC and IOWA scores) and radiographic results as well as complications were recorded. RESULTS AND CONCLUSION Complex fracture patterns were prevalent (AO C3 58.3%, Schatzker V-VI 79.1%), with severe soft tissues damage in 50% of cases. Mean time to definitive internal fixation was 6 days, with double-plate fixation mostly chosen. Clinical results were highly satisfying, with mean WOMAC and IOWA scores as 21.3 and 82.5, respectively. Soft tissue complication incidence was very low, with a single case of wound superficial infection (4.3%) and no cases (0%) of deep infection, skin necrosis or osteomyelitis. Staged management of high-energy PTFs leads to satisfying clinical and radiographic results with few complications in selected patients.
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Bäumlein M, Hanke A, Gueorguiev B, Nerlich M, Liodakis E, Perren T, Rillmann P, Ryf C, Loibl M. Long-term outcome after surgical treatment of intra-articular tibial plateau fractures in skiers. Arch Orthop Trauma Surg 2019; 139:951-959. [PMID: 30864087 DOI: 10.1007/s00402-019-03150-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Tibial plateau fractures occur frequently during downhill skiing. There is a lack of information about the outcome and development of posttraumatic osteoarthritis after internal fixation of such fractures at long-term follow-up in skiers. MATERIALS AND METHODS A population of 83 skiers was followed up in a case series after internal fixation of intra-articular tibial plateau fractures AO-OTA 41 B1-B3 and C1-C3. Functional outcomes Visual Analog Scale, Tegner Activity Scale, Modified Lysholm Score, Hospital for Special Surgery (HSS) Knee Score and X-ray images of the affected knees (preoperative, postoperative and at time of follow-up) were obtained. Radiological evaluation focused on severity of osteoarthritis according to the Kellgren and Lawrence score of the lateral, medial and retropatellar knee compartments separately. Subgroup analyses for fracture type and age were performed separately. RESULTS Patients age was 49.8 ± 12.9 years (range 19-74 years) at the time of surgery, with a mean follow-up period of 10.3 ± 1.9 years (range 6-14 years). All tibial plateau fractures affected the lateral compartment, while the medial compartment was affected in addition as part of bicondylar fractures in two cases. Both the Tegener Activity Scale and Lysholm Score decreased significantly during the follow-up period and their median values dropped from 6 (range 3-7) to 5 (range 2-7) and from 100 (range 90-100) to 95 (range 58-100), respectively (both p < .01). The median clinical knee function at the time of follow-up revealed an HSS Knee Score of 96.5 points (range 74-100). Among the whole patient population, the radiological evaluation at follow-up revealed a significantly higher grade of osteoarthritis in all compartments of the knee joint compared to the time of the operation (p < .01). The grade of osteoarthritis in the lateral compartment was significantly higher than that in the medial and retropatellar compartments (p < .01). CONCLUSIONS In addition to physiologic aging, progression of radiologic signs of osteoarthritis following internal fixation of intra-articular tibial plateau fractures in an athletic population of skiers is most severe in the lateral knee compartment corresponding to fracture location. However, the long-term functional outcomes seem to be very satisfactory.
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Affiliation(s)
- Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldinger Str., 35043, Marburg, Germany. .,Department of Trauma Surgery, Davos Hospital, Davos, Switzerland.
| | - Alexander Hanke
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | | | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | | | - Thomas Perren
- Department of Trauma Surgery, Davos Hospital, Davos, Switzerland
| | - Paavo Rillmann
- Department of Trauma Surgery, Davos Hospital, Davos, Switzerland
| | - Christian Ryf
- Department of Trauma Surgery, Davos Hospital, Davos, Switzerland
| | - Markus Loibl
- Department of Trauma Surgery, Davos Hospital, Davos, Switzerland.,Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
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Citak C, Kayali C, Ozan F, Altay T, Karahan HG, Yamak K. Lateral Locked Plating or Dual Plating: A Comparison of Two Methods in Simple Bicondylar Tibial Plateau Fractures. Clin Orthop Surg 2019; 11:151-158. [PMID: 31156765 PMCID: PMC6526137 DOI: 10.4055/cios.2019.11.2.151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/24/2019] [Accepted: 02/08/2019] [Indexed: 11/25/2022] Open
Abstract
Background In this study, our aim was to compare the results of the dual locking plate fixation technique and lateral locking plate fixation technique for tibial bicondylar plateau fractures without posteromedial fragment. Methods We evaluated 20 patients who underwent surgical treatment due to bicondylar tibial plateau fracture between 2010 and 2015. Ten patients were included in group 1, in which a dual locking plate was employed, whereas 10 patients were included in group 2, in which a lateral locking plate was used. In both groups, functional and clinical outcomes after treatment were rated according to the Knee Society Knee Scoring System, Rasmussen functional score, and Rasmussen radiological score. Results The mean follow-up time was 24 months. There were no significant differences between the groups with respect to functional and radiographic outcomes at the final follow-up. Conclusions In bicondylar tibial plateau fractures without posteromedial fragment, the lateral locking plate fixation technique showed the similar clinical and radiological outcomes as the dual locking plate fixation technique.
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Affiliation(s)
- Caner Citak
- Department of Orthopedics and Traumatology, Mardin State Hospital, Mardin, Turkey
| | - Cemil Kayali
- Department of Orthopedics and Traumatology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Firat Ozan
- Department of Orthopedics and Traumatology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Taskin Altay
- Department of Orthopedics and Traumatology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Huseyin Gokhan Karahan
- Department of Orthopedics and Traumatology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Kamil Yamak
- Department of Orthopedics and Traumatology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Lee KW, Yang DS, Hwang JY, Kim KJ, Choy WS. Arthroscopic Assessment of Cartilage Healing Status after Treatment of Tibial Plateau Fracture. Indian J Orthop 2019; 53:257-262. [PMID: 30967694 PMCID: PMC6415563 DOI: 10.4103/ortho.ijortho_190_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are a few reports on the healing status of the cartilage after the treatment of tibial plateau fracture. In this study, we analyzed the healing status of articular cartilage using second-look arthroscopy with clinical and radiological results from patient's in schatzker Type I, II, and III tibial plateau fracture. MATERIALS AND METHODS 43 patients operated between January 2011 and December 2013 were included in this retrospective study. Radiological evaluation was performed by comparing simple radiographs from the preoperative, postoperative, and final followup period. Clinical evaluations were performed using the Knee Society Knee Score (KSKS) and the Knee Society Functional Score (KSFS). Moreover, second-look arthroscopic evaluation was performed during implant removal, and cartilage healing status was classified according to the International Cartilage Repair Society grading system (ICRS). RESULTS In all 43 patients, bony union was achieved with a mean duration of 13.7 weeks. The degree of cartilage healing was poor when the step-off was high (P = 0.016). Furthermore, even in cases with satisfactory step-off <2 mm, there was no case with complete cartilage healing. Between ICRS grade and clinical results, the respective Pearson coefficient for KSKS and KSFS were r = -0.62 and r = -0.59 indicating mean statistically significant negative correlations (P = 0.001). CONCLUSION Even though step off was reduced anatomically and clinical outcome was excellent or good, there was not always complete cartilage healing in a followup on second-look arthroscopy. Therefore, we focused on not only radiologic and clinical outcome but also the actual status of cartilage with second-look arthroscopy.
