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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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Goyal T, Paul S, Choudhury AK, Abdusamad V. Use of Osteochondral and Meniscal Allografts from Bone Cuts of Total Knee Arthroplasty for the Treatment of Tibial Plateau Malunions: A Case Series of Four Patients Showing Early Results. Indian J Orthop 2021; 55:375-383. [PMID: 33927816 PMCID: PMC8046859 DOI: 10.1007/s43465-020-00347-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/31/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Intra-articular malunion of tibial plateau fracture is a complex problem to treat. We are presenting outcomes of our series of patients of malunited tibial plateau fractures treated with osteo-chondro-meniscal allograft from lateral tibial plateau harvested from patients undergoing total knee arthroplasty (TKA). METHODS The technique was used in four patients. Preoperative computed tomography (CT) scan was used to match donor and recipient graft dimensions and to measure any malalignment. Patients were evaluated for Visual analogue Scale (VAS) for pain (scale 1-10 cm), WOMAC (Western Ontario McMaster Osteo-Arthritis Index) score, knee range of motion, and limb alignment. RESULTS There were three medial tibial plateau malunions and one lateral tibial plateau malunion. Articular comminution with depression was seen in all of them. One patient underwent concurrent high tibial osteotomy for the elevation of the medial tibial plateau and posterior cruciate ligament reconstruction was performed concurrently in one patient. All patients showed improvement in knee range of motion, WOMAC score, and VAS score for knee pain. Limb alignment improved in all cases. Radiologically there was consolidation of the allograft in all the cases at 6 months. The mean follow-up was 15.2 months (range 12-18 months). CONCLUSION Osteochondral allograft can be a good choice for reconstructing large articular cartilage defects in tibial plateau malunions. Osteo-chondro-meniscal grafts obtained during TKA can be a viable alternative for reconstructing such defects with excellent early clinical, functional, and radiological outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab 151001 India
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - V. Abdusamad
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Abstract
The results of open reduction and internal fixation for tibial plateau fractures are generally favorable when articular morphology and stability are restored. When these goals of treatment are not achieved, limited function often results. The patient presented in this video complained of pain and an inability to resume his previous work. Evaluation suggested that root causes of these difficulties included widening of the plateau, significant depression of the articular surface, resultant valgus instability, and a displaced nonfunctioning lateral meniscus. This video demonstrates the planning and correction of a long-standing intraarticular malunion of a lateral tibial plateau fracture.
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Affiliation(s)
- Robert A Probe
- Baylor Scott & White Department of Orthopedic Surgery, Temple, TX
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Arthroscopy-Assisted Corrective Osteotomy, Reduction, Internal Fixation and Strut Allograft Augmentation for Tibial Plateau Malunion or Nonunion. J Clin Med 2020; 9:jcm9040973. [PMID: 32244592 PMCID: PMC7230929 DOI: 10.3390/jcm9040973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: The purpose of this study was to present the results of arthroscopy-assisted corrective osteotomy (AACO), reduction, internal fixation, and strut allograft augmentation for tibial plateau malunion or nonunion. Methods: Fifty-eight patients, mean age 49 ± 11.9 years old, with tibial plateau malunion (n = 44) or nonunion (n = 14), were included in this study. There were 19 Schatzker type II fractures (32.7%), 2 type III fractures (3.4%), 7 type IV fractures (12%), 20 type V fractures (34.5%), and 10 type VI fractures (17.2%). The mean follow-up period was 46.2 ± 17.6 months. Clinical and radiologic outcomes were scored by the Rasmussen system. Articular depression was measured from computed tomography. Secondary osteoarthritis was diagnosed when radiographs showed a narrowed joint space in the injured knee at follow-up. Results: Mean clinical score improved from 15.4 ± 3.9 (pre-revision) to 23.2 ± 4.5 (post-revision). Mean radiologic score improved from 7.7 ± 2.5 (pre-revision) to 12.0 ± 3.9 (post-revision). Fifty-six fractures achieved successful union. The average union time was 19.6 ± 7.5 weeks. Post-revision, 81% had good or excellent clinical results and 62% had good or excellent radiological results. Secondary osteoarthritis (OA) was noted in 91% of all injured knees, where 25.8% were mild OA, 25.8 % were moderate OA, and 38% were severe OA. There were 6 cases of deep infection (10.3%) and 1 case of wound edge necrosis (1.7%). Five cases were converted to total knee replacement after the index surgery with an average period of 13.5 months (range 8–24 months). Conclusions: Arthroscopy-assisted corrective osteotomy, reduction, internal fixation, and strut allograft augmentation can restore tibial plateau malunion/nonunion with well-documented radiographic healing and good clinical outcomes.
