Instrumented measurement of anterior-posterior laxity of the knee joint after tibial plateau fracture

Tibial plateau fracture is one of the commonest fractures which leads to the break in the continuity of the upper part of the tibia (shinbone) that involves the knee joint. It involves either lateral tibial condyle or medial tibial condyle or both. This fracture interferes with the normal functioning of the body in day-to-day life. Therefore, physiotherapy rehabilitation after surgery is essential to get back to normal functioning. A 60-year-old female who slipped from a two-wheeler started experiencing severe pain & swelling around the knee joint. Her relatives brought her to Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, Maharashtra. X-ray was done and she was diagnosed with lateral tibial condyle fracture (tibial plateau fracture) and then underwent open reduction internal fixation with plate osteosynthesis. Later, she was referred for physiotherapy rehabilitation, which aimed to restore mobility, regain full range of motion, develop muscle strength and build up to weight-bearing. The tibial plateau fracture is a form of fracture with a low occurrence and is a complicated fracture to treat.The above case study concludes that a traditional surgical procedure combined with timely planned physiotherapy rehabilitation contributed to progressive improvement in functional goals, which is an important factor in achieving a good recovery in such post-operative cases.

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Knee joint stability following fixation of tibial plateau fracture by angular locking plate fixation

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214546 ◽

2021 ◽

Author(s):

Jahidul Bari ◽

Wang . ◽

Wu .

Keyword(s):

Knee Joint ◽

Tibial Plateau ◽

Locking Plate ◽

Tibial Plateau Fracture ◽

Plate Fixation ◽

Weight Bearing ◽

Joint Stability ◽

Locking Plate Fixation ◽

Plateau Fracture ◽

The Mean

Background: Injuries to the tibial plateau generally occur because of a force directed either medially or laterally an axial compressive force or both an axial force and force from the side. Tibial plateau fractures resulting frequently in functional impairment.Methods: The total of cases included in the study was 47 in number. More than 20 years old patients of both sexes with tibial plateau fractures attended in the study. Proper informed consent was taken from the patients under the study and purpose of the study was explained. Ethical approval was obtained from the Institutional Ethics Committee. All data were processed, analyzed, and disseminated by MS Office and Statistical package for social sciences (SPSS) version 26 as per need.Results: In this study, for majority (51%) patients <12 weeks were in needed for union. Besides these, for 23.40% and 21.28% patients, time for union were 12-14 and >14 weeks respectively. Unfortunately, in 4.26%% cases (n=2) incidence of non-union was occur. The mean period of radiological union was 12.75 weeks (12-16 weeks). Most of the patients were allowed complete weight bearing at 11 to 14 weeks. Average time gap for complete weight bearing was 13.5 weeks. In assessing the knee stability of the participants, we observed, the mean (±SD) angle of knee joints was 112.08 ±12.32 degree. The mean (±SD) Knee Society Score (KSS) was found 77.51 ± 8.16. As per the functional outcomes among all the participants, majority of them (57.45%) got ‘good’ results whereas 29.79% got ‘Excellent’ and 8.51% got ‘Poor’ results.Conclusions: Satisfactory knee joint stability for patients with tibial plateau fracture angular locking plate fixation technic may be considered as an effective treatment method for orthopedic surgeons.

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Incidence and risk factors for decreased range of motion of the knee joint after surgery for closed tibial plateau fracture in adults

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02700-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Junyong Li ◽

Junzhe Zhang ◽

Kuo Zhao ◽

Yanbin Zhu ◽

Hongyu Meng ◽

...

Keyword(s):

Risk Factors ◽

Knee Joint ◽

Internal Fixation ◽

Range Of Motion ◽

Odds Ratio ◽

Open Reduction ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Plateau Fracture ◽

Independent Risk Factors

Abstract Purpose The aim of this study was to quantify the incidence of and identify independent risk factors for decreased range of motion (ROM) of the knee joint after surgery for closed tibial plateau fractures in adults. Methods This retrospective study was performed at the trauma centre in our hospital from January 2018 to December 2019. Data from adult patients with tibial plateau fractures treated by surgery were extracted from the electronic medical records. A total of 220 tibial plateau fracture patients were enrolled. We extracted the patients’ demographic characteristics, fracture characteristics, and surgery-related variables. Univariate and multivariate logistic regression models were used to investigate the potential independent risk factors. Results Fifty-seven patients developed decreased ROM of the knee joint at the 1-year follow-up in this study. The overall incidence was 25.9%. The independent predictors of decreased ROM after surgery, as identified in the multivariate analysis, were orthopedic polytrauma (odds ratio = 3.23; 95% CI = 1.68–6.20; p = 0.000), fracture type (Schatzker V-VI) (odds ratio = 2.52; 95% CI = 1.16–5.47; p = 0.019), and an open reduction and internal fixation approach (odds ratio = 2.10; 95% CI = 1.07–4.12; p = 0.031). Conclusions The study confirmed that patients with orthopaedic polytrauma, more complex fractures and those treated with open reduction and internal fixation (ORIF) surgery were more likely to suffer decreased ROM of the knee joint 1 year after surgery.