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Affiliation(s)
- Kwang Won Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Dae Suk Yang
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea,Address for correspondence: Dr. Dae Suk Yang, Department of Orthopedic Surgery, Eulji University College of Medicine, 95, Dunsanseo-Ro, Seo-Gu, Daejeon 35233, Korea. E-mail:
| | - Jae Yeon Hwang
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Kap Jung Kim
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
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Lokman K, Levent K. Comparison of surgical treatment results and clinical and radiological findings of tibial plateau fractures. SANAMED 2019. [DOI: 10.24125/sanamed.v14i2.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction:In this retrospective study, it was aimed to evaluate the correlation between operative treatment results and clinical and radiological findings of tibial plateau fractures. Patients and Methods: Between 1996 and 2006, 33 knees were operated for tibia plateau fracture of 32 patients. 29 patients were male and 3 were female. Only 3 cases (9.99%) were open tibial plateau fractures. The mean age was 45 years. Fractures classified using the Schatzker classification were: 17 (52%) type 1, 12 (12%) type 2, 9 (27%) type 5 and 6 (9%) type 6. Patients following the period were at least 44 weeks and maximum 480 weeks (mean 60 weeks). Results: The results of 33 patients were determined by the clinical and radiological system of Rasmussen. According to clinical findings, 17 cases were excellent, 9 were good, 6 were medium and 1 was poor. According to the radiological findings, 9 cases were excellent, 16 were good, 6 were medium and 2 were bad. The difference between clinical and radiological findings was analyzed with Pearson core analysis and statistically significant (p < 0.005). Comparison was made according to the time between injury and operation and no statistically significant difference was found (p > 0.005). The analyzes of the grade of fracture and the degree of fracture were statistically significant (p < 0.005). 42.4% of all patients had meniscus injury. Therefore, arthroscopy should be used with surgery. Conclusion: Anatomic reduction, rigid fixation of the joint and early mobilization can reduce complications and improve the function of the knee joint in tibial plateau fractures.
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Trans-articular Kirschner wire fixation in treating complex tibial plateau fractures complicated by multiple ligaments injuries: A case report and literature review. Injury 2018; 49:382-385. [PMID: 29162269 DOI: 10.1016/j.injury.2017.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 02/02/2023]
Abstract
There is no guideline and consensus about when and how to treat accompanying multi-ligaments injuries, especially anterior and/or posterior cruciate ligaments, in tibial plateau fractures. We report one case of fracture and dislocation of tibial plateau, treated by open reduction and internal plates fixation, augmented by trans-articular Kirschner wire fixation to overcome instability and malrotation of the knee joints discovered intraoperatively. The Kirschner wire was removed about four weeks after the index operation, and the patient begun functional exercise from then on. The fracture united uneventfully, the knee joint regained full range of motion without malalignment. The patient reported excellent knee function and satisfied with the operations. We suppose that trans-articular Kirschner wires fixation combined with open reduction internal plates fixation maybe is a treatment solution in treating complex tibial plateau fractures complicated by multiple ligamentous injuries.
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Hanke A, Bäumlein M, Lang S, Gueorguiev B, Nerlich M, Perren T, Rillmann P, Ryf C, Miclau T, Loibl M. Long-term radiographic appearance of calcium-phosphate synthetic bone grafts after surgical treatment of tibial plateau fractures. Injury 2017; 48:2807-2813. [PMID: 29096930 DOI: 10.1016/j.injury.2017.10.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Synthetic bone grafts (SBGs) are widely used to fill bone defects after fracture reduction. This study assessed the long-term resorption of two different calcium phosphate products (A=ChronOS™ inject and B=Norian® SRS®; both DePuy Synthes, Oberdorf, Switzerland) used in the surgical treatment of tibial plateau fractures. DESIGN Long-term clinical and radiologic follow-up of 52 patients after surgical treatment of intraarticular tibial plateau fractures augmented with SBGs. SETTING The study was performed at a level 3 trauma center. PATIENTS Between January 2000 and December 2006 a total of 52 patients with intraarticular tibial plateau fractures were operatively treated and augmented with SBGs consisting of a Brushite matix with β-TCP granules (SBG A) or hydroxylapatite with 4-6% carbonate content (SBG B). 46 patients could be contacted and 38 were included in the study. Half of the patients received SBG A and the other half SBG B. MAIN OUTCOME MEASUREMENTS Loss of reduction and SBG resorption was investigated by comparison of follow-up X-ray images to pre- and postoperative X-ray images. Furthermore, pain, activity level and knee function were evaluated by means of questionnaires and clinical examination. RESULTS The mean age of patients was 59.7±12.5years. The follow-up was 8.6±0.9years for SBG A and 11.6±1.4years for SBG B (p<0.001). In most cases SBG A was completely resorbed in a homogenous pattern, while SBG B was still visible on the X-ray images revealing a peripheral resorption pattern. A loss of reduction (>2mm) could be observed in two patients with SBG A and two patients with SBG B, although only one of them had an impaired knee function. CONCLUSIONS The composite SBG A reveals a comprehensive long-term resorption in comparison to SBG B. Nevertheless, both provided suitable mechanical support as part of the surgical treatment of tibial plateau fractures. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Alexander Hanke
- Department of Orthopaedic Trauma Surgery, Spital Davos, Davos, Switzerland; Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Martin Bäumlein
- Department of Orthopaedic Trauma Surgery, Spital Davos, Davos, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | | | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany
| | - Thomas Perren
- Department of Orthopaedic Trauma Surgery, Spital Davos, Davos, Switzerland
| | - Paavo Rillmann
- Department of Orthopaedic Trauma Surgery, Spital Davos, Davos, Switzerland
| | - Christian Ryf
- Department of Orthopaedic Trauma Surgery, Spital Davos, Davos, Switzerland
| | - Theodore Miclau
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, CA, United States
| | - Markus Loibl
- Department of Orthopaedic Trauma Surgery, Spital Davos, Davos, Switzerland; Department of Trauma Surgery, Regensburg University Medical Center, Regensburg, Germany.
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Abstract
INTRODUCTION This study sought to assess and compare long-term functional and clinical outcomes in patients with tibial plateau fractures that are treated nonsurgically. METHODS Over a period of 8 years, 305 consecutive tibial plateau fractures were treated by three surgeons at a single institution and followed prospectively in an Institutional Review Board-approved study. Overall, 41 patients (13%) were treated nonsurgically and 37 were available for follow-up. Indications for nonsurgical management were minimal fracture displacement or preclusion of surgery because of comorbidities. A series of univariate retrospective analyses were used to identify individual risk factors potentially predictive of Short Musculoskeletal Functional Assessment scores. RESULTS Thirty-seven patients were included with a mean follow-up of 21 ± 14.9 months. Overall, 59% of patients (n = 22) attained good to excellent functional outcomes. In patients for whom surgery was precluded because of comorbidities, outcome scores were significantly poorer (38.8 ± 23.0 versus 12.7 ± 14.2; P = 0.001). Surgery precluded by a factor other than minimal fracture displacement predicted poor outcome (P = 0.002). DISCUSSION Carefully selected patients with minimally displaced tibial plateau fractures can expect good to excellent outcomes when treated nonsurgically. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Schnetzke M, Swartman B, Bonnen I, Keil H, Schüler S, Grützner PA, Franke J. Vascular Impulse Technology versus elevation in the treatment of posttraumatic swelling of extremity fractures: study protocol for a randomized controlled trial. Trials 2017; 18:73. [PMID: 28209169 PMCID: PMC5314677 DOI: 10.1186/s13063-017-1824-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fractures of the extremities are often complicated by a variable degree of swelling secondary to hemorrhage and soft tissue injury. Patients typically require up to 7 days of inpatient bed rest and elevation to reduce swelling to an acceptable level for operative treatment with internal fixation. Alternatively, an intermittent pneumatic compression device, such as the Vascular Impulse Technology (VIT) system, can be used at the injured extremity to reduce the posttraumatic swelling. The VIT system consists of a pneumatic compressor that intermittently rapidly inflates a bladder positioned under the arch of the hand or the foot, which results in compression of the venous hand or foot plexus. That intermittent compression induces an increased venous velocity and aims to reduce the soft tissue swelling of the affected extremity. METHODS/DESIGN The VIT study is a prospective, monocenter, randomized controlled trial to compare the VIT system with elevation in the treatment of posttraumatic swelling in the case of a fracture of the upper and lower extremity. This study will include 280 patients with fractures of the upper and the lower extremity with nine different injury types. For each of the nine injury types a separate randomization to the two intervention groups (VIT group or control group) will be performed. The primary outcome parameter is the time taken for the swelling to resolve sufficiently to permit surgery. A separate analysis for each of the nine injury types will be performed. DISCUSSION In the proposed study, the effectiveness of the VIT system in the treatment of posttraumatic swelling of upper and lower extremity fractures will be evaluated. TRIAL REGISTRATION German Clinical Trial Register, No. DRKS00010510 . Registered on 17 July 2016.
