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Page BJ, Greenstein MD, Sheridan GA, Fragomen AT, Rozbruch SR. Extra-articular Osteotomy for the Management of Intra-articular Tibial Plateau Valgus Malunion. J Orthop Trauma 2024; 38:441-446. [PMID: 39007661 DOI: 10.1097/bot.0000000000002845] [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] [Accepted: 05/08/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES To report a case series of extra-articular osteotomies for the management of intra-articular tibial plateau malunions and to assess the ability to correct deformity and improve knee range of motion (ROM). METHODS . DESIGN Retrospective case series. SETTING Academic, tertiary, referral center. PATIENT SELECTION CRITERIA Adult patients with tibial plateau fracture malunion treated with extra-articular osteotomy of the femur and/or tibia between 2014 and 2023. OUTCOME MEASURES AND COMPARISON Mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), lateral distal femoral angle (LDFA), and posterior proximal tibia angle (PPTA) correction; knee ROM; and time to weight bearing. RESULTS There were 7 patients included, 6 (85.7%) were female and 1 (14.3%) were male. The median age was 43.5 years (IQR 38.5-51, range 32-62). Four (57.1%) patients were treated with a high tibial osteotomy (HTO), and 3 (42.9%) patients were treated with an HTO and distal femoral osteotomy. One patient had concomitant supramalleolar osteotomy with HTO to address distal tibia procurvatum and valgus. Four were treated with hexapod frames, and 3 were treated with plates and screws. Median follow-up was 22.5 months (IQR 10.5-107 months, range 7-148 months). Surgical intervention corrected median radiographic measures of valgus malalignment preoperatively relative to postoperative values. This included MAD (42.5 mm-0 mm), valgus angle (12.5 degrees-1.5 degrees), MPTA (95 degrees-88.0°), and LDFA (86.0°-87.3 degrees). Surgical intervention increased maximal knee range of motion preoperatively to postoperatively. Median time to full weight bearing was 81.5 days (IQR 46-57 days, range 41-184 days). Two patients were converted to total knee arthroplasty after 5 and 10 years following HTO with hexapod frame. CONCLUSIONS Extra-articular osteotomy is an effective treatment for addressing intra-articular malunion after tibia plateau fractures. It is effective in correcting the MAD, valgus deformity, MPTA, LDFA, PPTA, and improving knee ROM (measured through knee extension and flexion). LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Brian Joseph Page
- Hospital for Special Surgery, Orthopaedic Trauma Service, New York, NY
- New York Presbyterian-Weill Cornell Medical Center, Orthopaedic Trauma Service, New York, NY
| | | | - Gerard A Sheridan
- University Hospital Galway, Department of Orthopaedic Surgery, Galway, Ireland; and
| | - Austin T Fragomen
- Hospital for Special Surgery, Limb Lengthening and Complex Reconstruction Service, New York, NY
| | - S Robert Rozbruch
- Hospital for Special Surgery, Limb Lengthening and Complex Reconstruction Service, New York, NY
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Mahjoubi SE, Haichour I, Farhaoui AE, Jelti O, Lachkar A, Abdeljaouad N, Yacoubi H. Intra-articular elevating osteotomy for tibial plateau fracture malunion with intra-articular depression: Surgical technique and review. Trauma Case Rep 2024; 52:101038. [PMID: 38799029 PMCID: PMC11127600 DOI: 10.1016/j.tcr.2024.101038] [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] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
Open reduction with internal fixation is the gold standard treatment for tibial plateau fractures. However, some complications can be observed despite a well-established procedure. Apart from stiffness, malunion is the most frequent complication of tibial plateau fractures. These malunions may be intra-articular or extra-articular or combined. Intra-articular or extra-articular osteotomy is a good option to treat malunion in young and active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is a total replacement of the knee joint with arthroplasty. We report the case of a patient with a tibial plateau fracture treated initially at a traditional bonesetter complicated at the end of the treatment with the persistent of the knee pain and limping.
