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Kraml N, Haslhofer DJ, Winkler PW, Stiftinger JM, Heidecke S, Kwasny O, Gotterbarm T, Klasan A. Tibial plateau fractures are associated with poor functional outcomes and a low conversion rate to total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:1308-1316. [PMID: 38504506 DOI: 10.1002/ksa.12153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/21/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE The aim of this study was to analyse the functional outcome and the conversion rate to total knee arthroplasty (TKA) after surgically treated tibial plateau fractures (TPF). METHODS All patients undergoing surgical treatment of TPF at a single institution between January 2003 and December 2019 were retrospectively reviewed. The Knee injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale (TAS) were collected. The conversion rate to TKA was examined 2, 5, 7 and 10 years after surgical treatment of TPF. RESULTS Ninety-four patients, with a mean follow-up of 110.6 months (±60.0), were included in the functional outcome assessment. Mean KOOS scores were 75.4 for symptoms, 80.6 for pain, 84.3 for activities of daily living (ADL), 59.5 for sports and 61.3 for QOL. All subscales were significantly lower on the injured side compared with the contralateral leg. Lower KOOS was observed in patients with hardware removal and Schatzker type 5 and 6 injuries. Median TAS was postinjury (4) significantly lower than preinjury (5) (p < 0.001). The conversion rate to TKA was 6.3%, 10.9%, 11.7% and 12.2% after 2,5,7 and 10 years of follow-up, respectively. Patients undergoing TKA were older than patients with no conversion to TKA (2 years follow-up 53.8 vs. 64.5 years, p = 0.026). CONCLUSION TPFs decrease the function of the knee when compared with the contralateral side and to the preoperative condition. Bicondylar fractures are associated with worse functional outcomes. A conversion rate to TKA of 12.2% was found at 10 years follow-up. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nikolaus Kraml
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - David J Haslhofer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Philipp W Winkler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Julian M Stiftinger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Svenja Heidecke
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Oskar Kwasny
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Antonio Klasan
- Department for Orthopedics and Traumatology, AUVA Graz, Graz, Austria
- Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
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Neidlein C, Watrinet J, Pätzold R, Berthold DP, Prall WC, Böcker W, Holzapfel BM, Fürmetz J, Bormann M. Patient-Reported Outcomes following Tibial Plateau Fractures: Mid- to Short-Term Implications for Knee Function and Activity Level. J Clin Med 2024; 13:2327. [PMID: 38673600 PMCID: PMC11051425 DOI: 10.3390/jcm13082327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Patients with complex proximal tibial plateau fractures (TPFs) tend to overestimate the prognosis of their injury, potentially due to factors such as a limited understanding, optimism, and the influence of the pain intensity. Understanding the reasons behind this misperception is crucial for healthcare providers to effectively communicate with patients and establish realistic expectations for treatment outcomes. The purpose of this study was to analyze the outcomes of TPFs, with a particular focus on patient-reported outcome measures concerning functional recovery, pain levels, and overall satisfaction with treatment. The authors aim to provide valuable insights into the realistic expectations and potential limitations that patients may encounter during their recovery journey. Methods: In this retrospective single-center study, all surgically treated TPFs between January 2014 and December 2019 with a minimum follow-up of 12 months were included. Several patient-reported outcome measures were obtained, including the International Knee documentation Committee Score (IKDC), Lyholm score, Tegner score, and visual analog scale (VAS) for pain. Fractures were classified according to Schatzker, and then subgrouped into simple (Schatzker I-III) and complex (Schatzker IV-VI) fractures. Results: A total of 54 patients (mean age 51.1 ± 11.9 years, 59.3% female) with a mean follow-up time of 3.9 years were included. Schatzker II fractures were present in 48% (n = 26) of the cases, with Schatzker III in 6% (n = 3), Schatzker IV fractures in 6% (n = 3), and Schatker VI fractures in 41% (n = 22) of the cases. All outcome scores showed a significant improvement between the first year after surgery and the last follow-up (mean: 3.9 years). Simple fractures showed significantly lower patient-reported outcomes when compared to the preinjury state; however, good to excellent results were observed. Patient-reported outcomes of complex fractures showed no significant changes in the study period with good to excellent results. When it comes to the Lysholm score, there were no significant differences in the outcome between simple and complex fractures. Furthermore, there was a return-to-sports rate of 100%, with high rates of changing sporting activity in 25% (simple fractures) and 45% in complex fractures. Conclusions: The data from this study showed that both simple and complex tibial plateau fractures show favorable outcomes at the midterm follow-up, and that injury severity does not correlate with worse results. While patients may tend to overestimate the recovery speed, this research highlights the importance of long-term follow-up, demonstrating a substantial improvement between one year post-surgery and the final evaluation. Return-to-sports rates were high, with adjustments needed for certain activities. However, patients should recognize the need to shift to lower-impact sports and the lengthy recovery process.
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Affiliation(s)
- Claas Neidlein
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
| | - Julius Watrinet
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Robert Pätzold
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Daniel P. Berthold
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
| | - Wolf Christian Prall
- Devision of Knee, Hip, Shoulder and Elbow Surgery, Schoen Clinic Munich, Harlachinger Straße 51, 81547 Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
| | - Julian Fürmetz
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Markus Bormann
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
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Wang B, Zhu Y, Zhang B, Wang Y, Yan L, Xie X, Luo C. Incidence and Characteristics of Knee Ligament and Meniscal Injuries in Patients With Posterolateral Tibial Plateau Fractures. Orthop J Sports Med 2024; 12:23259671241238023. [PMID: 38601191 PMCID: PMC11005506 DOI: 10.1177/23259671241238023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 04/12/2024] Open
Abstract
Background Anterior cruciate ligament (ACL) tears are commonly seen with concomitant injuries to the posterolateral tibial plateau, while the occurrence of ACL injuries in posterolateral tibial plateau fractures (PTPFs) remains unclear. Purpose To (1) explore the incidence of knee ligament (anterior or posterior cruciate ligament, medial or lateral collateral ligament) and medial or lateral meniscus injuries in patients with PTPF and (2) find reliable PTPF-related parameters to predict the risk of knee ligament and meniscal injuries. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients diagnosed with PTPF who had computed tomography and magnetic resonance imaging (MRI) data were identified. Morphological parameters of the PTPF were measured on sagittal computed tomography images. Knee ligament and meniscal injuries were assessed using MRI. The association of ACL injuries with meniscal injuries was analyzed. Receiver operating characteristic (ROC) analysis was used to determine the value and cutoff point of the PTPF morphological parameters for diagnosing complete in-substance ACL tears. Results Overall, 113 patients with PTPF were included. ACL injuries were present in 94 (83.2%) patients, including 43 (38.1%) avulsion fractures and 28 (24.8%) complete in-substance tears. Patients with in-substance ACL tears had a higher incidence of lateral meniscus posterior horn tears compared with the other patients (PBonferroni < .001). ROC analysis revealed that both the fracture depression angle (cutoff point, 25.5°) and the posterior articular surface loss percentage (cutoff point, 37.5%) had a sensitivity >90% and a specificity >80% for the diagnosis of complete in-substance ACL tears. Conclusion ACL injuries were seen in 83.2% of the study patients. Complete in-substance ACL tears were associated with an increased incidence of lateral meniscus posterior horn tears. Among PTPF parameters, fracture depression angle and posterior articular surface loss percentage showed a high predictive value for the presence of complete in-substance ACL tears, thereby reducing delays in diagnosis and treatment.
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Affiliation(s)
- Binghao Wang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Zhu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Binbin Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yukai Wang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lifeng Yan
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuetao Xie
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Congfeng Luo
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Assink N, ten Duis K, de Vries JPPM, Witjes MJH, Kraeima J, Doornberg JN, IJpma FFA. 3D surgical planning including patient-specific drilling guides for tibial plateau fractures. Bone Jt Open 2024; 5:46-52. [PMID: 38240277 PMCID: PMC10797644 DOI: 10.1302/2633-1462.51.bjo-2023-0130.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Aims Proper preoperative planning benefits fracture reduction, fixation, and stability in tibial plateau fracture surgery. We developed and clinically implemented a novel workflow for 3D surgical planning including patient-specific drilling guides in tibial plateau fracture surgery. Methods A prospective feasibility study was performed in which consecutive tibial plateau fracture patients were treated with 3D surgical planning, including patient-specific drilling guides applied to standard off-the-shelf plates. A postoperative CT scan was obtained to assess whether the screw directions, screw lengths, and plate position were performed according the preoperative planning. Quality of the fracture reduction was assessed by measuring residual intra-articular incongruence (maximum gap and step-off) and compared to a historical matched control group. Results A total of 15 patients were treated with 3D surgical planning in which 83 screws were placed by using drilling guides. The median deviation of the achieved screw trajectory from the planned trajectory was 3.4° (interquartile range (IQR) 2.5 to 5.4) and the difference in entry points (i.e. plate position) was 3.0 mm (IQR 2.0 to 5.5) compared to the 3D preoperative planning. The length of 72 screws (86.7%) were according to the planning. Compared to the historical cohort, 3D-guided surgery showed an improved surgical reduction in terms of median gap (3.1 vs 4.7 mm; p = 0.126) and step-off (2.9 vs 4.0 mm; p = 0.026). Conclusion The use of 3D surgical planning including drilling guides was feasible, and facilitated accurate screw directions, screw lengths, and plate positioning. Moreover, the personalized approach improved fracture reduction as compared to a historical cohort.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kaj ten Duis
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Max J. H. Witjes
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joep Kraeima
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Job N. Doornberg
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Flinders University, Adelaide, Australia
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Ngo W, Craddock G, Frangenberg A, Park A, Basu N. Tibial Plateau Fracture With Use of Tibia Strut and Bone Filler in a 37-Year-Old Male: A Case Report. Cureus 2024; 16:e52913. [PMID: 38406058 PMCID: PMC10893992 DOI: 10.7759/cureus.52913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Tibial plateau fractures (TPFs) are orthopedic challenges with multiple injury modalities and clinical presentations. TPFs are often classified using the Schatzker classification system, which can dictate management. In our case, a 37-year-old male presented at an orthopedic specialty hospital with right knee pain after a fall from a truck ramp. X-rays and CT imaging demonstrated a comminuted bicondylar TPF in the emergency room with metaphyseal dissociation. The patient was placed in a knee immobilizer, made non-weight bearing, and scheduled for outpatient follow-up with a local orthopedic surgeon. The patient was lost to follow-up and referred to our clinic six months after the fall with the chief complaint of inability to ambulate with severe pain and instability in the knee. X-rays demonstrated a malunion of the bicondylar tibial plateau with fracture deformities of the medial femoral condyle and lateral tibial plateau. The patient's deformity was corrected with a medial opening wedge proximal tibial osteotomy with a fibula strut allograft and filled with beta-tricalcium bone filler. At the first month follow-up, the patient's pain was well controlled, fragments and the knee were appropriately aligned, and no significant soft tissue or joint effusion was appreciated on imaging. After failing nonoperative treatment, this patient with comminuted bicondylar TPF has received definitive treatment with open reduction and internal fixation. Higher rates of unacceptable results from nonoperative treatment are in line with the Schatzker series, in which operative treatment resulted in more acceptable outcomes. Because the fracture in this patient is consistent with a Schatzker VI classification with intra-articular depression, the patient should have initially been treated with an external fixator and not been sent home in a knee immobilizer. This led to a malunion that necessitated corrective surgery. Therefore, correctly classifying fracture severity is important for selecting the best treatment course and minimizing complications.
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Affiliation(s)
- Wayne Ngo
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Germain Craddock
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Alex Frangenberg
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Amber Park
- Medicine, Lincoln Memorial University DeBusk College of Osteopathic Medicine, Knoxville, USA
| | - Niladri Basu
- Orthopedics, Dallas Orthopaedic Trauma Institute, Dallas, USA
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张 月, 章 乐, 严 超, 王 刚. [Clinical study on the subchondral screw compression technique assisted reduction of residual or secondary collapse of lateral tibial plateau]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1459-1464. [PMID: 38130187 PMCID: PMC10739669 DOI: 10.7507/1002-1892.202308080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
Objective To explore the reduction and support effect of the subchondral screw compression technique for residual or secondary collapse of the lateral tibial plateau during operation. Methods Between January 2020 and June 2021, 11 patients with residual or secondary collapse of the lateral tibial plateau during operation were treated with the subchondral screw compression technique. There were 6 males and 5 females, aged 52.3 years old (range, 27-64 years). The fractures were caused by traffic accident in 10 cases and falling from height in 1 case and located at the left knee in 6 cases and the right knee in 5 cases. According to Schatzker classification, there were 5 cases of type Ⅱ fractures, 4 cases of type Ⅲ fractures, and 2 cases of type Ⅴfractures. According to the three columns classification, there were 5 cases of lateral column, 4 cases of lateral column and posterior column, and 2 cases of three columns. The time from injury to operation was 4.5 days (range, 3-7 days). During the follow-up, X-ray films were obtained and the Rasmussen standard was used to evaluate the quality of fracture reduction, meanwhile fracture healing was observed. The medial proximal tibial angle (mPTA), posterior tibial slope angle (pTSA), and articular surface collapse were measured at immediate and 12 months after operation. The knee joint range of motion was evaluated at last follow-up, and the knee joint function was evaluated using the Hospital for Special Surgery (HSS) score. Results All operations were successfully completed, with a mean operation time of 71.4 minutes (range, 55-120 minutes), and a mean hospital stay of 8.0 days (range, 5-13 days). The incisions all healed by first intention, without complications such as infection, flap necrosis, or vascular and nerve injury. All patients were followed up 16.5 months on average (range, 12-24 months). X-ray films showed that the fracture reduction score was 14-18 (mean, 16.7) according to Rasmussen score criteria; and 5 cases were rated as excellent and 6 as good. All fractures healed clinically with a mean clinical healing time of 14.9 weeks (range, 12-16 weeks), and there was no complications such as plate or screw loosening. At 12 months after operation, the mPTA and pTSA were (87.5±1.7)° and (6.2±3.1)°, respectively; there was no significant difference when compared to the values at immediate after operation [(87.6±1.8)° and (6.5±3.1)°] ( P>0.05). The articular surface of the tibial plateaus was effectively supported, and it collapsed again by 0-1.0 mm at 12 months, with an average of 0.4 mm. At last follow-up, the knee joint range of motion was 115°-135° (mean, 126.8°) and the HSS score for knee joint function was 87-98 (mean, 93.9). Five patients underwent secondary operation to remove the internal fixator at 12-18 months after operation. Conclusion The subchondral screw compression technique is helpful for the reduction of residual or secondary collapse of the lateral tibial plateau during operation, and can provide good support for osteochondral blocks.