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Saragaglia D, Rubens-Duval B, Pailhé R. Intra- and extra-articular proximal tibia malunion. Orthop Traumatol Surg Res 2020; 106:S63-S77. [PMID: 31208930 DOI: 10.1016/j.otsr.2019.03.018] [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: 11/15/2018] [Revised: 01/13/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023]
Abstract
Extra- and intra-articular proximal tibia malunion is not uncommon. Functional impact is variable but may lead to almost total impotence. The present study aimed to provide a review on malunion, answering 5 questions: (1) How should malunion be classified, and with what pathogenicity? Malunion results from reduction defect and/or secondary displacement in tibial plateau fracture (A2, A3, B, C on the AO classification), but also from previous epiphysiodesis or osteotomy (valgization or varization). (2) How should malunion be assessed? Pre-treatment work-up comprises standard X-ray (AP, lateral, full-length), but also 2D and 3D CT-scan to assess the severity and type of residual depression in old fracture. (3) What conservative treatments are available, and for whom? In under-50 year-olds, correction osteotomy is recommended: intra- or extra-articular or combined. In extra-articular malunion, especially in the absence of osteoarthritis, realignment osteotomy may be indicated even in elderly subjects. (4) What implants are suited to what malunion, and for whom? In over-50 year-olds with intra-or extra-articular or combined malunion, partial or total replacement is recommended, isolated or associated to realignment osteotomy. The open questions concern material removal, surgical approach and type of implant, bearing in mind that these implants raise technical difficulties. (5) What are the complications, and the results? Results with osteotomy and partial prostheses are generally satisfactory. Results in total replacement are poorer than for primary implants in osteoarthritis of the knee, with much more frequent complications. LEVEL OF EVIDENCE: V, expert opinion.
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Affiliation(s)
- Dominique Saragaglia
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, CHU de Grenoble-Alpes, hôpital Sud, Avenue de Kimberley, BP 338, 38434 Échirolles Cedex, France.
| | - Brice Rubens-Duval
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, CHU de Grenoble-Alpes, hôpital Sud, Avenue de Kimberley, BP 338, 38434 Échirolles Cedex, France
| | - Régis Pailhé
- Service de chirurgie de l'arthrose et du sport, urgences traumatiques des membres, CHU de Grenoble-Alpes, hôpital Sud, Avenue de Kimberley, BP 338, 38434 Échirolles Cedex, France
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Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:432-441. [PMID: 31543383 PMCID: PMC6938994 DOI: 10.1016/j.aott.2019.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/19/2019] [Accepted: 08/24/2019] [Indexed: 12/03/2022]
Abstract
Objective The aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment. Methods Our revision strategy was as follows: First, we determined the presence of any infection. Second, we determined whether the patient required total knee arthroplasty (TKA). Third, based on the characteristics of the tibial plateau fracture malunion, patients underwent one of the following surgical methods to achieve reduction: original fracture line osteotomy, tibial tubercle + original fracture line osteotomy, fibula head + original fracture line osteotomy, and metaphyseal open window reduction rod technique. The results was assessed with healing time, Rasmussen score, knee range of motion and complication rates. Results A total of 25 patients 16 men and 9 women; Mean age: 47.4 years (range: 35–63 years) underwent tibial plateau fracture revision operation. The time interval between the two surgeries was 2–24 months. The follow-up time was 12–30 months, and the operation time was 120–300 min. All patients received bone union at the last follow-up. The healing time was 3–6 months. The postoperative Rasmussen score was 19–29 (mean 23.8) compared with 14.4 points before the operation (p < 0.05). The postoperative knee joint activity was 60–110° (mean 95.0°), compared with 57.8° before the operation (p < 0.05). Six patients still had a 2-mm collapse on the articular surface, and 4 patients still had slight valgus (<5°). Except for 2 TKA cases, fracture reduction was excellent in 15 cases and good in 8 cases, with a good rate of 100%. Superficial wound infections occurred in 3 patients. Conclusion Because revision of tibial plateau fracture malunion caused by failure of initial treatment is difficult, it is necessary to create a detailed surgical plan before the operation. Satisfactory clinical effects can be obtained if the correct revision strategy is used. The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion. Level of Evidence Level IV, Therapeutic Study.