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Affiliation(s)
- Marc Schnetzke
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Benedict Swartman
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Isabel Bonnen
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Holger Keil
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Svenja Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Paul A Grützner
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany
| | - Jochen Franke
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen am Rhein, Germany.
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Fang C, Wong TM, Lau TW, To KK, Wong SS, Leung F. Infection after fracture osteosynthesis - Part I. J Orthop Surg (Hong Kong) 2017; 25:2309499017692712. [PMID: 28215118 DOI: 10.1177/2309499017692712] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Bone and surgical site infections after osteosynthesis are notoriously difficult to manage and pose a tremendous burden in fracture management. In this article, we use the term osteosynthesis-associated infection (OAI) to refer to this clinical entity. While relatively few surgically treated fractures become infected, it is challenging to perform a rapid diagnosis. Optimal management strategies are complex and highly customized to each scenario and take into consideration the status of fracture union, the presence of hardware and the degree of mechanical stability. At present, a high level of relevant evidence is unavailable; most findings presented in the literature are based on laboratory work and non-randomized clinical studies. We present this overview of OAI in two parts: an examination of recent literature concerning OAI pathogenesis, diagnosis and classification and a review of treatment options.
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Affiliation(s)
- Christian Fang
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Tak-Man Wong
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China.,3 Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Tak-Wing Lau
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Kelvin Kw To
- 2 Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Samson Sy Wong
- 2 Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Frankie Leung
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China.,3 Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Role of Joshi's external stabilization system with percutaneous screw fixation in high-energy tibial condylar fractures associated with severe soft tissue injuries. Chin J Traumatol 2016; 18:326-31. [PMID: 26917022 DOI: 10.1016/j.cjtee.2015.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries. METHODS Between June 2008 and June 2010, 25 consecutive patients who were 17e71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade I&II). The injury mechanisms were motor vehicle accidents (n=19), fall from a height (n=2) and assault (n=1). The fractures were classified according to Schatzker classification system. RESULTS There were 7 type-V, 14 type-VI and 1 type-lV Schatzker's tibial plateau fractures. The average interval between the injury and surgery was 6.8 days (range 2-13). The average hospital stay was 13 days (range, 7-22). The average interval between the surgery and full weight bearing was 13.6 weeks (range 11-20). The average range of knee flexion was 121°(range 105°-135°). The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections (n=4) with no knee stiffness. CONCLUSION JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.
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Freude T, Kraus TM, Sandmann GH. [Balloon osteoplasty as reduction technique in the treatment of tibial head fractures]. Unfallchirurg 2016; 118:838-43. [PMID: 26303629 DOI: 10.1007/s00113-015-0064-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tibial plateau fractures requiring surgery are severe injuries of the lower extremities. Depending on the fracture pattern, the age of the patient, the range of activity and the bone quality there is a broad variation in adequate treatment. AIM This article reports on an innovative treatment concept to address split depression fractures (Schatzker type II) and depression fractures (Schatzker type III) of the tibial head using the balloon osteoplasty technique for fracture reduction. METHODS Using the balloon technique achieves a precise and safe fracture reduction. This internal osteoplasty combines a minimal invasive percutaneous approach with a gently rise of the depressed area and the associated protection of the stratum regenerativum below the articular cartilage surface. This article lights up the surgical procedure using the balloon technique in tibia depression fractures. CONCLUSION Using the balloon technique a precise and safe fracture reduction can be achieved. This internal osteoplasty combines a minimally invasive percutaneous approach with a gentle raising of the depressed area and the associated protection of the regenerative layer below the articular cartilage surface. Fracture reduction by use of a tamper results in high peak forces over small areas, whereas by using the balloon the forces are distributed over a larger area causing less secondary stress to the cartilage tissue. This less invasive approach might help to achieve a better long-term outcome with decreased secondary osteoarthritis due to the precise and chondroprotective reduction technique.
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Affiliation(s)
- T Freude
- Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland.
| | - T M Kraus
- Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland
| | - G H Sandmann
- Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland
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Frosch KH, Krause M, Frings J, Drenck T, Akoto R, Müller G, Madert J. [Posttraumatic deformities of the knee joint : Intra-articular osteotomy after malreduction of tibial head fractures]. Unfallchirurg 2016; 119:859-76. [PMID: 27655027 DOI: 10.1007/s00113-016-0234-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Malreduction of tibial head fractures often leads to malalignment of the lower extremity, pain, limited range of motion and instability. The extent of the complaints and the degree of deformity requires an exact analysis and a standardized approach. True ligamentous instability should be distinguished from pseudoinstability of the joint. Also extra- and intra-articular deformities have to be differentiated. In intra-articular deformities the extent of articular surface displacement, defects and clefts must be accurately evaluated. A specific surgical approach is necessary, which allows adequate visualization, correct osteotomy and refixation of the fractured area of the tibial head. In the long-term course good clinical results are described for intra-articular osteotomies. If the joint is damaged to such an extent that it cannot be reconstructed or in cases of advanced posttraumatic osteoarthritis, total knee arthroplasty may be necessary; however, whenever possible and reasonable, anatomical reconstruction and preservation of the joint should be attempted.
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Affiliation(s)
- K-H Frosch
- Chirurgisch-Traumatologisches Zentrum, Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland.
| | - M Krause
- Chirurgisch-Traumatologisches Zentrum, Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - J Frings
- Chirurgisch-Traumatologisches Zentrum, Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - T Drenck
- Chirurgisch-Traumatologisches Zentrum, Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - R Akoto
- Chirurgisch-Traumatologisches Zentrum, Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - G Müller
- Chirurgisch-Traumatologisches Zentrum, Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
| | - J Madert
- Chirurgisch-Traumatologisches Zentrum, Abteilung Unfall- und Wiederherstellungschirurgie mit Sektion Knie- und Schulterchirurgie, Sporttraumatologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland
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Abstract
Tibial plateau fractures are common in the elderly population following a low-energy mechanism. Initial evaluation includes an assessment of the soft tissues and surrounding ligaments. Most fractures involve articular depression leading to joint incongruity. Treatment of these fractures may be complicated by osteoporosis, osteoarthritis, and medical comorbidities. Optimal reconstruction should restore the mechanical axis, provide a stable construct for mobilization, and reestablish articular congruity. This is accomplished through a variety of internal or external fixation techniques or with acute arthroplasty. Regardless of the treatment modality, particular focus on preservation and maintenance of the soft tissue envelope is paramount.