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Affiliation(s)
- 月雷 张
- 安徽医科大学第一附属医院创伤骨科(合肥 230000)Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P. R. China
| | - 乐成 章
- 安徽医科大学第一附属医院创伤骨科(合肥 230000)Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P. R. China
| | - 超 严
- 安徽医科大学第一附属医院创伤骨科(合肥 230000)Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P. R. China
| | - 刚 王
- 安徽医科大学第一附属医院创伤骨科(合肥 230000)Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P. R. China
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Morello V, Gamulin A. Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature. EFORT Open Rev 2023; 8:926-935. [PMID: 38038381 DOI: 10.1530/eor-23-0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Introduction Acute compartment syndrome (ACS) is an orthopedic emergency that may lead to devastating sequelae. Diagnosis may be difficult. The aim of this systematic review is to identify clinical and radiological risk factors for ACS occurrence in tibial fractures. Methods PubMed® database was searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Additional articles were found by a manual research of selected references and authors' known articles. Results The identification process individualized 2758 via database and 30 via other methods. After screening and eligibility assessment, 29 articles were included. Age, gender, occupation, comorbidities, medications, habits, polytrauma, multiple injuries, mechanism, sports, site, open vs closed, contiguous lesion, classification, and pattern were found to be related to ACS occurrence. Conclusions Younger age and male gender are strong independent risk factors in tibial plateau and shaft fractures. High-energy fractures, polytrauma, more proximal fractures and fractures with contiguous skeletal lesions are aggravating risk factors; higher AO/OTA and Schatzker classification types, increased displacement of the tibia relative to the femur, and increased tibial joint surface width are associated risk factors in tibial plateau fractures; higher AO Foundation/Orthopaedic Trauma Association classification types and subgroups and more proximal fractures within the diaphysis are associated risk factors in tibial shaft fracture. Open fractures do not prevent ACS occurrence. Increased fracture length is the only factor suggesting a higher risk of ACS in tibial pilon fractures. The presence of each independent predictor may have a cumulative effect increasing the risk of ACS occurrence.
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Affiliation(s)
- Vanessa Morello
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Axel Gamulin
- Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland
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Mizunuma Y, Takahashi T, Iguchi M, Sasanuma H, Saitsu A, Handa M, Matsumura T, Takeshita K. Use of a preoperative 3D templating and proximal lateral tibial fitting patient-specific instrumentation in fixed valgus complex primary total knee arthroplasty for a patient with retaining hardware for internal fixation to treat Schatzker type V tibial plateau fracture: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231215217. [PMID: 38033917 PMCID: PMC10687914 DOI: 10.1177/2050313x231215217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
A 72-year-old female patient with a fixed valgus knee deformity due to a Schatzker type V tibial plateau fracture treated with bilateral locking plates 8 years ago was admitted to our clinic with complaints of chronic pain and knee instability when walking. Radiographs revealed Kellgren-Lawrence Classification grade 4 knee osteoarthritis and 20.5° of valgus knee deformity. She was treated with three-dimensional templating and proximal lateral tibial fitting patient-specific instrumentation-assisted mechanically aligned posterior sacrificing total knee arthroplasty with minimal removal of the retained hardware for the internal fixation of the tibial plateau fracture via a lateral approach, resulting in a favorable clinical outcome. The use of proximal lateral tibial fitting patient-specific instrumentation in fixed valgus complex primary total knee arthroplasty for patients with retaining hardware for internal fixation to treat tibial plateau fractures is considered a treatment option to decrease surgical invasion.
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Affiliation(s)
- Yuta Mizunuma
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Japan
| | - Tsuneari Takahashi
- Department of Orthopedic Surgery, Ishibashi General Hospital, Shimotsuke, Japan
| | - Masaki Iguchi
- Department of Orthopedic Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Hideyuki Sasanuma
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Japan
| | - Akihiro Saitsu
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Japan
| | - Mikiko Handa
- Department of Orthopedics, Jichi Medical University, Shimotsuke, Japan
| | - Tomohiro Matsumura
- Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan
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O’Neill DC, Sato EH, Myhre LA, Kantor AH, Rothberg DL, Higgins TF, Marchand LS, Haller JM. Return to Skiing After Tibial Plateau Fracture. Orthop J Sports Med 2023; 11:23259671231205925. [PMID: 37868212 PMCID: PMC10585993 DOI: 10.1177/23259671231205925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 10/24/2023] Open
Abstract
Background Tibial plateau fractures in skiers are devastating injuries with increasing incidence. Few studies have evaluated patient-reported outcomes and return to skiing after operative fixation of a tibial plateau fracture. Purpose To (1) identify demographic factors, fracture characteristics, and patient-reported outcome measures that are associated with return to skiing and (2) characterize changes in skiing performance after operative fixation of a tibial plateau fracture. Study Design Case series; Level of evidence, 4. Methods We reviewed all operative tibial plateau fractures performed between 2016 and 2021 at a single level-1 trauma center. Patients with a minimum of 10-month follow-up data were included. Patients who self-identified as skiers or were injured skiing were divided into those who returned to skiing and those who did not postoperatively. Patients were contacted to complete the Patient-Reported Outcomes Measurement Information System-Physical Function domain (PROMIS-PF), the Knee injury and Osteoarthritis Outcome Score-Activities of Living (KOOS-ADL), and a custom return-to-skiing questionnaire. Multivariate logistic regression was performed with sex, injury while skiing, PROMIS-PF, and KOOS-ADL as covariates to evaluate factors predictive of return to skiing. Results A total of 90 skiers with a mean follow-up of 3.4 ± 1.5 years were included in the analysis. The rate of return to skiing was 45.6% (n = 41). The return cohort was significantly more likely to be men (66% vs 41%; P = .018) and injured while skiing (63% vs 39%; P = .020). In the return cohort, 51.2% returned to skiing 12 months postoperatively. The percentage of patients who self-reported skiing on expert terrain dropped by half from pre- to postinjury (61% vs 29.3%, respectively). Only 78% of return skiers had regained comfort with skiing at the final follow-up. Most patients (65%) felt the hardest aspect of returning to skiing was psychological. In the multivariate regression, the male sex and KOOS-ADL independently predicted return to skiing (P = .006 and P = .028, respectively). Conclusion Fewer than half of skiers who underwent operative fixation of a tibial plateau fracture could return to skiing at a mean 3-year follow-up. The knee-specific KOOS-ADL outperformed the global PROMIS-PF in predicting a return to skiing.
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Affiliation(s)
- Dillon C. O’Neill
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Eleanor H. Sato
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Luke A. Myhre
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Adam H. Kantor
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - David L. Rothberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Thomas F. Higgins
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Lucas S. Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Justin M. Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
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Assink N, Bosma E, Meesters AML, van Helden SH, Nijveldt RJ, ten Duis K, Witjes MJH, de Vries JPPM, Kraeima J, IJpma FFA. Initial and Residual 3D Fracture Displacement Is Predictive for Patient-Reported Functional Outcome at Mid-Term Follow-Up in Surgically Treated Tibial Plateau Fractures. J Clin Med 2023; 12:6055. [PMID: 37762994 PMCID: PMC10531969 DOI: 10.3390/jcm12186055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Conventional measures of fracture displacement have low interobserver reliability. This study introduced a novel 3D method to measure tibial plateau fracture displacement and its impact on functional outcome. METHODS A multicentre study was conducted on patients who had tibial plateau fracture surgery between 2003 and 2018. Eligible patients had a preoperative CT scan (slice thickness ≤ 1 mm) and received a Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. A total of 362 patients responded (57%), and assessment of initial and residual fracture displacement was performed via measurement using the 3D gap area (mm2). Patients were divided into four groups based on the 3D gap area size. Differences in functional outcome between these groups were assessed using analysis of variance (ANOVA). Multiple linear regression was used to determine the association between fracture displacement and patient-reported outcome. RESULTS Functional outcome appeared significantly worse when initial or residual fracture displacement increased. Multivariate linear regression showed that initial 3D gap area (per 100 mm2) was significantly negatively associated with all KOOS subscales: symptoms (-0.9, p < 0.001), pain (-0.0, p < 0.001), ADL (-0.8, p = 0.002), sport (-1.4, p < 0.001), and QoL (-1.1, p < 0.001). In addition, residual gap area was significantly negatively associated with the subscales symptoms (-2.2, p = 0.011), ADL (-2.2, p = 0.014), sport (-2.6, p = 0.033), and QoL (-2.4, p = 0.023). CONCLUSION A novel 3D measurement method was applied to quantify initial and residual displacement. This is the first study which can reliably classify the degree of displacement and indicates that increasing displacement results in poorer patient-reported functional outcomes.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | - Eelke Bosma
- Department of Trauma Surgery, Martini Hospital, 9712 CP Groningen, The Netherlands;
| | - Anne M. L. Meesters
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | - Sven H. van Helden
- Department of Trauma Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands; (S.H.v.H.); (R.J.N.)
| | - Robert J. Nijveldt
- Department of Trauma Surgery, Isala Hospital, 8025 AB Zwolle, The Netherlands; (S.H.v.H.); (R.J.N.)
| | - Kaj ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
| | - Max J. H. Witjes
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | | | - Joep Kraeima
- 3D Lab, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (M.J.H.W.); (J.K.)
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (A.M.L.M.); (K.t.D.)
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12
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Booth M, McDonough B, Tager D, Niemann M, Vaida J. Combined Lateral Plateau and PCL Injury in a Pediatric Patient: A Case Report. J Orthop Case Rep 2023; 13:108-111. [PMID: 37753141 PMCID: PMC10519317 DOI: 10.13107/jocr.2023.v13.i09.3896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/13/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Posterior cruciate ligament (PCL) injuries and tibial plateau fractures are common orthopedic injuries. In the pediatric population, femoral-sided avulsions are the most common injury pattern for PCL injuries. However, there is limited literature on the characterization and treatment of pediatric PCL avulsion with concomitant tibial plateau fracture. Case Report We present the case of an adolescent female who was involved in an all-terrain vehicle rollover. The patient sustained a femoral-sided PCL avulsion injury with an associated lateral tibial plateau fracture. The PCL avulsion was treated through arthroscopic cruciate repair, while the tibial plateau fracture was managed with open reduction and internal fixation (ORIF). Conclusion This case report highlights a rare combination of a femoral-sided PCL avulsion and lateral tibial plateau fracture in a pediatric patient. The treatment involved arthroscopic cruciate repair for the PCL avulsion and ORIF for the tibial plateau fracture. Further studies are needed to establish optimal management strategies for similar cases.
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Affiliation(s)
- Michael Booth
- Department of Orthopedics, West Virginia University, Morgantown, West Virginia
| | - Barry McDonough
- Department of Orthopedics, West Virginia University, Morgantown, West Virginia
| | - David Tager
- Department of Orthopedics, West Virginia University, Morgantown, West Virginia
| | - Michael Niemann
- Department of Orthopedics, West Virginia University, Morgantown, West Virginia
| | - Justin Vaida
- Department of Orthopedics, West Virginia University, Morgantown, West Virginia
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13
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Herbst E, Wessolowski MA, Raschke MJ. Extension of the Medial Approach to the Tibial Plateau via an Osteotomy of the Tibial Insertion of the Superficial Medial Collateral Ligament. J Clin Med 2023; 12:5208. [PMID: 37629247 PMCID: PMC10455629 DOI: 10.3390/jcm12165208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
The treatment of medial tibial plateau fractures can be challenging due to poor exposure of the articular surface. Therefore, a medial epicondyle osteotomy may be needed. Current methods describe osteotomy of the medial femoral epicondyle. However, this method requires additional detachment of the medial meniscus in order to ensure proper visualization. The aim of this study is to present a new technique using distal osteotomy of the superficial medial collateral ligament and to analyze the area of the exposed articular surface area. On each of eight fresh-frozen human cadaveric knees (mean age: 79.4 ± 9.4 years), an osteotomy and proximal reflection of the distal insertion of the superficial medial collateral ligament combined with a submeniscal arthrotomy was performed, followed by a medial epicondyle osteotomy. Using a three-dimensional measurement arm (Absolute Arm 8320-7, Hexagon Metrology GmbH), the exposed area was analyzed and compared to the entire medial articular surface using ANOVA (p < 0.05). Through the medial epicondyle osteotomy, 39.9 ± 9.7% of the anteromedial articular surface was seen. This area was significantly smaller compared to the osteotomy of the distal insertion of the superficial collateral ligament with an exposed articular surface of 77.2 ± 16.9% (p = 0.004). Thus, the distal osteotomy exposed 37.3% more of the articular surface compared to the medial epicondyle osteotomy. None of these techniques were able to adequately expose the posteromedial- and medial-most aspects of the tibial plateau. A distal superficial collateral ligament osteotomy may be superior to a medial epicondyle osteotomy when an extension of the anteromedial approach to the tibial plateau is required. A distal superficial medial collateral ligament osteotomy combines the advantages of better exposure of the medial articular surface with preservation of the blood supply to the medial meniscus. However, surgeons should carefully consider whether such an extended approach is necessary, as it significantly increases invasiveness.