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Kloen P, van Wulfften Palthe ODR, Nützinger J, Donders JCE. Early Revision Surgery for Tibial Plateau Fractures. J Orthop Trauma 2018; 32:585-591. [PMID: 30086042 DOI: 10.1097/bot.0000000000001280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe patients' outcomes after revision of tibial plateau fracture fixation within 12 months of the initial surgical procedure. To assess differences in objective outcome scores [International Knee Documentation Committee (IKDC), short form-36, arthrosis score, physical examination] depending on whether patients were treated for malreduction, malunion, or nonunion. DESIGN Retrospective case series. PATIENTS Twenty-seven patients who underwent revision within 1 year of primary surgery and with a minimum follow-up of 1 year. MAIN OUTCOME MEASUREMENT IKDC Subjective Knee Form, alignment, osteoarthritis, timed up and go test, range of motion, and physical and mental health (using the short form-36 survey). RESULTS At the most recent follow-up, the mean IKDC subjective knee score of all patients within the study group was 62 (SD 17). In the malreduction group, the mean was 71 (SD 17), in the malunion group the mean was 56 (SD 17), and in the nonunion group, the mean was also 56 (SD 12; χ 0.94; P = 0.624). Comparing the malreduction group with the malunion and nonunion groups combined, there was a significantly higher IKDC score (P = 0.019) in the malreduction group. CONCLUSION A suboptimal outcome after open reduction and internal fixation of a tibial plateau fracture is common. If the underlying cause of the fracture is malreduction, malunion, or a nonunion, salvage of the joint without a knee replacement is worthwhile. When using a strategy incorporating revision plate fixation, osteotomy (intra- and/or extraarticular), debridement, and bone grafting when needed, patients should experience favorable long-term outcomes, including less residual pain and functional limitations. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Peter Kloen
- Department of Orthopaedic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
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Mastrokalos DS, Panagopoulos GN, Koulalis D, Soultanis KC, Kontogeorgakos VA, Papagelopoulos PJ. Reconstruction of a Neglected Tibial Plateau Fracture Malunion with an Open-Book Osteotomy: A Case Report. JBJS Case Connect 2018; 7:e21. [PMID: 29244701 DOI: 10.2106/jbjs.cc.16.00041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Surgical management of tibial plateau fractures can be challenging, and complications can be devastating. We report the case of a lateral tibial plateau fracture malunion with an associated intra-articular depression, which we treated with an open-book osteotomy, obviating the need for an early corrective osteotomy or knee arthroplasty. CONCLUSION A tibial plateau fracture malunion can be reconstructed. The surgical team should give priority to salvage options, which can obviate or delay the need for and the implications of an early total knee arthroplasty, especially in a young and active patient.