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Affiliation(s)
- Sohaib E.L. Mahjoubi
- Corresponding authors at: Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
| | - Ilyesse Haichour
- Corresponding authors at: Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
| | - Amine E.L. Farhaoui
- Corresponding authors at: Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
| | - Oussama Jelti
- Corresponding authors at: Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
| | - Adnane Lachkar
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, LAMCESM, Oujda, Morocco
| | - Najib Abdeljaouad
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, LAMCESM, Oujda, Morocco
| | - Hicham Yacoubi
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, LAMCESM, Oujda, Morocco
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Oleo-Taltavull R, Corró S, Tomàs-Hernández J, Teixidor-Serra J, Selga-Marsà J, Porcel-Vázquez JA, Piedra-Calle CA, García-Sánchez Y, Guerra-Farfán EM, Andrés-Peiró JV. Staged treatment of bicondylar tibial plateau fractures: influence of frame configuration and quality of reduction on outcomes. Eur J Trauma Emerg Surg 2024; 50:1033-1041. [PMID: 38110517 DOI: 10.1007/s00068-023-02411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/19/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE Despite evolving treatment, the surgical management of high-energy tibial plateau fractures (TPF) remains challenging, associating high rates of complications. In recent decades, staged management has emerged as an encouraging option. The main goal of our study was to evaluate the influence of bridging external fixation (EF) frame configuration and the resultant quality of reduction (QOR) on outcomes after staged-treatment of bicondylar TPF. METHODS A retrospective review was conducted of patients with bicondylar TPF treated at our level-I trauma center using a staged-treatment protocol from January 2010 to January 2020. Data on baseline characteristics, injuries, treatments, and clinical/radiological results were collected. The QOR was evaluated on CT images after EF and on plain films after ORIF. RESULTS Sixty-eight patients were eligible for analysis. By our criteria, QOR was good in 57.4% and 70.6% after EF and ORIF, respectively. A squared EF configuration was associated with superior EF QOR (p = 0.032), while better EF QOR was linked to improved ORIF QOR (p = 0.016). No relationship between ORIF delay and ORIF QOR was identified. Postoperative complications were documented in 19 patients. Average ROM at one-year follow-up was 114.9 ± 12.6°, and non-influenced by anterior femoral pin placement. CONCLUSIONS Staged management of bicondylar TPF resulted in a reasonable rate of complications. A direct relationship between QORs obtained with EF and after ORIF was found. Squared frames were associated with faster and better reductions, regardless of the surgeon's background. Considering our results, we advocate for the wider use of squared EF configurations in these patients.
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Affiliation(s)
- Rafael Oleo-Taltavull
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Sebastián Corró
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Son Espases, Majorca, Spain
| | - Jordi Tomàs-Hernández
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Teixidor-Serra
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Selga-Marsà
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Carlos Alberto Piedra-Calle
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Yaiza García-Sánchez
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Ernesto Melchor Guerra-Farfán
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
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Pirato F, Rosso F, Dettoni F, Bonasia DE, Bruzzone M, Rossi R. How to manage a native stiff knee. EFORT Open Rev 2024; 9:363-374. [PMID: 38726987 PMCID: PMC11099574 DOI: 10.1530/eor-24-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Knee stiffness is a widely known and worrying condition in several postoperative knees. Less is known about native stiff knee. The aim of this manuscript is to summarize the available literature on native stiff knee epidemiology, classification and treatment. In 1989 stiff knee was defined as a knee with less than 50° of total range of motion. If range of motion is <30°, it is defined as an ankylosed knee. Knee stiffness can be divided into three main types: flexion contractures, extension contractures, and combined contractures. Different risk factors have been associated to native stiff knee and grouped into modifiable or not modifiable. Furthermore, risk factors can be divided into patients' related no patients'-related. Different treatment modalities can be indicated to treat knee stiffness, including manipulation under anesthesia (MUA), arthroscopic and open surgical release. When stiffness is associated with articular disruption TKA represent an option. TKA in native stiff knee can be challenging for the surgeon. Implant's choice and knee exposure are the first steps. In some cases, additional release and extensive can be considered. A stepwise approach and careful preoperative planning are mandatory to obtain long-term satisfactory outcomes. Native stiff knee is a rare but invalidating condition. Different treatment modalities have been proposed as treatment. However, considering that it is frequently associated to sever arthritis, TKA can be an option in painful stiff knees. Nature of knee stiffness necessitates a customized approach to ensure successful management and achieve satisfying outcomes.