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Prognostic factors in patients who underwent surgery for common peroneal nerve injury：a nest case-control study

10.21203/rs.3.rs-27986/v3 ◽

2021 ◽

Author(s):

Zhenhui Liu ◽

Maimaiaili Yushan ◽

Yanshi Liu ◽

Aihemaitijiang Yusufu

Keyword(s):

Knee Joint ◽

Functional Recovery ◽

Peroneal Nerve ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Common Peroneal Nerve ◽

Joint Dislocation ◽

Proximal Fibula ◽

Plateau Fracture ◽

Postoperative Knee

Abstract Background：Common peroneal nerve (CPN) injury is one of the most common nerve injuries in the lower extremities and the motor functional recovery of injured common peroneal nerve (CPN) was often unsatisfactory, the mechanism of which is still controversial. The purpose of this retrospective study was to determine the prognostic factors in patients who underwent surgery for CPN injury and provide a tool for clinicians to assess the patients’ prognosis. Methods：This is a retrospective cohort study of all patients who underwent neural exploration for injured CPN from 2009 to 2019. A total of 387 patients with postoperative follow-up more than 12 months were included in the final analysis. We used univariate logistics regression analyses to explore explanatory variables which were associated with recovery of neurological function. By applying multivariable logistic regression analysis, we determined variables incorporated into clinical prediction model, developed a nomogram by the selected variables, and then assessed discrimination of the model by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.Results：The case group included 67 patients and the control group 320 patients. Multivariate logistic regression analysis showed that area (urban vs rural, OR=3.35), occupation(“blue trouser” worker vs “white-trouser” worker, OR=4.39), diabetes (OR=11.68), cardiovascular disease (OR=51.35), knee joint dislocation (OR=14.91), proximal fibula fracture (OR=3.32), tibial plateau fracture (OR=9.21), vascular injury (OR=5.37) and hip arthroplasty (OR=75.96) injury increased the risk of poor motor functional recovery of injured CPN, while high preoperative muscle strength (OR=0.18) and postoperative knee joint immobilization (OR=0.11) decreased this risk of injured CPN. AUC of the nomogram was 0.904 and 95% CI was 0.863-0.946.Conclusions：Area, occupation, diabetes, cardiovascular disease, knee joint dislocation, proximal fibula fracture, tibial plateau fracture, vascular injury and hip arthroplasty injury are independent risk factors of motor functional recovery of injured CPN, while high preoperative muscle strength and postoperative knee joint immobilization are protective factor of motor functional recovery of injured CPN. The prediction nomogram can provide a tool for clinicians to assess the prognosis of injured CPN.

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A prospective study of surgical management of dual plating of bicondylar tibial plateau fracture

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20210525 ◽

2021 ◽

Vol 7 (2) ◽

pp. 241

Author(s):

Tutika Dinesh Kumar ◽

Deepak Chamalla ◽

Santhosh Babu Miryabbelli ◽

M. Sai Ashok

Keyword(s):

Clinical Outcome ◽

Knee Joint ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Articular Surface ◽

Schatzker Type ◽

Dual Plating ◽

Plateau Fracture ◽

Type V ◽

Bicondylar Tibial Plateau

Background: Tibial condyles with their articular surface forms major part of the knee joint, plays an important role in weight transmission and mobility. The proximal tibia fractures account for 1% of all the fractures. If these high velocity intra/peri articular fractures are not treated properly there will be high degree incidences of malunion, non-union, peri-op infections vs collapse of the medial condyle, ligamentous instability, malalignment of the axis, articular incongruity leading to post traumatic arthritis. Aim was to assess the anatomical reduction of articular surface of upper end of tibia and knee joint perfectly by operative treatment with internal fixation. Methods: The study was done for a period of 1 years on 30 patients with bicondylar tibial plateau fractures diagnosed with Schatzker type V and VI. Age ranged from 20-60 years with majority being in 30-39 years range with a largely male preponderance. Patients were followed up to 12 months.Results: Our study reported Honkonen Jarvinen clinical outcome to be 86% excellent, 11.7% good and 1.7% fair. The functional outcome was 81% excellent, 13% good, 5% fair and 1% poor. The Radiological outcome showed 79.2% excellent, 12% good, 0.70% fair results. Our study used Honkonen Jarvinen criteria for radiological, functional, clinical outcome which showed excellent to good result. Conclusions: Dual plating is ideal for all bicondylar Tibial plateau fracture of Schatzker type V and VI with appropriate timing of surgery and understanding the anatomy, LCP system, appropriate technique with dual incision, the complication can be minimized, giving excellent to good results.