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Affiliation(s)
| | | | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University of Muenster, 48149 Muenster, Germany
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14
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Xue H, Deng J, Zhang Z, Knoedler S, Panayi AC, Knoedler L, Mi B, Liu M, Dai G, Liu G. Different internal fixation methods for Hoffa-like fractures of the tibial plateau: a finite element analysis. Front Med (Lausanne) 2023; 10:1172377. [PMID: 37465644 PMCID: PMC10351422 DOI: 10.3389/fmed.2023.1172377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 07/20/2023] Open
Abstract
Due to the low incidence of posteromedial tibial plateau fractures and limited clinical data available, the optimal treatment for this type of fracture remains to be established. This type of fracture, also known as Hoffa-like fracture of the tibial plateau, shares a similar mechanism of injury with the Hoffa fracture of the femoral condyle. In the field of orthopedics, finite element analysis is considered a valuable method to guide clinical decision-making. In this study, four methods used for internal fixation of Hoffa-like fractures of the tibial plateau were compared using computer simulation and applying a finite element method (FEM). The methods compared were lateral L-plate fixation alone (Model A); lateral L-plate combined with posterior anti-slip plate (reconstruction plate/T-plate) fixation (Model B); lateral L-plate combined with posterior hollow nail fixation of the fracture block (Model C); and lateral L-plate combined with anterior hollow nail fixation of the fracture (Model D). The maximum displacement of the model and the maximum stress of the internal fixation material were analyzed by applying an axial load of 2,500 N. The results showed that, in the normal bone model, the maximum displacement of the fracture in Model A was 0.60032 mm, with improved stability through the addition of posterior lateral plate fixation in Model B and reduction of the displacement to 0.38882 mm. The maximum displacement in Model C and Model D was comparable, amounting to 0.42345 mm and 0.42273 mm, respectively. Maximum stress was 1235.6 MPa for Model A, 84.724 MPa for Model B, 99.805 MPa for Model C, and 103.19 MPa for Model D. In the internal fixation analysis of the osteoporotic fracture model, we observed patterns similar to the results of the normal bone model. The results indicated that Model B yielded the overall best results in the treatment of Hoffa-like fractures of the tibial plateau. The orthopedic surgeon may wish to implement these insights into the perioperative algorithm, thereby refining and optimizing clinical patient care. In addition, our findings pave the way for future research efforts.
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Affiliation(s)
- Hang Xue
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Junrong Deng
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenhe Zhang
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Adriana C. Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Bobin Mi
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Mengfei Liu
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guandong Dai
- Pingshan District People’s Hospital of Shenzhen, Pingshan General Hospital of Southern Medical University, Shenzhen, China
| | - Guohui Liu
- Department of Orthopedics, Jingshan Union Hospital, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
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15
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Lv H, Li W, Wang Y, Chen W, Yan X, Yuwen P, Hou Z, Wang J, Zhang Y. Prediction model for tibial plateau fracture combined with meniscus injury. Front Surg 2023; 10:1095961. [PMID: 37396296 PMCID: PMC10312001 DOI: 10.3389/fsurg.2023.1095961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose To investigate a prediction model of meniscus injury in patients with tibial plateau fracture. Methods This retrospective study enrolled patients with tibial plateau fractures who were treated in the Third Hospital of Hebei Medical University from January 1, 2015, to June 30, 2022. Patients were divided into a development cohort and a validation cohort based on the time-lapse validation method. Patients in each cohort were divided into a group with meniscus injury and a group without meniscus injury. Statistical analysis with Student's t-test for continuous variables and chi square test for categorical variables was performed for patients with and without meniscus injury in the development cohort. Multivariate logistic regression analysis was used to screen the risk factors of tibial plateau combined with meniscal injury, and a clinical prediction model was constructed. Model performance was measured by examining discrimination (Harrell's C-index), calibration (calibration plots), and utility [decision analysis curves (DCA)]. The model was validated internally using bootstrapping and externally by calculating their performance in a validation cohort. Results Five hundred patients (313 [62.6%] males, 187 [37.4%] females) with a mean age of 47.7 ± 13.8 years were eligible and were divided into development (n = 262) and validation (n = 238) cohorts. A total of 284 patients had meniscus injury, including 136 in the development cohort and 148 in the validation cohort We identified high-energy injuries as a risk factor (OR = 1.969, 95%CI 1.131-3.427). Compared with blood type A, patients with blood type B were more likely to experience tibial plateau fracture with meniscus injury (OR = 2.967, 95%CI 1.531-5.748), and office work was a protective factor (OR = 0.279, 95%CI 0.126-0.618). The C-index of the overall survival model was 0.687 (95% CI, 0.623-0.751). Similar C-indices were obtained for external validation [0.700(0.631-0.768)] and internal validation [0.639 (0.638-0.643)]. The model was adequately calibrated and its predictions correlated with the observed outcomes. The DCA curve showed that the model had the best clinical validity when the threshold probability was 0.40 and 0.82. Conclusions Patients with blood type B and high-energy injuries are more likely to have meniscal injury. This may help in clinical trial design and individual clinical decision-making.
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Affiliation(s)
| | | | | | | | | | | | | | - Juan Wang
- Correspondence: Yingze Zhang Juan Wang
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16
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Wei G, Niu X, Li Y, Chang T, Zhang J, Wang H, Li X, He Y, Wang R, Tian F, Xu Y. Biomechanical analysis of internal fixation system stability for tibial plateau fractures. Front Bioeng Biotechnol 2023; 11:1199944. [PMID: 37388773 PMCID: PMC10303893 DOI: 10.3389/fbioe.2023.1199944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023] Open
Abstract
Background: Complex bone plateau fractures have been treated with bilateral plate fixation, but previous research has overemphasized evaluating the effects of internal fixation design, plate position, and screw orientation on fracture fixation stability, neglecting the internal fixation system's biomechanical properties in postoperative rehabilitation exercises. This study aimed to investigate the mechanical properties of tibial plateau fractures after internal fixation, explore the biomechanical mechanism of the interaction between internal fixation and bone, and make suggestions for early postoperative rehabilitation and postoperative weight-bearing rehabilitation. Methods: By establishing the postoperative tibia model, the standing, walking and running conditions were simulated under three axial loads of 500 N, 1000 N, and 1500 N. Accordingly, finite element analysis (FEA) was performed to analyze the model stiffness, displacement of fractured bone fragments, titanium alloy plate, screw stress distribution, and fatigue properties of the tibia and the internal fixation system under various conditions. Results: The stiffness of the model increased significantly after internal fixation. The anteromedial plate was the most stressed, followed by the posteromedial plate. The screws at the distal end of the lateral plate, the screws at the anteromedial plate platform and the screws at the distal end of the posteromedial plate are under greater stress, but at a safe stress level. The relative displacement of the two medial condylar fracture fragments varied from 0.002-0.072 mm. Fatigue damage does not occur in the internal fixation system. Fatigue injuries develop in the tibia when subjected to cyclic loading, especially when running. Conclusion: The results of this study indicate that the internal fixation system tolerates some of the body's typical actions and may sustain all or part of the weight early in the postoperative period. In other words, early rehabilitative exercise is recommended, but avoid strenuous exercise such as running.
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Affiliation(s)
- Guoqiang Wei
- Department of Rehabilitation Medicine, Changzhi Medical College Affiliated Changzhi People’s Hospital, Changzhi, China
| | - Xiaofen Niu
- Department of Rehabilitation Medicine, Changzhi Medical College Affiliated Changzhi People’s Hospital, Changzhi, China
| | - Yuan Li
- Department of Orthopedics, Changzhi Medical College Affiliated Peace Hospital, Changzhi, China
| | - Tingjie Chang
- Department of Orthopedics, Changzhi Medical College Affiliated Peace Hospital, Changzhi, China
| | - Jianfang Zhang
- Department of Rehabilitation Medicine, Changzhi Medical College Affiliated Changzhi People’s Hospital, Changzhi, China
| | - Haiyan Wang
- Department of Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China
| | - Xiaohe Li
- Department of Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China
| | - Yujie He
- Department of Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China
| | - Ruijiang Wang
- Department of Orthopedics, Changzhi Second People’s Hospital, Changzhi, China
| | - Fei Tian
- Department of Health Management, Changzhi Medical College, Changzhi, China
- Department of Rehabilitation Medicine, Changzhi Medical College Affiliated Peace Hospital, Changzhi, China
| | - Yangyang Xu
- Beijing Key Laboratory for Design and Evaluation Technology of Advanced Implantable and Interventional Medical Devices, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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Chen Y, Li G, Wei L, Weng J, Liu S, Gu M, Liu P, Zhu Y, Xiong A, Zeng H, Yu F. Tibial plateau fracture and RNA sequencing with osteogenesis imperfecta: a case report. Front Endocrinol (Lausanne) 2023; 14:1164386. [PMID: 37229455 PMCID: PMC10203611 DOI: 10.3389/fendo.2023.1164386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/10/2023] [Indexed: 05/27/2023] Open
Abstract
Osteogenesis imperfecta (OI) is a hereditary skeletal dysplasia with an incidence of approximately 1:15,000 to 20,000. OI is usually caused by the mutation of COL1A1 and COL1A2, which would encode the α-chain of type I collagen. OI is clinically characterized by decreased bone mass, increased risk of bone fragility, blue sclerae, and dentinogenesis. Case presentation A 29-year-old male patient was diagnosed with right tibial plateau fracture caused by slight violence. Physical examination revealed the following: height, 140 cm; weight, 70 kg; body mass index (BMI), 35.71 kg/m2; blue sclera and barrel chest were observed. X-ray examination showed left convex deformity of the thoracic vertebrae with reduced thoracic volume. Laboratory examinations revealed a decrease in both vitamin D and blood calcium levels. Bone mineral density (BMD) was lower than the normal range. After the preoperative preparation was completed, the open reduction and internal fixation of the right tibial plateau fracture were performed. Meanwhile, whole blood samples of this OI patient and the normal control were collected for RNA transcriptome sequencing. The RNA sequence analysis revealed that there were 513 differentially expressed genes (DEGs) between this OI patient and the normal control. KEGG-enriched signaling pathways were significantly enriched in extracellular matrix (ECM)-receptor interactions. Conclusion In this case, DEGs between this OI patient and the normal control were identified by RNA transcriptome sequencing. Moreover, the possible pathogenesis of OI was also explored, which may provide new evidence for the treatment of OI.
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Affiliation(s)
- Yixiao Chen
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Guoqing Li
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Liangchen Wei
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jian Weng
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Su Liu
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Mingxi Gu
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Pei Liu
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yuanchao Zhu
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Ao Xiong
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Hui Zeng
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
| | - Fei Yu
- Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, China
- National and Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, China
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18
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Zhu K, Han S, Zhang Z, Wang C, Cui B, Chen Z. Efficacy of Antibiotic Cement in Preserving Endoplants After Infection With Plate Exposure. Surg Infect (Larchmt) 2023. [PMID: 37126412 DOI: 10.1089/sur.2022.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Background: To study the feasibility and efficacy of antibiotic cement in preserving endoplants after infection in patients with early tibial plateau fracture on plate exposure. Patients and Methods: A retrospective analysis of 23 patients treated for post-operative infection with plate exposure after tibial plateau fracture between 2017 and 2021. They were divided into the observation group (10 patients) and the control group (13 patients). Total operation time, length of hospitalization, hospitalization cost, the number of surgeries, white blood cell (WBC) count, neutrophil (NEUT) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the post-operative evaluation index, and complications were observed during the follow-up period. Results: All patients were followed up for 6 to 12 months; wound healing was observed in both groups. The total operation time for patients in the control group was longer compared with the observation group. However, the length of hospitalization, hospitalization cost, and number of surgeries in the observation group were less compared with the control group. No difference in WBC, NEUT, ESR, and CRP levels was observed one day after surgery. Furthermore, WBC, NEUT, ESR, and CRP levels were higher in patients in the control group compared with the observation group 72 hours after surgery. There were no differences in the post-operative evaluation index and complications in both groups. Conclusions: The antibiotic cement coating used for treating early post-operative infection in patients with tibial plateau fracture could effectively control infection while retaining endoplant, thereby promoting wound healing. It could also reduce pain and the medical burden on patients.
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Affiliation(s)
- Kun Zhu
- Department of Orthopaedic, The First Affiliated Hospital of Bengbu Medical College, BengBu, Anhui Province, China
- Anhui Key Laboratory of Tissue Transplantation, Bengbu Medical College, BengBu, Anhui Province, China
- Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjin, Jiangsu Province, China
| | - Shaoyu Han
- Trauma Center, The Fifth People's Hospital of Huai'an, Huai'an, Jiangsu Province, China
| | - Zhenqing Zhang
- Trauma Center, The Fifth People's Hospital of Huai'an, Huai'an, Jiangsu Province, China
| | - Chuangong Wang
- Trauma Center, The Fifth People's Hospital of Huai'an, Huai'an, Jiangsu Province, China
| | - Bingjun Cui
- Trauma Center, The Fifth People's Hospital of Huai'an, Huai'an, Jiangsu Province, China
| | - Zhixiang Chen
- Trauma Center, The Fifth People's Hospital of Huai'an, Huai'an, Jiangsu Province, China
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19
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Mortimer RB, Martirosian A. Tibial Plateau Fracture After Attack by an Escaped Goat. Wilderness Environ Med 2023; 34:103-105. [PMID: 36509670 DOI: 10.1016/j.wem.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/21/2022] [Accepted: 10/10/2022] [Indexed: 12/14/2022]
Abstract
Humans come into contact with goats in wild settings. If a goat feels threatened, it may address the perceived threat violently. While out walking, a 55-y-old man was attacked by an escaped domestic goat. Much as goats interact with each other, this goat pushed him over with its horns and then rose up on 2 legs to come back down on him with its head. The man experienced a Schatzker VI bicondylar tibial plateau fracture that required external and then internal fixation. Besides his physical injuries, he experienced acute stress disorder, which is common after traumatic events. Acute stress reactions can progress into chronic posttraumatic stress disorder but also often resolve. Psychological first aid is appropriate after traumatic events, including animal attacks. It is appropriate to screen for posttraumatic stress disorder symptoms after such events and treat or refer if present. After 1 y, the man returned to full function and experienced no posttraumatic stress disorder.