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Affiliation(s)
- Francesco Pirato
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
| | - Federico Dettoni
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
| | - Davide Edoardo Bonasia
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
| | - Matteo Bruzzone
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
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Biswas B, Halam AK, Chowdhury A, Purkayastha T, Reang S. Optimizing Surgical Management of Tibial Plateau Fractures: A Comparative Study of Minimally Invasive Versus Open Reduction Techniques. Cureus 2024; 16:e60078. [PMID: 38860085 PMCID: PMC11163304 DOI: 10.7759/cureus.60078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Tibial plateau fractures pose a significant challenge to orthopedic surgeons due to their complex nature and potential for long-term morbidity. Surgical intervention is often necessary to restore anatomical alignment and optimize functional outcomes. This study aimed to evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis (MIPPO) compared to open reduction and internal fixation (ORIF) in the management of tibial plateau fractures. MATERIALS AND METHODS The present hospital-based observational study was conducted at Agartala Government Medical College for two years. Seventy adult patients with tibial plateau fractures were included, with surgical interventions performed based on fracture characteristics. Postoperative outcomes, including knee range of movements, functional recovery, and complication rates, were assessed at six months. RESULTS MIPPO demonstrated superior outcomes compared to ORIF, with a higher proportion of participants achieving knee range of movements > 120 degrees (66.7% versus 36%; p = 0.030), excellent functional outcomes (66.7% versus 36%; p = 0.046), and lower postoperative complication rates (2.2% versus 28%; p = 0.001). Fracture union times were significantly shorter in MIPPO (12.49 weeks) when compared to ORIF (14 weeks) (p = 0.009). CONCLUSION MIPPO offers advantages over conventional ORIF in terms of functional recovery and complication rates while demonstrating comparable fracture union times. These findings advocate for the adoption of MIPPO as a preferred surgical technique for tibial plateau fractures.
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Affiliation(s)
- Bhaskar Biswas
- Orthopedics, Agartala Government Medical College and Govind Ballabh Pant (GBP) Hospital, Agartala, IND
| | - Ajoy K Halam
- Orthopedics, Dhalai District Hospital, Dhalai, IND
| | - Arpita Chowdhury
- Anesthesiology, Agartala Government Medical College and Govind Ballabh Pant (GBP) Hospital, Agartala, IND
| | - Tuhin Purkayastha
- Orthopedics, ICARE Institute of Medical Sciences and Research and Dr. Bidhan Chandra Roy Hospital, Haldia, Haldia, IND
| | - Santosh Reang
- Orthopedics, Agartala Government Medical College and Govind Ballabh Pant (GBP) Hospital, Agartala, IND
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Olivieri R, Koch M, Laso J, Franulic N, Zanetta H. Predictive factors for infection after osteosynthesis of tibial plateau fractures: a retrospective study of 314 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1831-1838. [PMID: 38427052 DOI: 10.1007/s00590-024-03856-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The reported incidence of infection related with tibial plateau fractures (IRTPF) ranges from 2 to 23%. This complication can result in catastrophic consequences such as deformity, post-traumatic osteoarthritis, chronic pain, loss of function, and substantial economic burdens on healthcare systems due to extended hospital stays and the resources required for treatment. Consequently, it is imperative to emphasize the identification of infection risk factors. METHODS A retrospective case-control study was designed, encompassing patients who underwent surgery for tibial plateau fractures between 2015 and 2020. Frequencies and measures of central tendency were compared between infected patients (cases) and