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Affiliation(s)
- Joshua C Rozell
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Krishna C Vemulapalli
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Joshua L Gary
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Derek J Donegan
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Chang H, Zhu Y, Zheng Z, Chen W, Zhao S, Zhang Y, Zhang Y. Meta-analysis shows that highly comminuted bicondylar tibial plateau fractures treated by single lateral locking plate give similar outcomes as dual plate fixation. INTERNATIONAL ORTHOPAEDICS 2016; 40:2129-2141. [DOI: 10.1007/s00264-016-3157-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
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Salvi AE. Letter to the Editor: Surgical Technique: Tscherne-Johnson Extensile Approach for Tibial Plateau Fractures. Clin Orthop Relat Res 2016; 474:854-6. [PMID: 26626926 PMCID: PMC4746183 DOI: 10.1007/s11999-015-4653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/23/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Andrea Emilio Salvi
- Department of Orthopaedics and Traumatology, Mellino Mellini Hospital Trust, Civil Hospital of Chiari (Brescia), Viale Mazzini, 4, 25032 Chiari, Brescia Italy
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Kraus TM, Freude T, Stöckle U, Stuby FM. Outcome und Komplikationen nach proximalen Tibiafrakturen. DER ORTHOPADE 2016; 45:24-31. [DOI: 10.1007/s00132-015-3206-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Harmata AJ, Uppuganti S, Granke M, Guelcher SA, Nyman JS. Compressive fatigue and fracture toughness behavior of injectable, settable bone cements. J Mech Behav Biomed Mater 2015; 51:345-55. [PMID: 26282077 DOI: 10.1016/j.jmbbm.2015.07.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/23/2015] [Accepted: 07/27/2015] [Indexed: 01/09/2023]
Abstract
Bone grafts used to repair weight-bearing tibial plateau fractures often experience cyclic loading, and there is a need for bone graft substitutes that prevent failure of fixation and subsequent morbidity. However, the specific mechanical properties required for resorbable grafts to optimize structural compatibility with native bone have yet to be established. While quasi-static tests are utilized to assess weight-bearing ability, compressive strength alone is a poor indicator of in vivo performance. In the present study, we investigated the effects of interfacial bonding on material properties under conditions that re-capitulate the cyclic loading associated with weight-bearing fractures. Dynamic compressive fatigue properties of polyurethane (PUR) composites made with either unmodified (U-) or polycaprolactone surface-modified (PCL-) 45S5 bioactive glass (BG) particles were compared to a commercially available calcium sulfate and phosphate-based (CaS/P) bone cement at physiologically relevant stresses (5-30 MPa). Fatigue resistance of PCL-BG/polymer composite was superior to that of the U-BG/polymer composite and the CaS/P cement at higher stress levels for each of the fatigue failure criteria, related to modulus, creep, and maximum displacement, and was comparable to human trabecular bone. Steady state creep and damage accumulation occurred during the fatigue life of the PCL-BG/polymer and CaS/P cement, whereas creep of U-BG/polymer primarily occurred at a low number of loading cycles. From crack propagation testing, fracture toughness or resistance to crack growth was significantly higher for the PCL-BG composite than for the other materials. Finally, the fatigue and fracture toughness properties were intermediate between those of trabecular and cortical bone. These findings highlight the potential of PCL-BG/polyurethane composites as weight-bearing bone grafts.
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Affiliation(s)
- Andrew J Harmata
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, TN, USA; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Sasidhar Uppuganti
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Mathilde Granke
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Scott A Guelcher
- Department of Chemical and Biomolecular Engineering, Vanderbilt University, Nashville, TN, USA; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
| | - Jeffry S Nyman
- Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA; Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN 37212, USA.
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Complex Osteotomies of Tibial Plateau Malunions Using Computer-Assisted Planning and Patient-Specific Surgical Guides. J Orthop Trauma 2015; 29:e270-6. [PMID: 25932528 DOI: 10.1097/bot.0000000000000301] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The accurate reduction of tibial plateau malunions can be challenging without guidance. In this work, we report on a novel technique that combines 3-dimensional computer-assisted planning with patient-specific surgical guides for improving reliability and accuracy of complex intraarticular corrective osteotomies. Preoperative planning based on 3-dimensional bone models was performed to simulate fragment mobilization and reduction in 3 cases. Surgical implementation of the preoperative plan using patient-specific cutting and reduction guides was evaluated; benefits and limitations of the approach were identified and discussed. The preliminary results are encouraging and show that complex, intraarticular corrective osteotomies can be accurately performed with this technique. For selective patients with complex malunions around the tibia plateau, this method might be an attractive option, with the potential to facilitate achieving the most accurate correction possible.
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Yao Y, Lv H, Zan J, Zhang J, Zhu N, Ning R, Jing J. A comparison of lateral fixation versus dual plating for simple bicondylar fractures. Knee 2015; 22:225-9. [PMID: 25747747 DOI: 10.1016/j.knee.2015.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 12/26/2014] [Accepted: 02/01/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The best fixation method for bicondylar tibial plateau fracture is debated. The aim of this study was to compare the effect of a lateral locking plate with that of dual plates in the treatment of tibial plateau fracture with a relatively intact medial condyle fragment. METHODS Eighty-six patients diagnosed with a bicondylar tibial plateau fracture with a relatively intact medial condyle were assigned to groups treated with either dual buttress plates (DP group) or a lateral locking plate (LP group). Preoperative characteristics, surgical details, and postoperative complications were recorded and compared between groups. Hospital for Special Surgery Knee Scoring System score was used to evaluate clinical outcome. RESULTS Both groups displayed satisfactory clinical and radiographic results. There were no significant differences in associated preoperative conditions between the DP and LP groups. Durations of hospital stay and operation were significantly shorter, and blood loss significantly less, in the LP group than in the DP group (P=0.045;0.038;0.031). The rate of delayed-union was significantly lower in the LP group than in the DP group (P=0.023). CONCLUSION Both dual-plate and lateral locking-plate fixation can provide satisfactory treatment of bicondylar tibial plateau fractures if properly used. When the medial tibial condyle is relatively intact, a lateral locking plate can provide stability similar to that of dual plate while decreasing operative duration and soft-tissue complications, which can assist fracture healing and shorten hospital stay. LEVEL OF EVIDENCE I - Randomized controlled trial.
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Affiliation(s)
- Yunfeng Yao
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China.
| | - Hao Lv
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Junfeng Zan
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Jisen Zhang
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Nan Zhu
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Rende Ning
- Department of Orthopaedic Surgery, The Third Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Juehua Jing
- Department of Orthopaedic Surgery, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China.
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Vauclair F, Almasri M, Gallusser N, Van Lanker H, Reindl R. Metaphyseal tibial level (MTL) screws: a modified percutaneous technique for lateral plateau depression fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:963-7. [PMID: 25956170 DOI: 10.1007/s00590-015-1639-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lateral tibial plateau fractures are more frequent than medial fractures, and those with articular depression are particularly challenging because of high displacement risk. To prevent secondary subsidence, the gold standard is raft screws with a periarticular or anti-glide plate. Graft is used to fill the metaphyseal defect created by reduction in the depressed fragment. We present a case of Schatzker II fracture managed in a complete percutaneous fashion, with a new combined technique of raft screws and interference screw used as a support. CASE REPORT A 51-year-old female sustained a Schatzker II tibial plateau fracture. Based on pre-operative CT, direction of reduction force to apply was drawn on coronal and sagittal cuts. OPERATIVE TECHNIQUE Under fluoroscopic control, the split component of the fracture was reduced. The cortical window was then drilled in the lateral cortex, and a K wire advanced under the depressed fragment under fluoroscopic guidance. After fragment reduction with a bone impacter, internal fixation was completed by percutaneous introduction of two subchondral cortical screws. A bioabsorbable interference screw was then introduced in the impacter tunnel to support impacted bone under the reduced articular surface. Finally, a cortical screw was introduced, from anterior to posterior to prevent screw cut-out. CONCLUSION The combination of subchondral screws in a jail technique with a bioabsorbable interference screw that we named metaphyseal tibia level (MTL) screw technique is, to our knowledge, not described. The MTL screw promises to be a true percutaneous reduction and fixation technique for Schatzker II and III fractures in patients with reasonable bone quality.