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Affiliation(s)
- Roger B Mortimer
- Department of Family and Community Medicine, University of California San Francisco, Fresno Medical Education Program, Fresno, CA.
| | - Armen Martirosian
- Department of Orthopedic Surgery, University of California San Francisco, Fresno Medical Education Program, Fresno, CA
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20
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Gonzalez LJ, Ganta A, Leucht P, Konda SR, Egol KA. Outcomes of the First Generation Locking Plate and Minimally Invasive Techniques Used for Fractures About the Knee. Iowa Orthop J 2023; 43:169-175. [PMID: 37383856 PMCID: PMC10296454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Locking plate technology was developed approximately 25-years-ago and has been successfully used since. Newer designs and material properties have been used to modify the original design, but these changes have yet to be correlated to improved patient outcomes. The purpose of this study was to evaluate the outcomes of first-generation locking plate (FGLP) and screw systems at our institution over an 18 year period. Methods Between 2001 to 2018, 76 patients with 82 proximal tibia and distal femur fractures (both acute fracture and nonunions) who were treated with a first-generation titanium, uniaxial locking plate with unicortical screws (FGLP), also known as a LISS plate (Synthes Paoli Pa), were identified and compared to 198 patients with 203 similar fracture patterns treated with 2nd and 3rd generation locking plates, or Later Generation Locking Plates (LGLP). Inclusion criteria was a minimum of 1-year follow-up. At latest follow-up, outcomes were assessed using radiographic analysis, Short Musculoskeletal Functional Assessment (SMFA), VAS pain scores, and knee ROM. All descriptive statistics were calculated using IBM SPSS (Armonk, NY). Results A total of 76 patients with 82 fractures had a mean 4-year follow-up available for analysis. There were 76 patients with 82 fractures fixed with a First-generation locking plate. The mean age at time of injury for all patients was 59.2 and 61.0% were female. Mean time to union for fractures about the knee fixed with FGLP was by 5.3 months for acute fractures and 6.1 months for nonunions. At final follow-up, the mean standardized SMFA for all patients was 19.9, mean knee range of motion was 1.6°-111.9°, and mean VAS pain score was 2.7. When compared to a group of similar patients with similar fractures and nonunions treated with LGLPs there were no differences in outcomes assessed. Conclusion Longer-term outcomes of first-generation locking plates (FGLP) demonstrate that this construct provides for a high rate of union and low incidence of complications, as well as good clinical and functional results. Level of Evidence: III.
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Affiliation(s)
- Leah J. Gonzalez
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - Abhishek Ganta
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - Philipp Leucht
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - Sanjit R. Konda
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
- Jamaica Hospital Medical Center, New York, New York, USA
| | - Kenneth A. Egol
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
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21
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Suda Y, Hiranaka T, Kamenaga T, Koide M, Fujishiro T, Okamoto K, Matsumoto T. Varus placement of the tibial component of Oxford unicompartmental knee arthroplasty decreases the risk of postoperative tibial fracture. Bone Joint J 2022; 104-B:1118-1125. [PMID: 36177640 DOI: 10.1302/0301-620x.104b10.bjj-2021-1508.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is reportedly lower when using components with a longer keel-cortex distance (KCDs). The aim of this study was to examine how slight varus placement of the tibial component might affect the KCDs, and the rate of tibial plateau fracture, in a clinical setting. METHODS This retrospective study included 255 patients who underwent 305 OUKAs with cementless tibial components. There were 52 males and 203 females. Their mean age was 73.1 years (47 to 91), and the mean follow-up was 1.9 years (1.0 to 2.0). In 217 knees in 187 patients in the conventional group, tibial cuts were made orthogonally to the tibial axis. The varus group included 88 knees in 68 patients, and tibial cuts were made slightly varus using a new osteotomy guide. Anterior and posterior KCDs and the origins of fracture lines were assessed using 3D CT scans one week postoperatively. The KCDs and rate of fracture were compared between the two groups. RESULTS Medial tibial fractures occurred after surgery in 15 patients (15 OUKAs) in the conventional group, but only one patient (one OUKA) had a tibial fracture after surgery in the varus group. This difference was significant (6.9% vs 1.1%; p = 0.029). The mean posterior KCD was significantly shorter in the conventional group (5.0 mm (SD 1.7)) than in the varus group (6.1 mm (SD 2.1); p = 0.002). CONCLUSION In OUKA, the distance between the keel and posterior tibial cortex was longer in our patients with slight varus alignment of the tibial component, which seems to decrease the risk of postoperative tibial fracture.Cite this article: Bone Joint J 2022;104-B(10):1118-1125.
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Affiliation(s)
- Yoshihito Suda
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Motoki Koide
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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22
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膝关节对角线损伤的评估诊断与手术策略探讨和疗效分析. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36. [PMID: 36111470 DOI: 10.7507/1002-1892.202207090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the evaluation, diagnosis, and surgical treatment of knee joint diagonal lesion and to observe its effectiveness. METHODS A retrospective analysis was performed on 9 patients with knee joint diagonal lesion admitted between November 2011 and November 2019, including 7 males and 2 females, aged 18-61 years, with an average age of 38.3 years. According to the clinical staging criteria of multiple ligament injury of knee joint, 6 patients with acute stage injury (≤3 weeks), the time from injury to operation was 5-16 days, with an average of 9.3 days; 3 patients with old stage injury (>3 weeks), the time from injury to operation was 7, 12, 144 months, respectively. Posterolateral complex injuries were all type C according to Fanelli classification, and the posterior cruciate ligament injury was grade 3 according to American Medical Association (AMA) classification. According to the three columns classification of tibial plateau fracture, there were 2 cases of zero column fracture and 7 cases of medial column fracture. Patients with acute injury were treated with posterior cruciate ligament reconstruction, posterolateral complex repair and/or reinforcement reconstruction, and tibial plateau fracture was treated with conservative treatment or internal fixation. Patients with malunion of tibial plateau in old stage were treated with limited osteotomy, bone grafting, and internal fixation; the stability of the knee joint was further evaluated during operation, then the posterior cruciate ligament reconstruction and/or posterolateral complex repair and reconstruction were performed as needed. Lysholm score and the International Knee Documentation Committee (IKDC) score before and after operation were used to evaluate knee function and effectiveness. RESULTS All patients were followed up 24-119 months, with an average of 51.7 months. All the incisions healed by first intention, and no complication such as incision infection, deep venous thrombosis of lower extremities occurred, and there was no reoperation during follow-up. The full-length X-ray films of both lower extremities at 6 months and 1, 2 years after operation showed that the alignment of both lower extremities returned to normal, and the stress position X-ray films showed that the stability in all directions recovered well. The X-ray films of the knee joint at 6 months after operation showed that the fracture of the tibial plateau healed well. At 1 year after operation, MRI showed that the signal of the repaired and reconstructed ligament was good, and there was no reconstruction failure such as ligament absorption or rupture occurred. At 1 year after operation, the muscle strength of the affected limbs was all rated as grade Ⅴ, and the active and passive range of motion of the knee joint recovered to 0°-130°. At 2 years after operation, the Lysholm score and IKDC score significantly improved when compared with those before operation (P<0.05). CONCLUSION Knee joint diagonal lesion is a special type of posterior cruciate ligament and posterolateral complex injury with anteromedial split and collapse fracture of tibial plateau, which requires correct evaluation and diagnosis of the injured structure, and detailed surgical and rehabilitation programs to achieve better effectiveness.
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23
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Jiang L, Chen E, Huang L, Wang C. Arthroscopy-Assisted Reduction Percutaneous Internal Fixation Versus Open Reduction Internal Fixation for Tibial Plateau Fracture: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211027838. [PMID: 34938818 PMCID: PMC8685730 DOI: 10.1177/23259671211027838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Arthroscopy-assisted reduction percutaneous internal fixation (ARIF) has emerged recently as an alternative treatment method in treating lower-energy tibial plateau fractures. To date, the comparison of clinical efficacy between ARIF and open reduction internal fixation (ORIF) is limited, with divergent conclusions. Purpose: To review studies on the clinical efficacy of ARIF and ORIF in the treatment of tibial plateau fracture. Study Design: Systematic review; Level of evidence, 3. Methods: A search was conducted using the PubMed, Web of Science, Cochrane Library, and EMBASE databases between inception and August 20, 2020, for retrospective and prospective studies evaluating ARIF versus ORIF in the treatment of tibial plateau fracture. We identified 6 clinical studies that met the inclusion criteria, with 231 patients treated with ARIF and 386 patients treated with ORIF. The risk of bias and the quality of evidence of the included studies were assessed. The 2 treatment types were compared in terms of clinical results and complications by using odds ratios (ORs), mean differences (MDs), or standardized mean differences (SMDs), with 95% confidence intervals (CIs). Heterogeneity among studies was quantified using the I2 statistic. Results: The quality of the studies was high. Compared with ORIF, treatment with ARIF led to better clinical function (SMD = 0.31; 95% CI, 0.14 to 0.48; I2 = 15%; P = .0005), shorter hospital stay (MD = –2.37; 95% CI, –2.92 to –1.81; I2 = 0%; P < .001), and more intra-articular lesions found intraoperatively (OR = 3.76; 95% CI, 1.49 to 9.49; I2 = 66%; P = .005). There were no complications or significant differences between the techniques in the radiological evaluation of reduction. Conclusion: Compared with ORIF, the ARIF technique for tibial plateau fractures led to faster postoperative recovery and better clinical function and the ability to find and treat more intra-articular lesions during the operation. However, the radiological evaluation of reduction and complications were not significantly different between the 2 groups.
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Affiliation(s)
- Liangjun Jiang
- Orthopedics Department, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Erman Chen
- Orthopedics Department, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lu Huang
- Orthopedics Department, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cong Wang
- Orthopedics Department, 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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24
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Prall WC, Kusmenkov T, Rieger M, Haasters F, Mayr HO, Böcker W, Fürmetz J. Radiological Outcome Measures Indicate Advantages of Precontoured Locking Compression Plates in Elderly Patients With Split-Depression Fractures to the Lateral Tibial Plateau (AO41B3). Geriatr Orthop Surg Rehabil 2021; 12:21514593211043967. [PMID: 34671507 PMCID: PMC8521727 DOI: 10.1177/21514593211043967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background Split-depression fractures to the lateral tibial plateau (AO41B3) often feature severe joint surface destructions. Precontoured locking compression plates (LCPs) are designed for optimum support of the reduced joint surface and have especially been emphasized in reduced bone quality. A lack of evidence still inhibits their broad utilization in elderly patients. Thus, aim of the present study was to investigate the implant-specific radiological outcomes of AO41B3-fractures in young versus elderly patients. Methods The hospital’s database was screened for isolated AO41B3-factures, open reduction and internal fixation (ORIF), and radiological follow-up ≥12 months. CT-scans, radiographs, and patients’ records were analyzed. Patients were attributed as young (18–49) or elderly (≥50 years). Additional subgrouping was carried out into precontoured LCP and conventional implants. The Rasmussen Radiological Score (RRS) after 12 months was set as primary outcome parameter. The RRS postoperatively and the medial proximal tibial angle (MPTA) postoperatively and after 12 months were secondary outcome parameters. Results Fifty nine consecutive patients were included (26 young, 38.2 ± 7.8 years; 33 elderly, 61.3 ± 9.4 years). There were no significant differences regarding mean size and depression depth of the lateral joint surface fragments. Prior to implant-specific subgrouping, the radiological outcome measures revealed no significant differences between young (RRS = 7.7 ± 1.7; MPTA = 90.3 ± 2.3°) and elderly (RRS = 7.2 ± 1.7; MPTA = 90.5 ± 3.3°). After implant-specific subgrouping, the radiological outcome revealed significantly impaired results in young patients with conventional implants (RRS(C) = 6.9 ± 1.6, RRS(LCP) = 8.5 ± 1.5, P = .015; MPTA(C) = 91.5 ± 1.9°, MPTA(LCP) = 89.1 ± 2.1°, P = .01). The effect was even more pronounced in elderly patients, with highly significant deterioration of the radiological outcome measures for conventional implants compared to precontoured LCP (RRS(C) = 5.7 ± 1.6, RRS(LCP) = 8.2 ± .8, P < .001; MPTA(C) = 92.6 ± 4.2°, MPTA(LCP) = 89.2 ± 1.4°, P = .002). Conclusion Utilizing precontoured LCP in the treatment of AO41B3-fractures is associated with improved radiological outcomes. This effect is significant in young but even more pronounced in elderly patients. Consequently, precontoured LCP should closely be considered in any AO41B3-fracture, but especially in elderly patients.