non-infected patients (controls) using rank-based statistical tests. Subsequently, two logistic regression models were employed to control for potential confounding variables. RESULTS A total of 314 patients were included, predominantly male (71.15%). Average age of 44.41 years. IRTPF were observed in 7.64% of the patients. In the univariate inferential statistical analysis, high-energy fractures (OR 6.35, p < 0.001), fractures with compartment syndrome (OR 7.10, p < 0.001), two-stage management with temporary external fixation (OR 8.18, p < 0.001), the use of 2 or more approaches in definitive surgery (OR 2.93, p = 0.011), and the use of two or more plates (OR 9.17, p < 0.001) were identified as risk factors for infection. On average, the duration of surgery in infected patients was 201.2 min, compared to 148.4 min in non-infected patients (p < 0.001). When performing two logistic regression models, the following independent risk factors were identified: high-energy fractures (OR 5.04, p = 0.012), the presence of compartment syndrome (OR 4.53, p = 0.007), and the use of two or more plates in definitive surgery (OR 5.04, p = 0.023). CONCLUSIONS High-energy tibial plateau fractures (Schatzker IV, V, and VI), the presence of concomitant compartment syndrome, and the use of 2 or more plates in definitive surgery are associated with a higher risk of infection related to fracture following open reduction and osteosynthesis treatment. LEVEL OF EVIDENCE Case-Control Study. LEVEL III EVIDENCE
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Affiliation(s)
- Rodrigo Olivieri
- Orthopedics Department, Knee Unit, Hospital del Trabajador ACHS, Ramón Carnicer 185, Providencia, Santiago, Chile.
| | - Marco Koch
- Orthopedics and Traumatology Resident, Universidad Andrés Bello, Santiago, Chile
| | - José Laso
- Orthopedics Department, Knee Unit, Hospital del Trabajador ACHS, Ramón Carnicer 185, Providencia, Santiago, Chile
- Hospital Barros Luco Trudeau, Santiago, Chile
| | - Nicolás Franulic
- Orthopedics Department, Knee Unit, Hospital del Trabajador ACHS, Ramón Carnicer 185, Providencia, Santiago, Chile
- Hospital Militar de Santiago, Santiago, Chile
| | - Hugo Zanetta
- Orthopedics and Traumatology Resident, Universidad Andrés Bello, Santiago, Chile
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Li W, Chen Y, Zhuang Q. Management of Complex Open Tibial Plateau Fracture: A Case Report on the Application of Locked Plate External Fixation Technique during Bone Callus Formation stage to Replace transarticular External Fixation. Orthop Rev (Pavia) 2024; 16:94035. [PMID: 38435437 PMCID: PMC10908589 DOI: 10.52965/001c.94035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Transarticular external fixation is primarily used for open fractures involving the joint. However, its biggest drawback is the potential forjoint dysfunction. The article reports a successful case with complex open tibial plateau fracture treated using locked plate external fixation technique during bone callus formation stage to replace transarticular external fixation. We present a case of a 55-year-old male who sustained a complex open fracture of the tibial plateau. In addition, he also suffered from multiple rib fractures, a fibula fracture, a clavicle fracture, hemorrhagic shock, and lung contusion. The patient has occurred tibial bone infection after undergoing open reduction and transarticular external fixation for fracture management. Our team skillfully applied locked plate external fixation technique during bone callus formation stage to replace transarticular external fixation. Ultimately, the approach not only successfully controls infection and achieves fracture healing but also preserves knee joint function after five years of follow-up. In conclusion,the application of locked plate external fixation technique during bone callus formation stage to replace transarticular external fixation is a valuable approach that orthopedic clinicians should consider and learn from when managing complex intra-articular fractures.