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Affiliation(s)
- Frédéric Vauclair
- Département de l'appareil locomoteur, Service d'orthopédie et traumatologie, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, BH 10-238, 1011, Lausanne, Switzerland,
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32
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van de Pol GJ, Iselin LD, Callary SA, Thewlis D, Jones CF, Atkins GJ, Solomon LB. Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures: Early results of a case series. Injury 2015; 46:1089-96. [PMID: 25771446 DOI: 10.1016/j.injury.2015.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/09/2015] [Accepted: 02/19/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Osteoporotic tibial plateau fractures (TPFs) are difficult to treat with either open reduction internal fixation (ORIF) or acute total knee arthroplasty (TKA). They have high complication rates, poor outcomes and often fail in the short- to mid-term. We investigated the use of impaction bone grafting (IBG) as an adjunct to stabilise the fracture in a cohort of osteoporotic TPFs. METHODS Nine consecutive osteoporotic TPFs were surgically stabilised with ORIF augmented with IBG or with IBG alone (one pure depression fracture) using on average allograft from 2 femoral heads/case (range 1-4 heads or 25-100 cm(3)). The median bone mineral density T-score of the patients was -2.9 (-2.5 to -4.5). All patients were mobilised weight-bearing as tolerated immediately after surgery and had regular follow-up to a minimum of 2 years where functional scores were taken and gait was assessed. Fracture reduction was assessed on plain radiographs and computed tomography (CT) scans; maintenance of fracture reduction was monitored using plain radiographs, CT and radiostereometric analysis (RSA). Bone graft remodelling was assessed by comparison of immediate post-operative CT scans with scans at a minimum of 1 year. RESULTS All surgeries were uneventful. All patients progressed to full weight bearing within 6 weeks of surgery and regained a normal gait by 3 months. Seven fractures healed with a cranio-caudal migration of less than 3mm (range 0-2.6mm using RSA and 0-2mm using CT). Two fractures had an isolated posterolateral fragment depression of 13.5mm and 9 mm, respectively, which did not affect the overall joint alignment or clinical outcomes at short-term follow-up. At latest CT follow-up, on average 51% of the graft area (range 36-70%) had remodelled into new host bone. CONCLUSION Impaction bone grafting shows promising results as an adjunct to the surgical stabilisation of osteoporotic TPFs. In this case series the technique provided enough fracture stability for patients to mobilise weight-bearing as tolerated immediately after surgery and achieve full weight-bearing by the sixth postoperative week. There was no failure of fixation and 7 of the 9 cases healed with minimal fracture displacement.
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Affiliation(s)
- Gerrit J van de Pol
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Lukas D Iselin
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Dominic Thewlis
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia
| | - Claire F Jones
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Gerald J Atkins
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
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Analysis for clinical effect of virtual windowing and poking reduction treatment for Schatzker III tibial plateau fracture based on 3D CT data. BIOMED RESEARCH INTERNATIONAL 2015; 2015:231820. [PMID: 25767804 PMCID: PMC4341848 DOI: 10.1155/2015/231820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 02/02/2015] [Indexed: 01/18/2023]
Abstract
Objective. To explore the applications of preoperative planning and virtual surgery including surgical windowing and elevating reduction and to determine the clinical effects of this technology on the treatment of Schatzker type III tibial plateau fractures. Methods. 32 patients with Schatzker type III tibial plateau fractures were randomised upon their admission to the hospital using a sealed envelope method. Fourteen were treated with preoperative virtual design and assisted operation (virtual group) and 18 with direct open reduction and internal fixation (control group). Results. All patients achieved primary incision healing. Compared with control group, virtual groups showed significant advantages in operative time, incision length, and blood loss (P < 0.001). The virtual surgery was consistent with the actual surgery. Conclusion. The virtual group was better than control group in the treatment of tibial plateau fractures of Schatzker type III, due to shorter operative time, smaller incision length, and lower blood loss. The reconstructed 3D fracture model could be used to preoperatively determine the surgical windowing and elevating reduction method and simulate the operation for Schatzker type III tibial plateau fractures.
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Sharma N, Singh V, Agrawal A, Bhargava R. Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: A retrospective analysis of 15 cases. Indian J Orthop 2015; 49:502-9. [PMID: 26538755 PMCID: PMC4598540 DOI: 10.4103/0019-5413.164044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Proximal tibia fractures with compartment syndrome present a challenge for orthopedic surgeons. More often than not these patients are subjected to multiple surgeries and are complicated by infection osteomyelitis and poor rehabilitation. There is no consensus in the management of these fractures. Most common mode is to do early fasciotomy with external fixation, followed by second stage definitive fixation. We performed a retrospective study of proximal tibia fractures with impending compartment syndrome treated by single stage fasciotomy and internal fixation. Results in terms of early fracture union, minimum complications and early patient mobilization were very good. MATERIALS AND METHODS Fifteen patients who were operated between July 2011 and June 2012 were selected for the study. All documents from their admission until the last followup in December 2013 were reviewed, data regarding complications collected and results were evaluated using Oxford Knee scoring system. RESULTS At the final outcome, there was anatomical or near anatomical alignment with no postoperative problems with range of motion of near complete flexion (>120) in all patients within 3 months. 13 patients started full weight bearing walking at 3 months. Delayed union in two patients and skin necrosis in one patient was observed. CONCLUSIONS Since the results are encouraging and the rehabilitation time is much less when compared to conventional approaches, it is recommended using this protocol to perform early fasciotomy with the definitive internal fixation as single stage surgery to obtain excellent followup results and to reduce rehabilitation time, secondary trauma, expense of treatment and infection rate.
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Affiliation(s)
- Naveen Sharma
- Department of Orthopaedics, NIMS Medical College, Jaipur, Rajasthan, India,Address for correspondence: Dr. Naveen Sharma, 354, Vivek Vihar, New Sanganer Road, Sodala, Jaipur - 302 019, Rajasthan, India. E-mail:
| | - Varun Singh
- Department of Orthopaedics, NIMS Medical College, Jaipur, Rajasthan, India
| | - Ashish Agrawal
- Department of Orthopaedics, NIMS Medical College, Jaipur, Rajasthan, India
| | - Rakesh Bhargava
- Department of Orthopaedics, NIMS Medical College, Jaipur, Rajasthan, India
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O'Neill BJ, Fox CM, Molloy AP, O'hEireamhoin S, Moore DP. The use of circular external fixators in the management of lower limb trauma in Dublin: a single surgeon's 20-year experience. Ir J Med Sci 2014; 185:133-8. [PMID: 25543203 DOI: 10.1007/s11845-014-1240-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 12/13/2014] [Indexed: 01/27/2023]
Abstract
INTRODUCTION It has been estimated that approximately 520,000 injury presentations are made to Irish accident and emergency departments each year. Fractures account for 20 % of these injuries. Circular external fixators (frames) have been shown to be a safe and effective method of treatment for long bone fractures where internal fixation is impossible or in-advisable. We present the outcomes of all frames applied at our institution for stabilisation of acute fractures over a 20-year period. METHODS AND METHODS We retrospectively reviewed a prospectively compiled database of all frames applied in our institution and identified all frames which were applied for acute lower limb trauma. RESULTS We identified 68 fractures in 63 patients. There were 11 femoral fractures and 57 tibial fractures. All fractures were classified using the AO Classification system, and most fractures were Type C fractures. We used an Ilizarov frame for 53 fractures and a Taylor Spatial Frame for 15 fractures. The mean time in frame was 365 days for a femoral fracture and 230 days for a tibial fracture. There were five tibial non-unions giving an overall union rate of 93 %. Factors associated with non-union included high-energy trauma and cigarette smoking. CONCLUSION The vast majority of lower limb fractures can be treated using 'conventional' methods. Complex fractures which are not amenable to open reduction and internal fixation or cast immobilisation can be treated in a frame with excellent results. The paucity of published reports regarding the use of frames for complex trauma reflects the under-utilisation of the technique.