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Affiliation(s)
| | | | - Dimitrios Koulalis
- Orthopaedic Department ULB, University Hospital Erasme Brussels, University of Brussels Medical School, Brussels, Belgium
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Van Nielen DL, Smith CS, Helfet DL, Kloen P. Early Revision Surgery for Tibial Plateau Non-union and Mal-union. HSS J 2017; 13:81-89. [PMID: 28167879 PMCID: PMC5264578 DOI: 10.1007/s11420-016-9529-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 09/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although relatively rare, non-unions and mal-unions of tibial plateau fractures present significant challenges for the orthopedic surgeon. With careful pre-operative planning, tibial plateau mal-union or non-union revision surgery with intra-articular and varus opening osteotomies can provides good functional results when performed early (within 1 year) after primary surgical procedure. QUESTIONS/PURPOSES We present our treatment algorithm for approaching and treating non-union or mal-union of tibial plateau fractures. Our aim is to give surgeons treating these difficult injuries an overview of the pertinent literature as well as describe the challenges and pitfalls we have experienced when treating non-union or mal-union of tibial plateau fractures. METHODS Using two case examples from our institution, one for mal-union and one for mal-reduction, we describe our treatment algorithm and surgical technique for managing these difficult injuries. We also provide a brief literature review outlining relevant studies and summarizing outcomes for similar injuries. A systematic literature review was conducted with the aim of determining the methods and outcomes commonly reported in the literature regarding revision surgery following tibial plateau non-union or mal-union. Due to the nature of revision surgery, there are no long-term randomized trials dealing with outcomes, but rather several smaller case series exist from which larger conclusions have to be drawn. RESULTS To date, we have successfully treated approximately 35 patients with this technique, and clinical follow-up continues to show good functional outcomes with reduced pain and little radiographic evidence of arthritic changes. Restoring long leg alignment, anatomic reduction of the articular surface, and achieving stable internal fixation are paramount in achieving the best long-term outcome. Due to the shallow soft tissue envelope around the proximal tibia, and the tendency for these fractures to fall into progressive valgus collapse, these problems can seem intimidating and complex. However, with well-planned surgery and meticulous surgical technique, reliable healing can be achieved. CONCLUSION By outlining our method, we hope to provide other surgeons with an algorithm to guide clinical and operative decision making. These difficult injuries can be daunting to treat, but if performed before the onset of severe degenerative arthritis, early revision surgery, as we describe, can be a viable alternative to total knee arthroplasty, particularly in younger, more active patients.
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Affiliation(s)
- Dominic L. Van Nielen
- 0000 0000 9013 4774grid.415882.2Deparmentof Orthopaedic Surgery, Naval Medical Center Portsmouth, 620 John Paul Jones Blvd, Portsmouth, VA 23708 USA
| | - Christopher S. Smith
- 0000 0000 9013 4774grid.415882.2Deparmentof Orthopaedic Surgery, Naval Medical Center Portsmouth, 620 John Paul Jones Blvd, Portsmouth, VA 23708 USA
| | - David L. Helfet
- 0000 0001 2285 8823grid.239915.5Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY 10021 USA
| | - Peter Kloen
- 0000000084992262grid.7177.6University of Amsterdam, Amsterdam, Netherlands
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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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Song EK, Seon JK, Agrawal PR. Single-Stage Corrective Osteotomies for Multiple Angular Deformities Around the Knee Joint with Patellar Instability in a Patient with Multiple Epiphyseal Dysplasia: A Case Report. JBJS Case Connect 2015; 5:e82. [PMID: 29252592 DOI: 10.2106/jbjs.cc.n.00177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE It is rare to find a case report on combined recurvatum and valgus deformity of the knee with associated patellar instability due to a depressed lateral tibial plateau in a young adult with multiple epiphyseal dysplasia. We treated such a patient with single-stage osseous and soft-tissue procedures and achieved a stable, well-aligned, pain-free, and mobile joint. CONCLUSION Patellar instability with genu recurvatum and genu valgum leading to reduced range of motion of the knee in multiple epiphyseal dysplasia shows mechanical and functional improvement following single-stage surgical intervention, thereby improving quality of life.
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Affiliation(s)
- Eun Kyoo Song
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do 519-809, South Korea. . .