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Affiliation(s)
- Wei Li
- Department of Orthopaedics, No.2 people’s hospital of Fuyang city,Yingzhou district, Fuyang city, Anhui province, 23600,China
| | - Yong Chen
- Department of Orthopaedics, No.2 people’s hospital of Fuyang city,Yingzhou district, Fuyang city, Anhui province, 23600,China
| | - Quankui Zhuang
- Department of Orthopaedics, No.2 people’s hospital of Fuyang city,Yingzhou district, Fuyang city, Anhui province, 23600,China
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Gahr P, Mittlmeier T, Grau A, Herlyn PKE, Rahn A, Fischer DC. Functional assessment and outcome following surgical treatment of displaced tibial plateau fractures: a retrospective analysis. Eur J Trauma Emerg Surg 2023; 49:2373-2379. [PMID: 37978059 PMCID: PMC10728243 DOI: 10.1007/s00068-023-02401-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Patients with tibial plateau fractures (TPF) are at risk of long-term hampered bipedal locomotion. A retrospective single-center study using patient-related outcome measures and a sophisticated assessment of walking abilities was conducted. METHODS Adults receiving surgical treatment of an isolated TPF between January 2012 and December 2016 received the KOOS questionnaire together with the invitation for an extensive follow-up examination on the clinical outcome including standardized assessment of the walking abilities (loadsol® system). Outcome was assessed relative to the severity of the injury or time to follow-up. Fractures were classified according to AO/OTA and Luo, respectively. RESULTS 58 out of 132 eligible patients filled in the questionnaire and participated at a median follow-up of 3.05 years after injury. For the categories "pain", "mobility", and "daily life activities", all patients were rather satisfied and this was virtually not related to the time between fracture and assessment. Relevant limitations were reported for "sports and recreational activities" and "quality of life". Loading of the previously fractured leg was most evidently changed on stairs and outdoor walking. Outcome was not related to either fracture type severity or time from injury. CONCLUSION Outcome after an isolated TPF is neither related to fracture type, severity of the fracture nor time from injury. Simple gait analysis techniques relying on different tasks appear to yield a more sophisticated image on functional deficits after TPF than classical exam of ground-level walking and correlate quite well with validated patient-related outcome measures as the KOOS.
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Affiliation(s)
- Patrick Gahr
- Department of Traumatology, Hand- and Reconstructive Surgery, University Medical Center, Rostock, Germany
| | - Thomas Mittlmeier
- Department of Traumatology, Hand- and Reconstructive Surgery, University Medical Center, Rostock, Germany.
| | - Anja Grau
- Department of Traumatology, Hand- and Reconstructive Surgery, University Medical Center, Rostock, Germany
- Department of Internal Medicine II, Klinikum Südstadt Rostock, Rostock, Germany
| | - Philipp K E Herlyn
- Department of Traumatology, Hand- and Reconstructive Surgery, University Medical Center, Rostock, Germany
- Department of Traumatology, Hand- and Reconstructive Surgery, Städtisches Klinikum Dresden-Friedrichstadt, Dresden, Germany
| | - Anja Rahn
- Department of Pediatrics, University Medical Center, Rostock, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, University Medical Center, Rostock, Germany
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Zhao WQ, Li XS, Hua J, Huang JF. Reverse traction with Kirschner wires and bilateral external fixation device combined with minimally invasive plate oseoynthesis technique for tibial plateau fractures of type Schatzker V and VI. INTERNATIONAL ORTHOPAEDICS 2023; 47:2327-2336. [PMID: 37477682 DOI: 10.1007/s00264-023-05877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/23/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Complex bicondylar tibial plateau fracture (TPF) has always been a tricky problem for surgeons. We created a novel external device used intraoperatively consisting of Kirschner wires, and combined with minimally invasive plate oseoynthesis (MIPO) technique to treat complex bicondylar TPFs, and the clinical effect and feasibility were further evaluated. METHODS From March 2016 to February 2021, 49 cases (29 males and 20 females) were identified as bicondylar TPF, the mean age 47.2 (27-69). All patients adopted the device and MIPO technique. A series of score, complications, and radiographs in the follow-up period, from three months, six months, one year, and two years and the last follow-up, were recorded, from visual analogue score (VAS), hospital for special surgery (HSS), and Short-Form 36 (SF-36), containing physical (PCS) and mental (MCS), and Rasmussen score. RESULTS Forty-seven patients showed good functional recovery. No patients were lost, mean follow-up time was 28.17 ± 2.81 (24.2-35.4) months. Operation time was 89.80 ± 13.46 (58-110) min. At the last follow-up, VAS was 1.3 ± 0.92 (0-4), HHS was 93.10 ± 2.63 (89-99), PCS was 49.20 ± 7.40 (38-65), and MCS was 50.08 ± 4.77 (43-62). Complications were as follows: cutaneous necrosis (3, 6%), asymptomatic arthritis (3, 6%), symptomatic arthritis (1, 2%), and deep venous thrombosis (1, 2%). Mean fracture healing time was 11.82 ± 1.5 (10-15.4) weeks. All patients got recovery without extra surgery and removed the implants at 12.85 ± 0.76 (11.2-15.4) months. CONCLUSION Temporary traction device of bilateral external fixator combined with MIPO technique was simple and convenient, with a smaller soft-tissue damage, an easier operational approach, and its worth being promoted.