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Clinical features and treatment of “Non-dislocated hyperextension tibial plateau fracture”

10.21203/rs.3.rs-18061/v1 ◽

2020 ◽

Author(s):

liangjun jiang ◽

qiang zheng ◽

zhijun pan ◽

hanxiao zhu ◽

erman chen

Keyword(s):

Knee Joint ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Articular Surface ◽

Slope Angle ◽

Ligament Injury ◽

Posterior Slope ◽

Plateau Fracture ◽

Posterior Slope Angle ◽

Postoperative Knee

Abstract Background To explore the epidemiological characteristics, clinical characteristics, treatment strategies and clinical results of non-dislocated hyperextension tibial plateau fracture. Method A total of 25 cases of non-dislocated hyperextension tibial plateau fracture patients were collected, including 12 males and 13 females, aged 27-79 years. Preoperative tibial plateau posterior slope angle was - 10 ~ 0 degrees, average - 5.2 degrees. Preoperative MRI showed 5 cases of MCL injury, 3 cases of PLC complex injury and 2 cases of PLC + PCL injury. The change of tibial plateau posterior slope angle was more than 10 degrees in patients with ligament injury, and the patients with a tibial plateau posterior slope angle change less than 10 degrees had no ligament injury; 6 patients with simple column fracture had a ligament injury, 2 patients with bilateral column fracture had a ligament injury, and 2 patients with three column fracture had a ligament injury. Results All patients were followed up for 12-24 months (average 16.4 months). The operation time was 65-180 minutes (average 124 minutes), and the bleeding volume was 20-200 ml (average 106 ml). The plate was placed on the anterior part of tibial plateau. Evaluation of postoperative fracture reduction: 20 cases were anatomic reduction, 5 cases were good reduction (between 2-5mm articular surface collapse), and the excellent rate of fracture reduction was 100%. The fracture healing time was 3-6 months (average 3.3 months). The postoperative knee Rasmussen score was 18-29 (average 24.9), and the postoperative knee joint mobility was 90-130 ° (average 118 °). Superficial infection occurred in 2 patients. Conclusions The main imaging characteristic of "non-dislocated hyperextension tibial plateau fracture" is the change of tibial plateau posterior slope angle. The injury of single anteromedial column/anterolateral column fracture is easy to combine with "diagonal" injury, and when the tibial plateau posterior slope angle changes more than 10 degrees, it is easy to be associated with ligament injury. By restoring the joint articular surface and lower limb force line, repairing the soft tissue structure, and reconstructing the knee joint stability, we can achieve satisfactory results.

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Analysis of Prognostic Risk Factors for Operative Common Peroneal Nerve: A Nest Case-Control Study

10.21203/rs.3.rs-27986/v1 ◽

2020 ◽

Author(s):

Zhenhui Liu ◽

Maimaiaili Yushan ◽

Yanshi Liu ◽

Aihemaitijiang Yusufu

Keyword(s):

Knee Joint ◽

Functional Recovery ◽

Peroneal Nerve ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Common Peroneal Nerve ◽