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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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Lustig S, Khiami F, Boyer P, Catonne Y, Deschamps G, Massin P. Post-traumatic knee osteoarthritis treated by osteotomy only. Orthop Traumatol Surg Res 2010; 96:856-60. [PMID: 21115418 DOI: 10.1016/j.otsr.2010.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/23/2010] [Accepted: 06/03/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteotomies to address lower extremity post-traumatic deformities are more complex than standard osteotomies performed for congenital deformities, standard osteotomies and their outcomes are not well known. We performed a multicentric retrospective study of these cases. We hypothesized that osteotomy without total knee replacement to correct fracture malunion deformities can provide long-term relief from athritic pain. PATIENTS AND METHODS Twenty-eight patients, mean age 46.4 years old, underwent, between 2000 and 2008, osteotomy for post traumatic osteoarthritis which had resulted in intraarticular malunion in six patients and extraarticular malunion in 22 cases. The initial trauma had occurred a mean 17.3 years before. There were 11 valgus and 17 varus deformities. Two osteotomies were performed in the callus to correct intraarticular malunion. The other osteotomies were performed outside the callus: in 25 cases to correct coronal plane deformities (nine tibial, 11 femoral and five tibial and femoral), including nine cases with associated derotation. Osteotomies were performed on the distal femoral metaphysis and the proximal tibia. There was also one case of supramalleolar derotation osteotomy of the tibia. All 28 patients were contacted again for a consultation. There was a postoperative clinical and radiographic follow-up of at least 2years for all patients despite four lost to follow-up patients. There were 18 patients with Ahlback grade 2 arthritis, nine grade 3 and one grade 4. RESULTS Two patients with an intraarticular malunion finally underwent revision surgery to receive total knee replacement because of persistent pain. These patients had grade 3 and 4 arthritis respectively and undercorrection persisted in the coronal plane. Four patients underwent repeated surgery for stiffness, early infection treated with debridement and antibiotics as well as femoral pseudarthrosis (two cases). After a mean follow-up of 3.8 years, the pain score had improved significantly with more marked improvement in extraarticular malunions (P=0.03). Functional improvement was moderate (equivalent in patients with Ahlback grades 2 and 3 arthritis) and articular range of motion did not change. Osteotomy corrected valgus and varus deformities with a mean realignment effect of 9° and 10° respectively. DISCUSSION Osteotomy should correct the three components of the traumatic deformity at the distal femoral metaphysic level to allow mechanical axis and rotation anomalies correction, and at the proximal tibia level for realignment purposes. Supramalleolar tibial osteotomy should be performed for tibial derotation. Pain relief with osteotomy had better outcomes when dealing with extraarticular malunions. In unicompartmental grade 2 and 3 arthritis, the indications can be fairly broad in young patients. Besides providing temporary relief, osteotomy facilitates future total knee replacement surgery in these cases. LEVEL OF EVIDENCE Level 4; non controlled, retrospective study.
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Affiliation(s)
- S Lustig
- Albert-Trillat Surgical Center, North Lyon Teaching Hospital Center, Lyon 1 Claude-Bernard University, 8, rue des Margnolles, 69300 Caluire-et-Cuire, France
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Abstract
The selection of a surgical approach for the treatment of tibia plateau fractures is an important decision. Approximately 7% of all tibia plateau fractures affect the posterolateral corner. Displaced posterolateral tibia plateau fractures require anatomic articular reduction and buttress plate fixation on the posterior aspect. These aims are difficult to reach through a lateral or anterolateral approach. The standard posterolateral approach with fibula osteotomy and release of the posterolateral corner is a traumatic procedure, which includes the risk of fragment denudation. Isolated posterior approaches do not allow sufficient visual control of fracture reduction, especially if the fracture is complex. Therefore, the aim of this work was to present a surgical approach for posterolateral tibial plateau fractures that both protects the soft tissue and allows for good visual control of fracture reduction. The approach involves a lateral arthrotomy for visualizing the joint surface and a posterolateral approach for the fracture reduction and plate fixation, which are both achieved through one posterolateral skin incision. Using this approach, we achieved reduction of the articular surface and stable fixation in six of seven patients at the final follow-up visit. No complications and no loss of reduction were observed. Additionally, the new posterolateral approach permits direct visual exposure and facilitates the application of a buttress plate. Our approach does not require fibular osteotomy, and fragments of the posterolateral corner do not have to be detached from the soft tissue network.
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