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Affiliation(s)
- Wolf C Prall
- Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Salzburg, Austria.,Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Thomas Kusmenkov
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Maximilian Rieger
- Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Salzburg, Austria
| | - Florian Haasters
- Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Salzburg, Austria.,Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Hermann O Mayr
- Division of Knee, Hip and Shoulder Surgery, Schoen Clinic Munich Harlaching, Academic Teaching Hospital of the Paracelsus Medical University (PMU), Salzburg, Austria.,Department of Orthopaedics and Trauma Surgery, Freiburg University Hospital, Albert-Ludwigs-University, Freiburg, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Julian Fürmetz
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
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25
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Hsu TL, Li TC, Lai FP, Ouhyoung M, Chang CH, Wang CT. Late-onset isolated cerebral fat embolism syndrome after a simple tibial plateau fracture: a rare case report. J Int Med Res 2021; 49:3000605211028415. [PMID: 34282643 PMCID: PMC8295961 DOI: 10.1177/03000605211028415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
Fat embolism syndrome (FES) is a complication of long bone fractures that often occurs within 72 hours of injury. Early-onset isolated cerebral fat embolism is catastrophic and rarely reported. We herein present a rare case of delayed-onset isolated cerebral FES that developed 10 days after definite fixation of a left tibial plateau fracture. A 70-year-old woman was injured in a traffic accident and diagnosed with a left tibial plateau fracture. However, she developed sudden loss of consciousness (E4V1M1) and quadriplegia 10 days after fracture fixation. Her vital signs showed no respiratory distress. Diagnosis of isolated cerebral FES was made based on magnetic resonance imaging of the brain, the findings of which were compatible with the clinical neurological findings. After supportive care and rehabilitation, her consciousness became clear on the second day of admission, and her consciousness changed to E4V5M6. She gradually regained strength in her right limbs but had residual left limb paraplegia. Isolated cerebral FES should always be considered for patients who develop a change in consciousness, even beyond 72 hours after injury. Imaging may not initially show definitive abnormalities. Repeated magnetic resonance imaging should be considered if the initial clinical presentation does not fully meet Gurd's criteria.
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Affiliation(s)
- Ta-Li Hsu
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City
| | - Tien-Chi Li
- Department of Radiology, Far Eastern Memorial Hospital, New Taipei City
| | - Fei-Pi Lai
- Graduate Institute of Networking and Multimedia, National Taiwan University, New Taipei City
| | - Ming Ouhyoung
- Graduate Institute of Networking and Multimedia, National Taiwan University, New Taipei City
| | - Chih-Hung Chang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City
| | - Cheng-Tzu Wang
- Department of Orthopaedic Surgery, Far Eastern Memorial Hospital, New Taipei City
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Jiahao L, Kun Z, Binfei Z, Yan Z, Hanzhong X, Shuangwei Q, Chen F, Na Y, Ding T, Pengfei W. Relationship Between the Incidence of Deep Vein Thrombosis During Hospitalization and the Energy of Injury in Tibial Plateau Fractures. Clin Appl Thromb Hemost 2021; 26:1076029620913948. [PMID: 32988241 PMCID: PMC7545747 DOI: 10.1177/1076029620913948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to investigate the relationship between the incidence of deep vein thrombosis (DVT) during hospitalization and the energy of injury in tibial plateau fractures (TPFs). One hundred and forty patients were enrolled between September 1, 2014, and October 1, 2017. According to Schatzker's classification, they were classified into the low-energy (type I-III) and high-energy (type IV-VI) groups. For DVT evaluation, duplex ultrasonography was performed in the lower extremities preoperatively and postoperatively. The location and changes of DVT were recorded. All patients underwent mechanical and chemical thromboprophylaxis. The incidence of DVT in TPFs was 36.43% and 46.43% preoperatively and postoperatively, respectively. The DVT incidence was 31.75% (20/63) in the low-energy group and 40.26% (31/77) in the high-energy group preoperatively, and 44.44% (28/63) in the low-energy group and 48.05% (37/77) in the high-energy group postoperatively. There was no significant difference between the 2 groups preoperatively (P = .298) and postoperatively (P = .785). The days between operation and discharge (P = .016), blood loss during surgery (P = .016), and preoperative d-dimer level (P = .02) showed differences between the 2 groups. Additionally, 29 new thrombi (14 [48.28%] in the high-energy group and 15 [51.72%] in the low-energy group) appeared and 16 preoperative thrombi disappeared postoperatively. Despite mechanical and chemical thromboprophylaxis, the DVT risk in patients with TPFs remains high. Although the DVT incidence is not significantly different between high-energy and low-energy injuries, the occurrence of DVT should be carefully monitored.
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Affiliation(s)
- Li Jiahao
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
- Department of Hand and Foot Microsurgery, Baoji Hospital of Traditional Chinese Medicine, Shaanxi, China
| | - Zhang Kun
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Zhang Binfei
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Zhuang Yan
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Xue Hanzhong
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Qu Shuangwei
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Fei Chen
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Yang Na
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Tian Ding
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Wang Pengfei
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
- Wang Pengfei, Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China.
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27
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Wang Z, Zheng B, Jin Y, Yang G, Chen G, Liang J, Zhou X, Yang X. Arthroscopy-assisted surgery: The management of posterolateral tibial plateau depression fracture accompanying ligament injury: A case series and review of the literature. J Orthop Surg (Hong Kong) 2020; 28:2309499019891208. [PMID: 31876260 DOI: 10.1177/2309499019891208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Tibial plateau fractures are multiple fracture patterns associated with soft-tissue injuries. Among which, the combined existence of posterolateral tibial plateau depression fracture with anterior cruciate ligament (ACL) rupture has been reported rarely. Meanwhile, surgical method for the treatment of depression fracture is fairly complex. The aim of this article is to show a case series of this unusual injury pattern and the therapy of posterolateral tibial plateau depression fracture accompanying ACL rupture. In our treatment, arthroscopy assisted reduction of depression fracture and ACL reconstruction reduces surgical trauma and leads to good functional recovery. We also review the current literature.
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Affiliation(s)
- Zhangfu Wang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Binbin Zheng
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Yanjun Jin
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Guangyong Yang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Guofu Chen
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Junbo Liang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Xiaobo Zhou
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
| | - Xiangdong Yang
- Department of Orthopaedics, Taizhou Hospital, Wenzhou Medical University, Linhai, China
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Houskamp DJ, Tompane T, Barlow BT. What Is the Critical Tibial Resection Depth During Unicompartmental Knee Arthroplasty? A Biomechanical Study of Fracture Risk. J Arthroplasty 2020; 35:2244-2248. [PMID: 32362480 DOI: 10.1016/j.arth.2020.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/26/2020] [Accepted: 04/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Fracture after medial unicompartmental knee arthroplasty (UKA) is a rare complication. Biomechanical studies evaluating association between depth of resection and maximum load to failure are lacking. The purpose of this study is to establish the relationship between depth of resection of the medial tibial plateau and mean maximum load to failure. METHODS Medial tibial resections were performed from 2 to 10 mm in 25 standardized fourth-generation Sawbones composite tibias (Sawbones, Vashon Island, Washington). A metal-backed tibial component with a 9-mm polyethylene bearing was used (Stryker PKR). Tibias were mounted on a biomechanical testing apparatus (MTESTQuattro) and axially loaded cyclically 10 times per cycle and incrementally increased until failure occurred. RESULTS Load to failure was recorded in 25 proximal tibia model samples after medial UKA using sequential resections from 2 to 10 mm. Analysis of variance testing identified significant differences in mean maximum load to failure between groups (P = .0003). Analysis of regression models revealed a statistically significant fit of a quadratic model (R2 = 0.59, P = .0001). The inflection point of this quadratic curve was identified at 5.82 mm, indicating that the maximum load to failure across experimental models in this study began to decline beyond a resection depth of 5.82 mm. CONCLUSION In this biomechanical model, medial tibial resections beyond 5.82 mm produced a significantly lower mean load to failure using a quadratic curve model. Resections from 2 to 6 mm showed no significant differences in mean load to failure. Identification of the tibial resection depth at which the mean load to failure significantly decreases is clinically relevant as this depth may increase the risk of periprosthetic fracture after a medial UKA.
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Scott BL, Lee CS, Strelzow JA. Five-Year Risk of Conversion to Total Knee Arthroplasty After Operatively Treated Periarticular Knee Fractures in Patients Over 40 Years of Age. J Arthroplasty 2020; 35:2084-2089.e1. [PMID: 32317199 DOI: 10.1016/j.arth.2020.03.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Periarticular knee fractures present a significant challenge to minimize post-traumatic osteoarthritis. The purpose of this study is to compare the rates of conversion to total knee arthroplasty (TKA) for different periarticular knee fractures, investigate the rate of knee injections as a more rapid assessment of knee symptoms, and identify risk factors that lead to conversion to TKA following periarticular fractures. METHODS A comprehensive retrospective review of the Humana administrative claims database was performed. A total of 2813 patients greater than 40 years of age with diagnosis code for tibial plateau fracture or distal femur fracture linked to a Current Procedural Terminology code of open reduction internal fixation between 2007 and 2011 were evaluated. The rates of TKA and knee injections within 5 years were compared. Cox proportional hazards model was used to evaluate risk factors for conversion. RESULTS Of 2813 periarticular fractures, the 5-year rate of conversion to TKA was 3.3%. The rate of conversion for tibial plateau fractures was significantly higher at 4.5% compared to 2.3% for distal femur fractures (P = .001). Tibial plateau fracture, obesity, and female gender were risk factors found to portend an increased risk of conversion to TKA with hazard ratios of 1.77, 1.69, and 1.88, respectively. The overall rate of knee injections was 12.8% with an average time to injection of 18.2 months after open reduction internal fixation. CONCLUSION The rate of conversion to TKA for periarticular knee fractures overall was 3.3%, while the rate of knee injections within 5 years of surgery was 12.8%, suggesting a not insignificant minority of patients require treatment for symptomatic knee pain. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Bryan L Scott
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Cody S Lee
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Jason A Strelzow
- Department of Orthopaedic and Rehabilitation Medicine, University of Chicago, Chicago, IL
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Zu B, Wang J, Liu J, Chen Z. [Application of modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020; 34:702-706. [PMID: 32538559 DOI: 10.7507/1002-1892.201910010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore effectiveness of reduction and internal fixation via modified anterolateral supra-fibular-head approach in treatment of tibial plateau fractures involving posterolateral column. Methods Between January 2016 and September 2018, 19 patients diagnosed as tibial plateau fractures involving posterolateral column were treated with reduction and internal fixation via modified anterolateral supra-fibular-head approach. There were 11 males and 8 females with an average age of 43.2 years (range, 28-65 years). The causes of tibial fracture were traffic accident (12 patients), falling injury (5 patients), and falling from height (2 patients). According to the Schatzker typing, the tibial fractures were rated as type Ⅱ in 9 cases, type Ⅲ in 4 cases, type Ⅴ in 4 cases, and type Ⅵ in 2 cases. The time from injury to operation was 5-13 days (mean, 8.5 days). There were 2 patients with osteoporosis. The operation time, intraoperative blood loss, and postoperative complications were recorded. The knee X-ray film was reviewed regularly to observe the fracture healing. At last follow-up, the fracture reductions were evaluated by Rasmussen radiological score. The knee joint function was evaluated by Hospital for Special Surgery (HSS) score system. Results The average operation time was 95 minutes (range, 65-130 minutes). The average intraoperative blood loss was 220 mL (range, 150-350 mL). All incisions healed by first intention. No complications such as infection or deep venous thrombosis occurred. All patients were followed up 12-20 months (mean, 15.4 months). X-ray films showed that the fractures healed with the healing time of 12-20 weeks (mean, 14.5 weeks). No complications such as loosening or breakage of internal fixation occurred. At last follow-up, according to the Rasmussen radiological score, the fracture reductions were evaluated as excellent in 13 cases, good in 4 cases, fair in 1 case, and poor in 1 case. HSS scores of knee joint function were excellent in 14 cases, good in 3 cases, fair in 1 case, and poor in 1 case. The knee joint range of motion was 90°-135°, with an average of 113.4°. Conclusion Application of modified anterolateral supra-fibular-head approach in reduction and internal fixation for tibial plateau fractures involving posterolateral column has the advantages of full exposure, less trauma, safety, and reliable reduction and fixation.