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Affiliation(s)
- B J O'Neill
- Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
| | - C M Fox
- Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
| | - A P Molloy
- Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
| | - S O'hEireamhoin
- Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
| | - D P Moore
- Department of Orthopaedics, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Parkkinen M, Madanat R, Mäkinen TJ, Mustonen A, Koskinen SK, Lindahl J. The usefulness of MRI and arthroscopy in the diagnosis and treatment of soft-tissue injuries associated with split-depression fractures of the lateral tibial condyle. Bone Joint J 2014; 96-B:1631-6. [DOI: 10.1302/0301-620x.96b12.34077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The role of arthroscopy in the treatment of soft-tissue injuries associated with proximal tibial fractures remains debatable. Our hypothesis was that MRI over-diagnoses clinically relevant associated soft-tissue injuries. This prospective study involved 50 consecutive patients who underwent surgical treatment for a split-depression fracture of the lateral tibial condyle (AO/OTA type B3.1). The mean age of patients was 50 years (23 to 86) and 27 (54%) were female. All patients had MRI and arthroscopy. Arthroscopy identified 12 tears of the lateral meniscus, including eight bucket-handle tears that were sutured and four that were resected, as well as six tears of the medial meniscus, of which five were resected. Lateral meniscal injuries were diagnosed on MRI in four of 12 patients, yielding an overall sensitivity of 33% (95% confidence interval (CI) 11 to 65). Specificity was 76% (95% CI 59 to 88), with nine tears diagnosed among 38 menisci that did not contain a tear. MRI identified medial meniscal injuries in four of six patients, yielding an overall sensitivity of 67% (95% CI 24 to 94). Specificity was 66% (95% CI 50 to 79), with 15 tears diagnosed in 44 menisci that did not contain tears. MRI appears to offer only a marginal benefit as the specificity and sensitivity for diagnosing meniscal injuries are poor in patients with a fracture. There were fewer arthroscopically-confirmed associated lesions than reported previously in MRI studies. Cite this article: Bone Joint J 2014;96-B:1631–6.
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Affiliation(s)
- M. Parkkinen
- Helsinki University Central Hospital, Topeliuksenkatu
5, 00260 Helsinki, Finland
| | - R. Madanat
- Massachusetts General Hospital and Harvard
Medical School, Fruit Street, Jackson 1126, Boston, Massachusetts
02114, USA
| | - T. J. Mäkinen
- Mount Sinai Hospital and University of
Toronto, 600 University Avenue, Toronto, Ontario, M5G
1X5, Canada
| | - A. Mustonen
- Omasairaala Oy, Puutarhurinkuja
2, 00300 Helsinki, Finland
| | - S. K. Koskinen
- Helsinki University Central Hospital, Topeliuksenkatu
5, 00260 Helsinki, Finland
| | - J. Lindahl
- Helsinki University Central Hospital, Topeliuksenkatu
5, 00260 Helsinki, Finland
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Lack of evidence to support present medial release methods in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22:3100-12. [PMID: 24996864 DOI: 10.1007/s00167-014-3148-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this review was to identify a reliable sequential medial release protocol for restoration of soft tissue balance in total knee arthroplasty of the varus osteoarthritic knee and to allow for improved intraoperative decision-making. METHOD Current medial release sequences and applicability based upon pre-operative deformity have been reviewed. Furthermore, risks associated with over release, and the necessity of medial release, are discussed. RESULTS The different medial release sequences are discussed in relation to pre-operative deformity, along with potential complications associated with medial release. It was found that release sequences may include the deep and superficial components of the medial collateral ligament, the posteromedial capsule, the posterior oblique ligament, the pes anserinus (pes A), and tendons of the semimembranosus and medial gastrocnemius muscle. The sequences described were found to vary substantially between studies, and very few studies had systematically quantified the effect of each release on balance. CONCLUSION While medial release is the standard intraoperative mode of balancing, there is a lack of evidence to support current methods. The correct method for defining intraoperatively the sequence, extent and magnitude of releases required remains ill-defined. It could be argued that the classic extensive medial release may be unnecessary and may be associated with iatrogenic injury to the pes A and saphenous nerve, instability and abnormal knee kinematics. Minimal medial release may allow for improved soft tissue balancing leading ultimately to improved functional outcome. LEVEL OF EVIDENCE V (expert opinion).
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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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Open reduction and internal fixation of posterolateral tibial plateau fractures through fibula osteotomy-free posterolateral approach. J Orthop Trauma 2014; 28:513-7. [PMID: 24343250 DOI: 10.1097/bot.0000000000000047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the outcome of patients with posterolateral tibial plateau fractures after open reduction and internal fixation with a fibula osteotomy-free posterolateral approach. DESIGN Retrospective chart and operation note review. SETTING A medical college-affiliated tertiary hospital. MATERIALS AND METHODS A retrospective chart and radiographic review of posterolateral tibial plateau fractures treated with a posterolateral approach between January 2006 and July 2010 was performed. The primary (ie, the total Rasmussen function score) and secondary (ie, the postoperative infection, knee deformity, and complications) outcomes were analyzed. RESULTS A total of 32 patients were identified for this study. Patients were followed for an average of 18.2 months (range, 12-36 months); the total Rasmussen function score was 24.8 ± 2.9 points. The results were rated as excellent (≥27 points) in 19 patients, good (20-26 points) in 11, and fair (10-19 points) in 2 patients. No wound infections, screw loosening or implant fracture, and nonunion, deformity, or fracture redisplacement were seen. Stretch injury of the common peroneal nerve was found in 1 patient, who obtained recovery 2 months after additional conservative management. CONCLUSIONS Adequate open reduction and internal fixation with a fibula osteotomy-free posterolateral approach can attain a satisfactory clinical outcome for patients with posterolateral tibial plateau fractures. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Draenert M, Draenert Y, Draenert K, Pohlemann T, Erler M. Primary cancellous bone formation around micro-chambered beads. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014. [DOI: 10.1016/j.recote.2014.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Lee HJ, Jung HJ, Chang EC, Lee JS, Jung HS. Second-look arthroscopy after surgical treatment of Schatzker type II plateau fractures through the lateral submeniscal approach. Arch Orthop Trauma Surg 2014; 134:495-9. [PMID: 24477291 DOI: 10.1007/s00402-014-1932-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Indexed: 10/25/2022]
Abstract
MAIN PROBLEM To evaluate cartilage healing using second-look arthroscopic examination in tibia plateau fracture patients who have undergone open reduction and internal fixation with a submeniscal approach technique. METHODS Between January 2007 and January 2010, we used second-look arthroscopy during 18-24-month follow-up of 20 patients with Schatzkar type II tibial plateau fractures who had undergone open reduction and internal fixation with a submeniscal approach technique. We classified patients according to step-off, knee range of motion, and Knee Society Score, and compared the results with those obtained by arthroscopy. RESULTS Radiologically, 16 cases (80 %) were reduced within 2 mm of step-off. In 11 of these cases, according to the Outerbridge classification, we checked for chondromalacia from grade II to III. We observed 2 mm of step-off in four cases, and each had chondromalacia of at least grade III. The Knee Society Score was associated with chondromalacia grade (p < 0.05). CONCLUSION Even in patients with normal joint range of motion and good clinical and radiological results, the actual condition of the articular cartilage varied significantly. Therefore, more long-term and regular follow-up is needed for proximal plateau fractures.
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Affiliation(s)
- Han-Jun Lee
- Department of Orthopaedic Surgery, Chung-Ang University, College of Medicine, Seoul, Korea
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Draenert ME, Draenert Y, Draenert K, Pohlemann T, Erler M. [Primary cancellous bone formation around micro-chambered beads]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:131-7. [PMID: 24512804 DOI: 10.1016/j.recot.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 11/23/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The question has been raised whether benign bone defects in patients can be treated with bone forming osteoconductive ceramics achieving primarily a cancellous bone scaffold, which is under load from the beginning. MATERIAL AND METHODS Ten reconstructions were performed in 9patients (6women and 3male), with a mean age of 49 (25-65)years, suffering a high variety of epi- and metaphyseal defects, four tibial fractures, two calcaneal fractures, one pathological phalangeal fracture, one chondroma of the distal femur and two open-wedge osteotomies were filled with micro-chambered ceramic beads of 4 and 6mm in diameter. The mean follow up was 22 (7- 8)months. X-rays and CT-scans formed the basis for the evaluation of the reconstruction of the cancellous bone scaffolds. RESULTS All cancellous structures were rebuilt, if completely filled with bone-forming elements. If the filling was incomplete, no physiological cancellous bone scaffold resulted. The β-TCP micro-chambered beads were completely reabsorbed or sandwich-like incorporated at the time of evaluation. The HA micro-chambered beads revealed a contrast enhancement and were integrated in the osseous construction of the bone scaffold. CONCLUSION Primary cancellous bone formation can be achieved with osteoconductive ceramic micro-chambered beads and can be combined with any osteosynthesis for stable fixation.