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Affiliation(s)
- Wei-Qiang Zhao
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Xu-Song Li
- Department of Orthopaedics & Traumatology, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, 528401, Guangdong, China
| | - Jiang Hua
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China.
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
| | - Jie-Feng Huang
- Department of Orthopaedics & Traumatology, The First Affiliated Hospital of Zhejiang Chinese Medical University, 54 Youdian Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China.
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
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Fang Z, Pei X, Cheng Y, Chen J, Zhou W, Chen Y, Baosu Y, Qian S, Liu X, Wang G. Comparison of the intraarticular osteotomy and the "window" osteotomy in the treatment of tibial plateau fracture involving depressed posterolateral fragments. BMC Musculoskelet Disord 2023; 24:694. [PMID: 37649090 PMCID: PMC10466811 DOI: 10.1186/s12891-023-06803-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES The methods of reduction of depressed posterolateral fragments in tibial plateau fracture through anterolateral approaches remain controversial. This paper aimed to compare the intraarticular osteotomy technique and the "window" osteotomy technique for the reduction of depressed posterolateral fragments through anterolateral approach. METHOD From January 2015 to January 2022, we retrospectively reviewed the data on patients with tibial plateau fracture involving depressed posterolateral fragments treated with the intraarticular osteotomy or the "window" osteotomy. 40 patients underwent the intraarticular osteotomy were divided into group A, while 36 patients underwent the "window" osteotomy were divided into group B. The operative time, bone grafting volume, fracture healing time, complication, reduction quality and postoperative functional results were compared between the two groups. RESULTS The average follow-up duration was 16.6 ± 3.7 months. The average bone grafting volume for all patients in group B was essential larger than group A (p = 0.001). Compared to group B, patients in groups A had significantly shorter fracture healing time (p = 0.011). The depth of depressed articular surface, PSA and the radiographic evaluation at 2 days and 6 months after surgery in group A were significantly lower than group B (p<0.05). Based on the HSS knee-rating score, no significant difference in function results was found between the two groups (p>0.05). No significant difference was found in operation time and blood loss between the two groups (p>0.05). CONCLUSION The intraarticular osteotomy could obtain satisfactory clinical results in tibial plateau fracture involving posterolateral fragments.
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Affiliation(s)
- Zhixun Fang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Xuan Pei
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 Huangjiahuxi Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Yipeng Cheng
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 Huangjiahuxi Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Jianan Chen
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou City, Guangdong Province, China
| | - Wei Zhou
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 Huangjiahuxi Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Yu Chen
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 Huangjiahuxi Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Yaolatu Baosu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, 2 Huangjiahuxi Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Shenglong Qian
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China
| | - Ximing Liu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.
- Hubei University of Chinese Medicine, 16 Huangjiahu West Road, Hongshan District, Wuhan City, Hubei Province, China.
| | - Guodong Wang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan City, Hubei Province, China.
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