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Affiliation(s)
- Bo Zu
- Department of Orthopedics, Anqing Hospital, Anhui Medical University, Anqing Anhui, 246003, P.R.China
| | - Jianjun Wang
- Department of Orthopedics, Anqing Hospital, Anhui Medical University, Anqing Anhui, 246003, P.R.China
| | - Jinrui Liu
- Department of Orthopedics, Anqing Hospital, Anhui Medical University, Anqing Anhui, 246003, P.R.China
| | - Zhi Chen
- Department of Orthopedics, Anqing Hospital, Anhui Medical University, Anqing Anhui, 246003, P.R.China
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Lv H, Zhang Q, Chen W, Song Z, Zheng Z, Zhang Y. Epidemiological Study of Tibial Plateau Fractures Combined with Intercondylar Eminence Fractures. Orthop Surg 2020; 12:561-569. [PMID: 32347009 PMCID: PMC7189054 DOI: 10.1111/os.12658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate the epidemiological characteristics of tibial plateau fractures combined with intercondylar eminence fractures and identify the risk factors. METHODS This retrospective study enrolled patients with tibial plateau fractures who were treated in the third hospital of Hebei Medical University from January 2015 to December 2018; 1020 patients (693 [68%] men and 327 [32%] women) meeting the inclusion and exclusion criteria had a mean age of 45.2 ± 13.8 years. In total, 506 (50%) cases were left injuries, 495 (48%) were right injuries, and 19 (2%) were bilateral injuries. Among them, 458 (44.9%) with a mean age of 47.0 ± 13.9 years had intercondylar eminence fractures, including 324 men and 134 women. A total of 562 (55.1%) patients were identified without intercondylar eminence fractures, including 369 (65.7%) men and 193 (34.3%) women with an average age of 43.8 ± 13.6 years. The distribution characteristics of tibial plateau fractures with intercondylar eminence involved were identified. The potential associations among fractures and various other factors, such as age, gender, occupation, and mechanism of injury, were explored. RESULTS The highest proportion age group of tibial plateau fractures included the ages 35-54 years, with more men than women for both age groups. For males, the highest proportion age group was 35-44 years, and for females, it was 55-64 years (χ 2 = 71.336, P < 0.01). According to Schatzker classification, type IV tibial plateau fractures had the highest risk of intercondylar eminence being involved (70.6%) without significance with type V (69.5%) and VI (68.2%) but with greater significance with types I (11.9%), II (39.2%), and III (9.4%, χ 2 = 280.187, P < 0.01). Multiple analysis showed that simple fractures, including types I, II, and III (OR 0.108, 95% CI: 0.080-0.145), were less likely to involve intercondylar eminence fractures than complex fractures, including types IV, V, and VI. Patients aged >74 years were more likely to have intercondylar eminence fractures compared with other age groups. Retired patients (OR 4.332, 95% CI: 1.147-16.362) were more likely to have fractured intercondylar eminence. CONCLUSION The current study revealed the characteristics of tibial plateau fractures, especially those involving intercondylar eminence fractures, as well as their proportion, distribution, and risk factors, which can be used as reference data for clinical assessment and surgical protocol selection.
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Affiliation(s)
- Hongzhi Lv
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Qi Zhang
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Wei Chen
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Zhaohui Song
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Zhanle Zheng
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yingze Zhang
- Editorial DepartmentThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
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Callary SA, Jones CF, Kantar K, Du Toit H, Baker MP, Thewlis D, Atkins GJ, Solomon LB. A New Approach to Surgical Management of Tibial Plateau Fractures. J Clin Med 2020; 9:E626. [PMID: 32110908 DOI: 10.3390/jcm9030626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
Tibial plateau fractures (TPFs) are challenging, requiring complex open reduction and internal fixation (ORIF) and are often associated with complications including surgical site infections (SSIs). In 2007, we introduced a novel management protocol to treat TPFs which consisted of an angiosome- or perforator-sparing (APS) anterolateral approach followed by unrestricted weight bearing and range of motion. The primary aim of this retrospective study was to investigate complication rates and patient outcomes associated with our new management protocol. In total, 79 TPFs treated between 2004 and 2007 through a classic anterolateral surgical approach formed the "Classic Group"; while 66 TPFS treated between 2007 and 2013 formed the "APS Group". Fracture reduction, maintenance of reduction and patient-reported outcomes were assessed. There was a clinically important improvement in the infection incidence with the APS (1.5%) versus the Classic technique (7.6%) (1/66 versus 2/79 for superficial infections; 0/66 versus 4/79 for deep infections). Despite a more aggressive rehabilitation, there was no difference in the fracture reduction over time or the functional outcomes between both groups (p > 0.05). The APS anterolateral approach improved the rate of SSIs after TPFs without compromising fracture reduction and stabilisation. We continue to use this new management approach and early unrestricted weight bearing when treating amenable TPFs.
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Polat B, Gurpinar T, Polat AE, Ozturkmen Y. Factors influencing the functional outcomes of tibia plateau fractures after surgical fixation. Niger J Clin Pract 2019; 22:1715-1721. [PMID: 31793479 DOI: 10.4103/njcp.njcp_432_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims The aim of this study is to assess the functional and radiological outcomes of 52 surgically treated tibial plateau fractures and to determine the factors affecting functional outcomes. Subjects and Methods A total of 52 patients who were operated between 2007 and 2014 due to tibial plateau fractures were retrospectively reviewed. The Knee Society Score (KSS) was used for the functional outcome assessment. The Kellgren-Lawrence radiological evaluation score was used for the relationship between postoperative trauma and osteoarthritis in the last follow-up. Results Patients' mean age was 47.7 years (range, 14-84 years). The immobilization period was 4.2 weeks (range, 0-8 weeks), the full weightbearing time was 3.3 months (range, 1.5-5 months), and the follow-up time was 47 months (range, 17-102 months). Patients' mean KSS was 84.3 (range, 40-100). According to the Kellgren-Lawrence classification, 26 patients had grade 0, 11 patients had grade 1, 8 patients had grade 2, 5 patients had grade 3, and 2 patients had grade 4 postoperative osteoarthritis. Conclusion Use of graft if there is collapse on joint surface, early knee motion, and early started full weightbearing after surgical fixation of tibial plateau fracture is essential for successful outcome. Findings of osteoarthritis on X-rays are not related to poor functional outcome at the mid- to long-term follow-up of surgical treated tibial plateau fractured patients.
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Affiliation(s)
- B Polat
- Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Kyrenia, Istanbul, Turkey
| | - T Gurpinar
- Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - A E Polat
- Department of Orthopaedics and Traumatology, Dr. Akçiçek State Hospital, Kyrenia, Cyprus
| | - Y Ozturkmen
- Department of Orthopaedics and Traumatology, Istanbul Education and Research Hospital, Istanbul, Turkey
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Abstract
RATIONALE Unicompartmental knee arthroplasty (UKA) is an effective method to treat single compartment disease of the knee joint. Report about the complications of UKA, especially tibial plateau fractures, is rare. Given its rarity, its pathogenesis is not well described, and a standard of treatment is still not established. Therefore, relevant studies and analysis of this complication have a significant effect on helping physicians avoid risks and guide clinical diagnosis and treatment. PATIENT CONCERNS The 1st case corresponds to a 70-year-old male patient who complained of knee pain, difficulty walking, nocturnal rest pain, and elevated skin temperature at 3 weeks after the left knee arthroplasty. The second case is a 72-year-old female patient who complained of left knee pain and swelling during movement at 2 weeks after the left knee arthroplasty. DIAGNOSIS The 1st case showed a fracture of the medial malleolus of the left knee and a secondary depression of the medial tibial plateau in X-rays and the second case showed a fracture of the medial malleolus of the left knee in computed tomography (CT) and X-rays. INTERVENTIONS The 1st case was treated with plate and screw fixation and the second case was treated conservatively and immobilized using brace and remained nonweight bearing for 6 weeks. OUTCOMES After 1 year, both patients have good joint activity, and there was no pain or loosening of the prosthesis and fragment displacement. LESSONS The incidence of tibial plateau fractures (TPF) related to UKA might be low, but fatal and difficult to treat. Its pathogenesis determines procedure-related factors; when fracture develops, treatment should be based on the degree of displacement, stability of implant fixation, etc.
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Affiliation(s)
- Chao Lu
- Orthopedics Department, Guangdong Second Traditional Chinese Medicine Hospital
| | - Guozhu Ye
- Orthopedics Department, Guangdong Second Traditional Chinese Medicine Hospital
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wengang Liu
- Orthopedics Department, Guangdong Second Traditional Chinese Medicine Hospital
| | - Huai Wu
- Orthopedics Department, Guangdong Second Traditional Chinese Medicine Hospital
| | - Gaoyi Wu
- Orthopedics Department, Guangdong Second Traditional Chinese Medicine Hospital
| | - Jin Chen
- Orthopedics Department, Guangdong Second Traditional Chinese Medicine Hospital
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Li YS, Lin KC, Chen CY, Tarng YW, Chang WN. Popliteal artery occlusion concomitant with a tibial plateau fracture and posterior cruciate ligament avulsion fracture. J Int Med Res 2019; 48:300060519869073. [PMID: 31510833 PMCID: PMC7593672 DOI: 10.1177/0300060519869073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In acute trauma, posterior cruciate ligament (PCL) injury may occur concomitantly with a
bony fracture and be easily overlooked. A popliteal artery injury associated with a tibial
plateau fracture and PCL avulsion fracture is rare. Missed or delayed diagnosis of this
condition leads to a high amputation rate. Therefore, close attention is required with
this type of injury. The limb can be saved though early detection and immediate
reconstruction of the injured artery, followed by fasciotomy. We report here a rare case
of popliteal artery occlusion proximal to the surgical zone, which was diagnosed after
fixation of a medial tibial plateau fracture and posterior cruciate avulsion injury. In
dashboard injuries without knee dislocation, the arterial intima may be injured and become
vulnerable, even with an initial ankle brachial index greater than 0.9. This can cause
concomitant occlusion of the popliteal artery due to iatrogenic retraction during surgery.
Therefore, a neurovascular examination should be repeated to prevent delayed-onset
thrombosis. To the best of our knowledge, this is the first case of popliteal artery
injury concomitant with a tibial plateau fracture and PCL avulsion owing to initial
dashboard injury-related arterial intima injury, which can present with a normal ankle
brachial index.
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Affiliation(s)
- Yi-Syuan Li
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung City
| | - Kai-Cheng Lin
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung City
| | - Chun-Yu Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung City
| | - Yih-Wen Tarng
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung City
| | - Wei-Ning Chang
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, Kaohsiung City
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Vendeuvre T, Monlezun O, Brandet C, Ingrand P, Durand-Zaleski I, Gayet LE, Germaneau A, Khiami F, Roulaud M, Herpe G, Rigoard P. Comparative evaluation of minimally invasive 'tibial tuberoplasty' surgical technique versus conventional open surgery for Schatzker II-III tibial plateau fractures: design of a multicentre, randomised, controlled and blinded trial (TUBERIMPACT study). BMJ Open 2019; 9:e026962. [PMID: 31481365 PMCID: PMC6731842 DOI: 10.1136/bmjopen-2018-026962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Fractures of the tibial plateau are in constant progression. They affect an elderly population suffering from a number of comorbidities, but also a young population increasingly practicing high-risk sports. The conventional open surgical technique used for tibial plateau fractures has several pitfalls: bone and skin devascularisation, increased risks of infection and functional rehabilitation difficulties. Since 2011, Poitiers University Hospital is offering to its patients a new minimally invasive technique for the reduction and stabilisation of tibial plateau fractures, named 'tibial tuberoplasty'. This technique involves expansion of the tibial plateau through inflation using a kyphoplasty balloon, filling of the fracture cavity with cement and percutaneous screw fixation. We designed a study to evaluate the quality of fracture reduction offered by percutaneous tuberoplasty versus conventional open surgery for tibial plateau fracture and its impact on clinical outcome. METHODS AND ANALYSIS This is a multicentre randomised controlled trial comparing two surgical techniques in the treatment of tibial plateau fractures. 140 patients with a Schatzker II or III tibial plateau fracture will be recruited in France. They will be randomised either in tibial tuberoplasty arm or in conventional surgery arm. The primary outcome is the postoperative radiological step-off reduction blindly measured on CT scan (within 48 hours post-op). Additional outcomes include other radiological endpoints, pain, functional abilities, quality of life assessment and health-economic endpoints. Outcomes assessment will be performed at baseline (before surgery), at day 0 (surgery), at 2, 21, 45 days, 3, 6, 12 and 24 months postsurgery. ETHICS AND DISSEMINATION This study has been approved by the ethics committee Ile-De-France X and will be conducted in accordance with current Good Clinical Practice (GCP) guidelines, Declaration of Helsinki and standard operating procedures. The results will be disseminated through presentation at scientific conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER Clinicaltrial.gov:NCT03444779.
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Affiliation(s)
- Tanguy Vendeuvre
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Spine and Neuromodulation Functional Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Poitiers University, Poitiers, France
- Institut Pprime, Futuroscope, Poitou-Charentes, France
| | - Olivier Monlezun
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Claire Brandet
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Pierre Ingrand
- UFR Medecine et Pharmacie, Universite de Poitiers, Poitiers, France
| | | | - Louis-Etienne Gayet
- Department of Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - Frederic Khiami
- Department of Orthopaedic Surgery and Traumatology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Manuel Roulaud
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Guillaume Herpe
- Department of Radiology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Philippe Rigoard
- Prismatics Lab, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Spine and Neuromodulation Functional Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Poitiers University, Poitiers, France
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Chen H, Yang J, Tan Z. Upregulation of microRNA-9-5p inhibits apoptosis of chondrocytes through downregulating Tnc in mice with osteoarthritis following tibial plateau fracture. J Cell Physiol 2019; 234:23326-23336. [PMID: 31169312 DOI: 10.1002/jcp.28900] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 12/13/2022]
Abstract
Osteoarthritis (OA) is a common degenerative joint disease which is typically progressed with age, affecting smaller joints of hands, lower limbs, and the vertebral column. It has been reported that microRNAs could regulate the biological processes of OA. Therefore, the purpose of this study was to elucidate miR-9-5p's role in regulating cartilage remodeling of OA mice following tibial plateau fracture (TPF) through regulation of tenascin C (Tnc). Initially, we determined the expression of miR-9-5p and Tnc in mice with OA and then testified their relationship. The results displayed a high expression of Tnc, but a poor expression of miR-9-5p with high methylation in OA. Tnc was confirmed to be a target gene of miR-9-5p. Moreover, based on gain- and loss-function experiments, an increase of miR-9-5p and loss of Tnc had the potential to inhibit cell apoptosis, while facilitating cell proliferation, migration, invasion, and cartilage remodeling of mice with OA following TPF. This was further demonstrated by a higher expression of type II collagen, lower type X collagen, and protogenin expression. Subsequently, downregulation of miR-9-5p aggravated the pathological changes of mice, illustrated by an increase in the Mankin score. In conclusion, the present study proved that overexpression of miR-9-5p suppressed chondrocytes apoptosis and promoted cartilage remodeling through downregulating of Tnc in mice with OA.