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Affiliation(s)
- M E Draenert
- Center of Orthopaedic Sciences, Munich, Alemania; Clinic for Restorative Dentistry and Periodontology, Ludwig Maximilian University, Munich, Alemania.
| | - Y Draenert
- Center of Orthopaedic Sciences, Munich, Alemania
| | - K Draenert
- Center of Orthopaedic Sciences, Munich, Alemania
| | - T Pohlemann
- Department of Trauma-, Hand-, and Reconstructive Surgery, Saarland University, Homburg, Alemania
| | - M Erler
- Departamento de Traumatología, Clínica Berka, Universidad de Madrid, Madrid, España
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Bicondylar tibial plateau fracture treated by open reduction and fixation with unilateral locked plating. Kaohsiung J Med Sci 2013; 29:568-77. [DOI: 10.1016/j.kjms.2013.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 09/05/2012] [Indexed: 11/19/2022] Open
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Medium-term results after complex intra-articular fractures of the tibial plateau. J Orthop Sci 2013; 18:569-77. [PMID: 23661179 DOI: 10.1007/s00776-013-0404-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 04/01/2013] [Indexed: 02/09/2023]
Abstract
BACKGROUND To present the medium-term results of intra-articular, bicondylar AO/OTA classification type C fractures of the tibial plateau in a retrospective study at a level-1 trauma center in 22 patients with 23 fractures. METHODS Demographic data for the patients and details of current clinical and radiological follow-up findings were obtained to assess range of motion, clinical stability and alignment of the knee, and posttraumatic arthrosis (Kellgren/Lawrence score). Functional outcomes were assessed using the Lysholm score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) form. RESULTS Patients' mean age was 46 years (range 20-67 years). Leading causes of the fractures were high-energy traffic accidents and falls. There were seven C1, seven C2, and nine C3 fractures. ORIF was performed in 20 patients; in two patients an external fixator and in one patient cannulated screws alone were used. In 13/22 patients, an angle-stable locking plate (Less Invasive Stabilization System, LISS) was used for osteosynthesis. The mean follow-up period was 67 months (range 36-109 months). The overall complication rate was 39.1%, including four infections and four cases of pseudarthrosis (17.4%). The average flexion of the injured knee was significantly lower in comparison with the contralateral side (124.9° vs. 135.2°). Knee stability did not differ statistically significantly. Current radiographs revealed no signs of posttraumatic arthrosis in 30.4% of cases, mild signs in 34.8%, clear signs in 26.1%, and severe signs in 13% using the Kellgren and Lawrence scale. The average Lysholm score was 66.2 points, and the average KOOS score was 67.84. One patient was in category A, and 2 were in category B in the IKDC overall categories, whereas 5 patients were in category C and 14 were even in category D. CONCLUSIONS Complex articular tibial plateau fractures are associated with a high rate of complications, continue to have a severe impact on function in the injured knee, lead to early post-traumatic arthrosis, and result in long-lasting subjective symptoms for the patients.
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Loibl M, Bäumlein M, Massen F, Gueorguiev B, Glaab R, Perren T, Rillmann P, Ryf C, Naal FD. Sports activity after surgical treatment of intra-articular tibial plateau fractures in skiers. Am J Sports Med 2013; 41:1340-7. [PMID: 23733831 DOI: 10.1177/0363546513489524] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial plateau fractures occur frequently while participating in winter sports, but there is no information on whether skiers can resume sports and recreational activities after internal fixation of these fractures. HYPOTHESIS Skiers can resume low-impact sports activity after internal fixation of tibial plateau fractures. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 103 patients were surveyed by postal questionnaires to determine their sports activities at a mean of 7.8 ± 1.8 years after internal fixation of intra-articular tibial plateau fractures. The survey also included the Lysholm score, the Tegner activity scale, and a visual analog scale (VAS) for pain. RESULTS At the time of the survey, 88% of the patients were engaged in sports activities (rate of return to sports, 88%), and 53% continued to participate in downhill skiing. The median number of different activities declined from 5 (range, 1-17) preoperatively to 4 (range, 0-11) postoperatively (P < .01). Sports frequency and duration per week did not change: 3 (range, 1-7) preoperatively versus 3 (range, 0-7) postoperatively (P = .275) and 4 hours (range, 1-16 hours) preoperatively versus 3.5 hours (range, 0-15 hours) postoperatively (P = .217), respectively. Median values of all outcome scores declined: Lysholm score, 100 (range, 85-100) preoperatively versus 94.5 (range, 37-100) postoperatively (P < .01); VAS, 0 (range, 0-7) preoperatively versus 1 (range, 0-8) postoperatively (P < .01). Median Tegner activity scale scores declined in all age groups except for patients aged 51 to 60 years. The ability to participate in sports at the time of follow-up compared with the ability before the accident was rated as "similar" by 57 patients (62.0%) and as "worse" by 35 patients (38.0%). The more severe fracture types, B3 and C3 according to the AO classification system, were associated with poorer outcomes related to return to sports and functional scores. CONCLUSION A large percentage of skiers with surgically treated intra-articular tibial plateau fractures cannot continue to participate in downhill skiing; however, the majority could resume an active lifestyle for several years after the trauma. Fracture type seems to be an important factor influencing physical activity and general functional outcome.
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Affiliation(s)
- Markus Loibl
- Department of Orthopaedic Trauma Surgery, Spital Davos, Promenade 4, CH-7270 Davos, Switzerland.
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Mauffrey C, Fader R, Hammerberg EM, Hak DJ, Stahel PF. Incidence and pattern of technical complications in balloon-guided osteoplasty for depressed tibial plateau fractures: a pilot study in 20 consecutive patients. Patient Saf Surg 2013; 7:8. [PMID: 23452513 PMCID: PMC3605372 DOI: 10.1186/1754-9493-7-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 02/18/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Inflation bone tamps are becoming increasingly popular as a reduction tool for depressed tibial plateau fractures. A number of recent publications have addressed the technical aspects of balloon inflation osteoplasty. However, no study has yet been published to describe the technical limitations, intraoperative complications, and surgical bailout strategies for this new technology. METHODS Observational retrospective study of all patients managed with inflatable bone tamps for depressed tibial plateau fractures between October 1, 2010 and December 1, 2012. The primary outcome parameter was the rate of complications, which were stratified into "minor" and "major" depending on the necessity for altering the surgical plan intraoperatively, and based on the risk for patient harm. This study was approved by the Institutional Review Board of the State of Colorado. RESULTS A consecutive series of 20 patients were managed by balloon inflation osteoplasty for depressed tibial plateau fractures during the 15 months study period. The mean age was 42.8 years (range 20-79), with 9 females and 11 males. A total of 13 patients sustained an adverse intraoperative event (65%), with three patients sustaining multiple technical complications. Minor events (n = 8) included the burst of a balloon with extrusion of contrast dye, and the unintentional posterior wall displacement during balloon inflation. Major events (n = 5) included the intra-articular injection of calcium phosphate in the knee joint, and the inability to elevate the depressed articular fragment with the inflatable bone tamp. CONCLUSION The observed intraoperative complication rate of 65% reflects a steep learning curve for the use of inflation bone tamps to reduce depressed tibial plateau fractures. Specific surgical bailout options are provided in this article, based on our early anecdotal experience in a pilot series of 20 consecutive cases. Patients should be advised on the benefits and risks of this new technology as part of the shared decision-making process during the informed consent.