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Affiliation(s)
- Hongwei Chen
- Department of Orthopedics, Yiwu Central Hospital, Affiliated Hospital of Wenzhou Medical University, Yiwu, People's Republic of China
| | - Jun Yang
- Department of Orthopedics, The Affiliated Hospital of Xinyang Vocational and Technical College, Xinyang, People's Republic of China
| | - Zhihong Tan
- Department of Orthopaedics, Huizhou Hospital of Traditional Chinese Medicine, Huizhou, People's Republic of China
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Kołodziejczyk K, Kuliński K, Fedorowicz K, Langner M, Czubak J, Pomianowski S. Difficulties in Treating Complex Knee Injuries with Fracture of Posterior Tibial Plateau. Ortop Traumatol Rehabil 2019; 20:293-300. [PMID: 30648655 DOI: 10.5604/01.3001.0012.6463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of the study was to assess the outcomes of surgical treatment of complex knee injuries with a posterior inverted-L approach to the knee joint. MATERIAL AND METHODS The study retrospectively enrolled 13 patients who underwent surgical treatment due to knee injuries with posterior tibial plateau fractures in 2015-2017. Pre-operative planning was based on antero-po-sterior and lateral X-rays and CT images. The fracture was assessed according to Luo's three-column classification. Radiographic postoperative assessment was based on lower limb (standing) X-rays and measurements of the MPTA, aPPTA, JLCA, and aFaT angles in the operated and healthy limbs. Clinical assessment was based on the IKDC, KOOS, and Tegner-Lysholm Knee Scoring Scale. RESULTS Mean follow-up duration was 11.5 months (4-25 months). Anatomical joint surface reduction was achiev-ed in 12 patients and bone union was present in all patients. A posterior inverted-L approach was used in 9 pa-tients and combined approaches in 8 patients. According to the three-column classification, single-column fractures were found in 3 patients, two-column fractures in 4, and three-column fractures in 6 patients. The KOOS was 82%, the IKDC score was 80%, and the Tegner-Lysholm score was 82 points. Radiographic assessments of the operated knee joints showed an MPTA of 88.64 degrees, aPPTA of 79.78 degrees, JLCA of 0.8 degrees, and aFaT of 7.9 degrees. CONCLUSIONS 1. Anatomical reduction and stable fixation of posterior plateau fractures of the proximal tibia are crucial in fracture management. 2. A posterior inverted-L approach is very useful when treating posterior tibial plateau fractures.
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Affiliation(s)
- Kamil Kołodziejczyk
- Samodzielny Publiczny Szpital Kliniczny CMKP im. prof. A. Grucy, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education in Otwock, Poland Klinika Ortopedii, Traumatologii i Ortopedii Dziecięcej / Department of Orthopaedics, Children's Orthopaedics and Traumatology
| | - Krzysztof Kuliński
- Samodzielny Publiczny Szpital Kliniczny CMKP im. prof. A. Grucy, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospita, Centre of Postgraduate Medical Education in Otwock, Poland Klinika Chirurgii Urazowej Narządu Ruchu i Ortopedii / Department of Traumatology and Orthopaedics
| | - Krzysztof Fedorowicz
- Samodzielny Publiczny Szpital Kliniczny CMKP im. prof. A. Grucy, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospita, Centre of Postgraduate Medical Education in Otwock, Poland Klinika Chirurgii Urazowej Narządu Ruchu i Ortopedii / Department of Traumatology and Orthopaedics
| | - Maciej Langner
- Samodzielny Publiczny Szpital Kliniczny CMKP im. prof. A. Grucy, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospita, Centre of Postgraduate Medical Education in Otwock, Poland Klinika Chirurgii Urazowej Narządu Ruchu i Ortopedii / Department of Traumatology and Orthopaedics
| | - Jarosław Czubak
- Samodzielny Publiczny Szpital Kliniczny CMKP im. prof. A. Grucy, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospital, Centre of Postgraduate Medical Education in Otwock, Poland Klinika Ortopedii, Traumatologii i Ortopedii Dziecięcej / Department of Orthopaedics, Children's Orthopaedics and Traumatology
| | - Stanisław Pomianowski
- Samodzielny Publiczny Szpital Kliniczny CMKP im. prof. A. Grucy, Otwock, Polska / Gruca Orthopaedic and Trauma Teaching Hospita, Centre of Postgraduate Medical Education in Otwock, Poland Klinika Chirurgii Urazowej Narządu Ruchu i Ortopedii / Department of Traumatology and Orthopaedics
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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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Yan X, Yao X, Fang Y, Liang Y, Yang Y, Huang F. [Biomechanical study on nickel-titanium three-dimensional memory alloy mesh combined with autologous bone for living model of canine tibial plateau collapse fracture]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 32:1549-1553. [PMID: 30569682 DOI: 10.7507/1002-1892.201807024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the effect of nickel-titanium three-dimensional memory alloy mesh combined with autologous bone for living model of canine tibial plateau collapse fracture by biomechanical testing. Methods Sixteen healthy 12-month-old Beagle dogs were randomly divided into 4 group, 4 dogs in each group. The dogs were used to establish the tibial plateau collapse fracture model in groups A, B, and C. Then, the nickel-titanium three-dimensional memory alloy mesh combined with autologous bone (the fibula cortical bone particles), the artificial bone (nano-hydroxyapatite), and autologous fibula cortical bone particles were implanted to repair the bone defects within 4 hours after modeling in groups A, B, and C, respectively; and the plate and screws were fixed outside the bone defects. The dogs were not treated in group D, as normal control. At 5 months after operation, all animals were sacrificed and the tibial specimens were harvested and observed visually. The destructive axial compression experiments were carried out by the biomechanical testing machine. The displacement and the maximum failure load were recorded and the axial stiffness was calculated. Results All animals stayed alive after operation, and all incisions healed. After 1-3 days of operation, the animals could stand and move, and no obvious limb deformity was found. The articular surfaces of the tibial plateau specimens were completely smooth at 5 months after operation. No obvious articular surface collapse was observed. The displacement and maximum failure load of specimens in groups A and D were significantly higher than those in groups B and C ( P<0.05). But no significant difference was found between groups A and D and between groups B and C ( P>0.05). Conclusion The nickel-titanium three-dimensional memory alloy mesh combined with autologous bone for subarticular bone defect of tibial plateau in dogs has good biomechanical properties at 5 months after operation, and has better axial stiffness when compared with the artificial bone and autologous bone graft.
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Affiliation(s)
- Xin'an Yan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | | | - Yue Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| | - Yu Liang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yun Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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41
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Solomon LB, Kitchen D, Anderson PH, Yang D, Starczak Y, Kogawa M, Perilli E, Smitham PJ, Rickman MS, Thewlis D, Atkins GJ. Time dependent loss of trabecular bone in human tibial plateau fractures. J Orthop Res 2018; 36:2865-2875. [PMID: 29786151 DOI: 10.1002/jor.24057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 05/15/2018] [Indexed: 02/04/2023]
Abstract
We investigated if time between injury and surgery affects cancellous bone properties in patients suffering tibial plateau fractures (TPF), in terms of structural integrity and gene expression controlling bone loss. A cohort of 29 TPF, operated 1-17 days post-injury, had biopsies from the fracture and an equivalent contralateral limb site, at surgery. Samples were assessed using micro-computed tomography and real-time RT-PCR analysis for the expression of genes known to be involved in bone remodeling and fracture healing. Significant decreases in the injured vs control side were observed for bone volume fraction (BV/TV, -13.5 ± 6.0%, p = 0.011), trabecular number (Tb.N, -10.5 ± 5.9%, p = 0.041) and trabecular thickness (Tb.Th, -4.6 ± 2.5%, p = 0.033). Changes in these parameters were more evident in patients operated 5-17 days post-injury, compared to those operated in the first 4 days post-injury. A significant negative association was found between Tb.Th (r = -0.54, p < 0.01) and BV/TV (r = -0.39, p < 0.05) in relation to time post-injury in the injured limb. Both BV/TV and Tb.Th were negatively associated with expression of key molecular markers of bone resorption, CTSK, ACP5, and the ratio of RANKL:OPG mRNA. These structure/gene expression relationships did not exist in the contralateral tibial plateau of these patients. This study demonstrated that there is a significant early time-dependent bone loss in the proximal tibia after TPF. This bone loss was significantly associated with altered expression of genes typically involved in the process of osteoclastic bone resorption but possibly also bone resorption by osteocytes. The mechanism of early bone loss in such fractures should be a subject of further investigation. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2865-2875, 2018.
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Affiliation(s)
- Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.,Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - David Kitchen
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.,Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Paul H Anderson
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, 5000, Australia
| | - Dongqing Yang
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Yolandi Starczak
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Masakazu Kogawa
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Egon Perilli
- The Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, 5001, Australia
| | - Peter J Smitham
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.,Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Mark S Rickman
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.,Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Gerald J Atkins
- Centre for Orthopaedic and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia
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42
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Yan Z, Liang Y, Fang Y, Yao X, Ma K, Huang F. [Biomechanical study of nickel-titanium three-dimensional memory alloy mesh and autologous bone in treatment of canine tibial plateau collapse fracture]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018; 32:722-725. [PMID: 29905052 DOI: 10.7507/1002-1892.201709068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To evaluate the biomechanical effect of a nickel-titanium (Ni-Ti) three-dimensional memory alloy mesh in treating a canine tibial plateau collapse fracture model and to lay a foundation for further experiments in vivo. Methods Sixteen tibial plateau specimens of 8 adult Beagle dogs were harvested. Twelve specimens were taken to prepare canine tibial plateau collapse fracture models (Schatzker type Ⅲ) and randomly divided into groups A, B, and C, with 4 specimens in each group. Four normal tibia specimens were used as blank control group (group D). In groups A and B, the bone defects were repaired with Ni-Ti three-dimensional shape memory alloy mesh combined with autologous bone and simple autologous bone respectively, and fixed with the lateral plate and screw. In group C, the bone defect was directly fixed with the lateral plate and screw. By using a biomechanical tester, a progressive load (0-1 700 N) was loaded vertically above the femoral condyle. The maximum failure load was recorded and the stiffness was calculated according to the load-displacement curve. Results The maximum failure loads in groups A, B, C, and D were (1 624.72±7.02), (1 506.57±3.37), (1 102.00±1.83), and (1 767.64±24.56) N, respectively; and the stiffnesses were (129.72±20.83), (96.54±27.05), (74.96±17.70), and (169.01±35.62) N/mm, respectively. The maximum failure load and stiffness in group A were significantly higher than those in groups B and C, but which were significantly lower than those in group D ( P<0.05). Conclusion Ni-Ti three-dimensional memory alloy mesh combined with autologous bone can repair the Schatzker type Ⅲ tibial plateau collapse fracture, which has better biomechanical properties than simple autologous bone grafting.
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Affiliation(s)
- Zhaokui Yan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | | | - Yue Fang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| | - Xiangyu Yao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Kunlong Ma
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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43
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Gebel PJ, Tryzna M, Beck T, Wilhelm B. Tibial plateau fractures: Fracture patterns and computed tomography evaluation of tibial plateau fractures in winter sports. Orthop Rev (Pavia) 2018; 10:7517. [PMID: 29770177 PMCID: PMC5937364 DOI: 10.4081/or.2018.7517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/28/2018] [Accepted: 01/28/2018] [Indexed: 11/25/2022] Open
Abstract
The purpose was to analyze tibial plateau fractures (TPF) by computed tomography (CT) by creating a frequency map (FM). We hypothesized that a FM shows clinically important aspects of involvement that are not expressed in classic classifications. 185 TPF were retrospectively evaluated in this single center study. We created a FM onto an axial template of an intact subarticular tibial plateau and separated the joint surface in 9 areas, counted the frequency of involvement. The FM gives information of location and grade of damage and expressed three major fracture areas in 76%. 5 specific fracture types add up to 51%. The dorsal parts of the tibial plateau are involved in a higher percentage (+8%). True lateral fractures are less often than plane radiographs suggest. An impression was found in 50%. The complexity of TPFs is high, but 5 specific types could be identified in >50%. The complexity is not sufficiently covered in common classifications, especially the dorsal involvement. The FM is a simple and useful tool that complements common classifications and can be used as guideline for surgical treatment.
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Affiliation(s)
- Philipp Jan Gebel
- Department of Orthopedic Surgery and Traumatology, Spital Thun-Simmental AG, Thun
| | - Malte Tryzna
- Department of General Surgery and Traumatology, Kantonsspital Graubünden, Chur
| | - Thomas Beck
- Department of General Surgery and Traumatology, Spital Wallis, Visp, Switzerland
| | - Bernd Wilhelm
- Department of General Surgery and Traumatology, Spital Wallis, Visp, Switzerland
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Kugelman DN, Qatu AM, Haglin JM, Konda SR, Egol KA. Participation in Recreational Athletics After Operative Fixation of Tibial Plateau Fractures: Predictors and Functional Outcomes of Those Getting Back in the Game. Orthop J Sports Med 2017; 5:2325967117743916. [PMID: 29276713 PMCID: PMC5734475 DOI: 10.1177/2325967117743916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Tibial plateau fractures can be devastating traumatic injuries to the knee, particularly in active athletes. Purpose/Hypothesis: The purpose of this study was to report on the return to participation in recreational athletics after operatively managed tibial plateau fractures. In addition, this study assessed factors associated with the ability to return to participation in recreational athletics after tibial plateau fractures treated with open reduction internal fixation and compared final outcomes between patients who were able to return to recreational athletics and those who could not. The hypothesis was that returning to participation in recreational athletics would be dependent on the time from surgery after operative fixation of tibial plateau fractures. Less severe injuries would be associated with a quicker return to athletics. Study Design: Case-control study; Level of evidence, 3. Methods: All tibial plateau fractures treated by 1 of 3 surgeons at a single academic institution over an 11-year period were prospectively followed. Final outcomes were evaluated using the Short Musculoskeletal Function Assessment at latest follow-up. All complications were recorded at each follow-up. Differences between the groups were compared using Student t tests for continuous variables. Chi-square analysis was used to determine whether differences between categorical variables existed. Logistic regression was performed to assess independent variables associated with returning to participation in recreational athletics. Results: A total of 169 patients who underwent operative management of their tibial plateau fracture reported participation in recreational athletics before their injury. By the 6-month time point, 48 patients (31.6%) had returned to participation in recreational athletics, and at final follow-up (mean, 15 months), 89 patients (52.4%) had returned to participation in recreational athletics. Predictors of returning to recreational athletics included white race, female sex, social alcohol consumption, younger age, increased range of motion (ROM), low-energy Schatzker patterns (I-III), injuries not inclusive of orthopaedic polytrauma or open fractures, and no postoperative complications. White race, social alcohol consumption, and increased ROM were associated with returning to athletics at both 6-month and final follow-up. Lack of a venous thromboembolism was associated with returning to athletics at final follow-up. Patients who returned to recreational athletics had associations with better functional outcomes and emotional status than those who did not. Conclusion: The number of patients who returned to participation in recreational athletics gradually increased over time after operative fixation of tibial plateau fractures. Less severe injuries and a lack of postoperative complications were associated with a quicker return to athletics. Predictors of returning to participation in recreational athletics after operatively managed tibial plateau fractures can be used to target patients at risk of not returning to play to provide interventions aimed at improving their recovery, such as early knee range of motion, muscle strengthening, and participation in low-impact activities.
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Affiliation(s)
- David N Kugelman
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
| | - Abdullah M Qatu
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
| | - Jack M Haglin
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
| | - Sanjit R Konda
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
| | - Kenneth A Egol
- Hospital for Joint Diseases, New York University Langone Medical Center, New York, New York, USA.,Jamaica Hospital Medical Center, New York, New York, USA
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45
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Li DQ, Song DY, Ni JD, Ding ML, Huang J. A case report of Schatzker type VI tibial plateau fracture treated with double reverse traction closed reduction combined with minimally invasive percutaneous plate osteosynthesis technique: A case report. Medicine (Baltimore) 2017; 96:e8394. [PMID: 29137023 PMCID: PMC5690716 DOI: 10.1097/md.0000000000008394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
RATIONALE The knee joint is an important weight-bearing joint, tibial plateau fractures affect knee function and stability. High-energy intra-articular fractures involving the tibial plateau can cause management-related problems such as wound dehiscence; severe comminution leading to malalignment; and delayed complications such as varus collapse, implant failure, and arthritis of the knee joint. The treatment of severe or complex tibial plateau fractures can be quite difficult. Traditional methods of open reduction and plating require extensive exposures, which may further compromise soft tissue and devascularize bone fragments, leading to infection. In this case, a novel device, double reverse traction combined with MIPPO technique, was used and provided the possibility of minimally invasive and personalized orthopedic surgery to treat severe comminuted Schatzker type VI tibial plateau fracture and tibial shaft fracture and got satisfactory results. PATIENT CONCERNS A previously healthy 56-year-old man presented to the emergency room after a fall from a height, who lost the movement of the left knee with pain and swelling. DIAGNOSES X-rays showed a tibial plateau comminuted fracture, Schatzker type VI, and tibial shaft fracture. INTERVENTIONS Applying less extensile exposure and the indirect reduction technique of double reverse traction and closed reduction combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique, we got satisfactory recovery of the severe comminuted Schatzker type VI tibial plateau fracture and tibial shaft fracture. OUTCOMES This severe comminuted fracture and tibial shaft fracture were successfully reduced and got satisfactory recovery of knee joint function. LESSONS Double reverse traction combined with MIPPO technique can reduce the risk of surgical complications, such as bleeding, oozing, and wound infection. It can be applied in patients with comorbidities such as cardiac disease, hypertension, and heart failure who may otherwise not be candidates for surgery. The cost burden is lower than that of the traditional traction table.
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Affiliation(s)
- Dian-Qing Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
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Elabjer E, Benčić I, Ćuti T, Cerovečki T, Ćurić S, Vidović D. Tibial plateau fracture management: arthroscopically-assisted versus ORIF procedure - clinical and radiological comparison. Injury 2017; 48 Suppl 5:S61-S64. [PMID: 29122125 DOI: 10.1016/s0020-1383(17)30742-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tibial plateau fractures are articular injuries that may influence final functional outcome of the knee. Although these fractures comprise only 1% of all fractures, the fracture pattern is usually complex and requires anatomical reduction and absolutely stable fixation to achieve satisfactory results. The development of knee osteoarthritis is a common late complication and it can be strongly influenced by additional, underestimated cartilage defects, and meniscal and ligament tears. MATERIALS AND METHODS Between January 2012 and February 2015, a total of 78 patients with tibial plateau fractures (Schatzker type I-III) were enrolled in the study. Patients were divided into two groups: one group was treated with arthroscopically-assisted reduction and internal fixation (ARIF) and the other with open reduction and internal fixation (ORIF). The final number of patients was 75; 40 in the ARIF group and 35 in the ORIF group. Radiography and computed tomography were used to assess fracture pattern. An immediate postoperative radiograph was performed, and then repeated at 6 weeks, and 3,6 and 12 months after surgery. Demographic data (age and sex), additional intraarticular injuries, hospital stay and complications were noted, and clinical and radiological Rasmunssen score at 3, 6 and 12 months after surgery were evaluated. RESULTS Additional intraarticular lesions were found in 27 patients; 20 in the ARIF group and 7 in the ORIF group (p = 0.06). There was a statistically significant difference in average duration of hospital stay: 3.10 ± 0.63 days for the ARIF group and 5.51 ± 1.66 days for the ORIF group (p = 0.0001). All fractures healed within 3 months following surgery. The overall complication rate was 12%. There was no statistically significant difference in complication rate between the two groups (p = 0.63). Clinical and radiological scores were excellent in most patients in both groups. There was no statistically significant difference in average clinical and radiological Rasmunssen scores between the two groups. CONCLUSIONS Both ARIF and ORIF can provide equally good results; however, ARIF seems to offer a more precise evaluation and treatment of associated intraarticular lesions and to reduce the duration of hospital stay.
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Affiliation(s)
- Esmat Elabjer
- Clinic for Traumatology University Hospital "Sisters of Mercy", Draškovićeva 19,10000 Zagreb, Croatia
| | - Ivan Benčić
- Clinic for Traumatology University Hospital "Sisters of Mercy", Draškovićeva 19,10000 Zagreb, Croatia
| | - Tomislav Ćuti
- Clinic for Traumatology University Hospital "Sisters of Mercy", Draškovićeva 19,10000 Zagreb, Croatia
| | - Tomislav Cerovečki
- Clinic for Traumatology University Hospital "Sisters of Mercy", Draškovićeva 19,10000 Zagreb, Croatia
| | - Stjepan Ćurić
- Clinic for Traumatology University Hospital "Sisters of Mercy", Draškovićeva 19,10000 Zagreb, Croatia
| | - Dinko Vidović
- Clinic for Traumatology University Hospital "Sisters of Mercy", Draškovićeva 19,10000 Zagreb, Croatia; University Hospital "Sisters of Mercy", Clinic for Traumatology, Draškovićeva 19,10000 Zagreb, Croatia.
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Cinque ME, Godin JA, Moatshe G, Chahla J, Kruckeberg BM, Pogorzelski J, LaPrade RF. Do Tibial Plateau Fractures Worsen Outcomes of Knee Ligament Injuries? A Matched Cohort Analysis. Orthop J Sports Med 2017; 5:2325967117723895. [PMID: 28840154 PMCID: PMC5560511 DOI: 10.1177/2325967117723895] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Tibial plateau fractures account for a small portion of all fractures; however, these fractures can pose a surgical challenge when occurring concomitantly with ligament injuries. Purpose/Hypothesis: The purpose of this study was to compare 2-year outcomes of soft tissue reconstruction with or without a concomitant tibial plateau fracture and open reduction internal fixation. We hypothesized that patients with a concomitant tibial plateau fracture at the time of soft tissue surgery would have inferior outcomes compared with patients without an associated tibial plateau fracture. Study Design: Cohort study; Level of evidence, 3. Methods: Forty patients were included in this study: 8 in the fracture group and 32 in the matched control group. Inclusion criteria for the fracture group included patients who were at least 18 years old at the time of surgery and sustained a tibial plateau fracture and a concomitant injury of the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, or fibular collateral ligament in isolation or any combination of cruciate or collateral ligaments and who subsequently underwent isolated or combined ligament reconstruction. Patients were excluded if they underwent prior ipsilateral knee surgery, sustained additional bony injuries, or sustained an isolated extra-articular ligament injury at the time of injury. Each patient with a fracture was matched with 4 patients from a control group who had no evidence of a tibial plateau fracture but underwent the same soft tissue reconstruction procedure. Results: Patients in the fracture group improved significantly from preoperatively to postoperatively with respect to Short Form–12 (P < .05) and Western Ontario and McMaster Universities Osteoarthritis Index total scores (P < .05). The Lysholm (P = .075) and Tegner scores (P = .086) also improved, although this was not statistically significant. Patients in the control group improved significantly from preoperatively to postoperatively across all measured scores. A comparison of the postoperative results between the 2 groups showed no statistically significant difference. Conclusion: The presence of a tibial plateau fracture in conjunction with a ligamentous knee injury did not have a negative effect on postoperative patient-reported outcomes. Patient-reported outcome scores after surgery in both the fracture and control groups improved beyond the minimally clinically important difference, indicating that the presence of a fracture did not detract from the outcomes observed in patients without fractures undergoing concomitant ligament reconstruction.
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Affiliation(s)
- Mark E Cinque
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jonathan A Godin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Gilbert Moatshe
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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48
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Freeman K, Michalson JL, Anderson DD, Brown TD, DeCoster TA, Dirschl DR, Karam MD, Marsh JL. Tibial Plateau Fractures: A New Rank Ordering Method For Determining To What Degree Injury Severity Or Quality Of Reduction Correlate With Clinical Outcome. Iowa Orthop J 2017; 37:57-63. [PMID: 28852336 PMCID: PMC5508287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Injury severity may be the most important factor in determining outcome after articular fractures, but there is a surprising paucity of clinical evidence to support this assertion. The purpose of this study was to utilize a new method for rank ordering a group of patient radiographs to assess the effect of injury severity and quality of reduction on patient outcomes after tibial plateau fractures. METHODS Tibial plateau fractures in 64 patients were treated operatively or non-operatively based on physician preference from standard of care techniques. Fracture severity and reduction quality were stratified from radiographs by four expert clinicians using an iTunes-based rank ordering methodology. The images were distributed electronically, and the ranks were performed on local computers at three different institutions. Clinical outcomes were measured with the SF-12 health questionnaire and the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS There was excellent or very good agreement between raters for injury severity ranking (correlation 0.77-0.91) and quality of reduction (correlation 0.66-0.82). There was no correlation between the injury severity nor quality of reduction and general or joint-specific clinical outcomes. CONCLUSIONS Expert orthopaedic traumatologists strongly agree on how to rank order tibial plateau fractures based both on injury severity and quality of reduction. The novel electronic interface utilized allows an ever-expanding series of cases to be ranked quickly, conveniently, and across multiple centers. This interface holds great promise for establishing prospective, continuously expanding rank orders of various fracture types, which may have great value for clinical research, education about fracture severity, and for prognosis and treatment decisions. In the present study, neither injury severity nor quality of reduction correlated with the clinical outcomes. Other patient- and injury-related factors may be more important in determining clinical outcome of tibial plateau fractures than the appearances of the radiographs at the time of injury or after reduction. Level of Evidence: level III evidence.
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Affiliation(s)
- Katie Freeman
- Department of Orthopaedics, The University of Missouri
| | | | | | - Thomas D. Brown
- Department of Orthopaedics and Rehabilitation, The University of Iowa
| | - Thomas A. DeCoster
- Department of Orthopaedics and Rehabilitation, The University of New Mexico
| | - Douglas R. Dirschl
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago
| | - Matthew D. Karam
- Department of Orthopaedics and Rehabilitation, The University of Iowa
| | - J. Lawrence Marsh
- Department of Orthopaedics and Rehabilitation, The University of Iowa
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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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50
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Stein L, Herold R, Austin A, Beer W. Fat Emboli Syndrome in a Child with Duchenne Muscular Dystrophy After Minor Trauma. J Emerg Med 2016; 50:e223-6. [PMID: 26924510 DOI: 10.1016/j.jemermed.2016.01.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 12/31/2015] [Accepted: 01/22/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Fat embolism syndrome is the result of systemic manifestations of fat emboli in the microcirculation. Duchenne muscular dystrophy is a condition that increases the risk of fracture resulting in fat emboli. CASE REPORT We describe a patient with Duchenne muscular dystrophy who exhibited cardiopulmonary, neurologic, and ophthalmologic sequelae consistent with fat emboli syndrome after minor trauma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fat embolism syndrome is a rare but important consideration with significant morbidity and risk of mortality in patients with Duchenne muscular dystrophy after even minor trauma. Early recognition and aggressive resuscitation are crucial to positive clinical outcomes.
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Affiliation(s)
- Loretta Stein
- Department of Ophthalmology, Naval Medical Center San Diego, San Diego, California
| | - Richard Herold
- Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California
| | - Andrea Austin
- Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California
| | - William Beer
- Department of Emergency Medicine, Naval Medical Center San Diego, San Diego, California
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