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Affiliation(s)
- Cyril Mauffrey
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - Ryan Fader
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - E Mark Hammerberg
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - David J Hak
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
| | - Philip F Stahel
- Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO 80204, USA
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Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type IV tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma 2013; 27:e18-23. [PMID: 22495525 DOI: 10.1097/bot.0b013e31825316ea] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This study presents a retrospective review of 8 patients with 9 cases of an uncommon variant of medial tibial plateau fracture treated with a surgical approach not previously described in the literature. The fracture pattern is characterized by a displaced medial tibial plateau fracture with significant central and posterior impaction of the lateral tibial articular surface but an intact lateral cortex. A novel surgical approach with an intra-articular osteotomy of the lateral tibial plateau was used to facilitate visualization, reduction, and instrumentation of the lateral articular injury. Early clinical and radiographic results of this treatment approach were reviewed. We describe the fracture pattern, surgical technique, and early results and propose this technique as a reasonable alternative for treatment of a challenging clinical entity.
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Kraus TM, Martetschläger F, Müller D, Braun KF, Ahrens P, Siebenlist S, Stöckle U, Sandmann GH. Return to sports activity after tibial plateau fractures: 89 cases with minimum 24-month follow-up. Am J Sports Med 2012; 40:2845-52. [PMID: 23118120 DOI: 10.1177/0363546512462564] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial plateau fractures requiring surgery are severe injuries. For professionals, amateurs, and recreational athletes, tibial plateau fractures might affect leisure and professional life. HYPOTHESIS Athletic patients will be affected in their sporting activity after a tibial plateau fracture. Despite a long rehabilitation time and program, physical activity will change to low-impact sports. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 89 consecutive patients (age range, 14-76 years) were included in the study and were surveyed by a questionnaire. Inclusion criteria were surgical treatment of tibial plateau fractures between 2003 and 2009 with a minimum follow-up of 24 months. The sporting activity was determined at the time of injury, 1 year postoperatively, and at the time of the survey at an average of 52.8 months postoperatively. The clinical evaluation included the Lysholm score, the Tegner activity scale, the activity rating scale (ARS), and a visual analog scale (VAS) for pain perception. Fractures were classified and analyzed using both the Arbeitsgemeinschaft für Osteosynthesefragen (AO) and the Schatzker classifications. RESULTS At the time of injury, 88.8% of all patients were engaged in sports compared with 62.9% 1 year postoperatively and 73.0% at the time of the survey. Of the professional or competitive athletes (n = 11 at the time of injury), only 2 returned to competition at the time of the survey. The number of different sporting activities declined from 4.9 at the time of injury to 3.6 at the time of the survey (P < .001). The sports frequency and the activity duration per week, being 2.8 sessions and 4.5 hours at the time of injury, respectively, declined to 2.4 sessions and 3.8 hours (P < .001 and P = .007, respectively) at the time of the survey, respectively. The Lysholm score (98.7 points before accident) and the VAS for pain perception (0.2 before accident) illustrated significant declines to 76.6 points for the Lysholm score and 2.6 for the VAS (P < .001 and P < .001, respectively) at the time of the survey. The high-energy traumas, Schatzker IV to VI, had significant worse results in the clinical scores compared with the low-energy traumas (Lysholm, P < .001; Tegner, P = .027). CONCLUSION The majority of patients could not return to their previous level of activity, and for patients playing competitive sports, this injury can be a career ender. Overall, we noticed a postinjury shift toward activities with less impact. However, at the time of the survey, 73% of all patients were engaged in sports.
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Affiliation(s)
- Tobias M Kraus
- Department of Traumatology and Reconstructive Surgery, BG Traumacenter Tübingen, Eberhard Karls University, Tübingen, Germany.
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Tibial plateau fractures: compared outcomes between ARIF and ORIF. Strategies Trauma Limb Reconstr 2012; 7:163-75. [PMID: 23086660 PMCID: PMC3482433 DOI: 10.1007/s11751-012-0148-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 10/08/2012] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study is to compare arthroscopic assisted reduction internal fixation (ARIF) treatment with open reduction internal fixation (ORIF) treatment in patients with tibial plateau fractures. We studied 100 patients with tibial plateau fractures (54 men and 46 women) examined by X-rays and CT scans, divided into 2 groups. Group A with associated meniscus tear was treated by ARIF technique, while in group B ORIF technique was used. The follow-up period ranged from 12 to 116 months. The patients were evaluated both clinically and radiologically according to the Rasmussen and HSS (The Hospital for Special Surgery knee-rating) scores. In group A, the average Rasmussen clinical score is 27.62 ± 2.60 (range, 19–30), while in group B is 26.81 ± 2.65 (range, 21–30). HSS score in group A was 76.36 ± 14.19 (range, 38–91) as the average clinical result, while in group B was 73.12 ± 14.55 (range, 45–91). According to Rasmussen radiological results, the average score for group A was 16.56 ± 2.66 (range, 8–18), while in group B was 15.88 ± 2.71 (range, 10–18). Sixty-nine of 100 patients in our study had associated intra-articular lesions. We had 5 early complications and 36 late complications. The study suggests that there are no differences between ARIF and ORIF treatment in Schatzker type I fractures. ARIF technique may increase the clinical outcome in Schatzker type II–III–IV fractures. In Schatzker type V and VI fractures, ARIF and ORIF techniques have both poor medium- and long-term results but ARIF treatment, when indicated, is the best choice for the lower rate of infections.
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Ruiz-Ibán MÁ, Diaz-Heredia J, Elías-Martín E, Moros-Marco S, Cebreiro Martinez Del Val I. Repair of meniscal tears associated with tibial plateau fractures: a review of 15 cases. Am J Sports Med 2012; 40:2289-95. [PMID: 22962298 DOI: 10.1177/0363546512457552] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial plateau fractures are frequently associated with meniscal tears. Little is known about the results of meniscal repair in this group of patients. PURPOSE To determine the results of repair of meniscal tears found during arthroscopically assisted reduction and internal fixation (ARIF) of tibial plateau fractures. STUDY DESIGN Case series; Level of evidence, 4. METHODS In a cohort of 51 tibial plateau fractures treated with ARIF, 15 associated meniscal tears (15 knees) in 14 patients were repaired. There were 12 peripheral longitudinal tears of the lateral meniscus, 1 longitudinal peripheral tear of the medial meniscus, 1 full-thickness radial tear of the lateral meniscus, and 1 bird-beak tear of the lateral meniscus. Repairs were performed using an outside-in technique for the anterior horn and all-inside repair for the body and posterior horn lesions. Mean (SD) age at operation was 47.3 (14.0) years. Patients were followed for a mean (SD) of 4.83 (1.01) years and evaluated using the Rasmussen, Honkonen, Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores. A second-look arthroscopy was performed in 13 knees a mean (SD) of 14.2 (10.1) months after the initial surgery. RESULTS The mean (SD) Rasmussen score was 29.1 (0.96). Thirteen of 15 patients scored good or excellent results in all Honkonen sections. The mean (SD) Lysholm score was 88.6 (12.4). The mean (SD) IKDC score was 79.3 (19.3). There was a small decrease of the activity level according to the Tegner score when compared with the preoperative situation (1.20 [1.82], P = .022). There were not any meniscal symptoms in any case. Of the 13 menisci evaluated with second-look arthroscopy, 12 had healed completely and a radial tear had healed partially in the vascular zone. In one of the cases that healed, a new tear was found in a different location. CONCLUSION Meniscal repair of tears associated with tibial plateau fractures has good results. All patients had good or excellent clinical results. Second-look arthroscopy confirmed complete healing in 92% of meniscal tears when performed.
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Affiliation(s)
- Miguel Ángel Ruiz-Ibán
- Unidad de Cirugía Artroscópica, Departamento de COT, Hospital Ramón y Cajal, Cta Colmenar Km 9.100, Madrid 28034, Spain.
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