Joint Dislocation ◽

Proximal Fibula ◽

Plateau Fracture ◽

Postoperative Knee

Abstract Background Common peroneal nerve (CPN) injury is one of the most common nerve injuries in the lower extremities and the motor functional recovery of injured common peroneal nerve (CPN) was often unsatisfactory, the mechanism of which is still controversial. The purpose of this retrospective study was to determine the factors associated with the neural recovery of injured CPN in patients undergoing surgical exploration of CPN.Methods This is a retrospective cohort study of all patients who underwent neural exploration for injured CPN from 2009 to 2019. A total of 387 patients with postoperative follow-up more than 12 months were included in the final analysis. We used univariate logistics regression analyses to assess which explanatory variables are associated with recovery of neurological function. We used multivariable logistic regression analysis to determine variables incorporated into clinical prediction model, developed a nomogram by the selected variables, and then assessed discrimination of the model by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.Results There were 67 patients divided into case group and 320 patients divided into control group. In multivariate logistic regression analysis, we found that city area (OR = 3.35), labor occupation (OR = 4.39), diabetes (OR = 11.68), cardiovascular disease (OR = 51.35), knee joint dislocation (OR = 14.91), proximal fibula fracture (OR = 3.32), tibial plateau fracture (OR = 9.21), vascular injury (OR = 5.37) and hip arthroplasty (OR = 75.96) injury increased the risk of poor motor functional recovery of injured CPN, while high preoperative muscle strength (OR = 0.18) and postoperative knee joint immobilization (OR = 0.11) decreased this risk of injured CPN. AUC of the nomogram was 0.904 and 95% CI was 0.863–0.946.Conclusions City area, labor occupation, diabetes, cardiovascular disease, knee joint dislocation, proximal fibula fracture, tibial plateau fracture, vascular injury and hip arthroplasty injury are independent risk factors of motor functional recovery of injured CPN, while high preoperative muscle strength and postoperative knee joint immobilization are protective factor of motor functional recovery of injured CPN. The prediction nomogram can be used to predict the prognosis of injured CPN.

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Prognostic factors in patients who underwent surgery for common peroneal nerve injury: a nest case–control study

BMC Surgery ◽

10.1186/s12893-020-01033-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhenhui Liu ◽

Maimaiaili Yushan ◽

Yanshi Liu ◽

Aihemaitijiang Yusufu

Keyword(s):

Knee Joint ◽

Functional Recovery ◽

Peroneal Nerve ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Common Peroneal Nerve ◽

Joint Dislocation ◽

Proximal Fibula ◽

Plateau Fracture ◽

Postoperative Knee

Abstract Background Common peroneal nerve (CPN) injury is one of the most common nerve injuries in the lower extremities and the motor functional recovery of injured common peroneal nerve (CPN) was often unsatisfactory, the mechanism of which is still controversial. The purpose of this retrospective study was to determine the prognostic factors in patients who underwent surgery for CPN injury and provide a tool for clinicians to assess the patients’ prognosis. Methods This is a retrospective cohort study of all patients who underwent neural exploration for injured CPN from 2009 to 2019. A total of 387 patients with postoperative follow-up more than 12 months were included in the final analysis. We used univariate logistics regression analyses to explore explanatory variables which were associated with recovery of neurological function. By applying multivariable logistic regression analysis, we determined variables incorporated into clinical prediction model, developed a nomogram by the selected variables, and then assessed discrimination of the model by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results The case group included 67 patients and the control group 320 patients. Multivariate logistic regression analysis showed that area (urban vs rural, OR = 3.35), occupation(“blue trouser” worker vs “white-trouser” worker, OR = 4.39), diabetes (OR = 11.68), cardiovascular disease (OR = 51.35), knee joint dislocation (OR = 14.91), proximal fibula fracture (OR = 3.32), tibial plateau fracture (OR = 9.21), vascular injury (OR = 5.37) and hip arthroplasty (OR = 75.96) injury increased the risk of poor motor functional recovery of injured CPN, while high preoperative muscle strength (OR = 0.18) and postoperative knee joint immobilization (OR = 0.11) decreased this risk of injured CPN. AUC of the nomogram was 0.904 and 95% CI was 0.863–0.946. Conclusions Area, occupation, diabetes, cardiovascular disease, knee joint dislocation, proximal fibula fracture, tibial plateau fracture, vascular injury and hip arthroplasty injury are independent risk factors of motor functional recovery of injured CPN, while high preoperative muscle strength and postoperative knee joint immobilization are protective factors of motor functional recovery of injured CPN. The prediction nomogram can provide a tool for clinicians to assess the prognosis of injured CPN.

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Prognostic factors in patients who underwent surgery for common peroneal nerve injury：a nest case-control study

10.21203/rs.3.rs-27986/v2 ◽

2020 ◽

Author(s):

Zhenhui Liu ◽

Maimaiaili Yushan ◽

Yanshi Liu ◽

Aihemaitijiang Yusufu

Keyword(s):

Knee Joint ◽

Functional Recovery ◽

Peroneal Nerve ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Common Peroneal Nerve ◽

Joint Dislocation ◽

Proximal Fibula ◽

Plateau Fracture ◽

Postoperative Knee

Abstract Background: Common peroneal nerve (CPN) injury is one of the most common nerve injuries in the lower extremities and the motor functional recovery of injured common peroneal nerve (CPN) was often unsatisfactory, the mechanism of which is still controversial. The purpose of this retrospective study was to determine the prognostic factors in patients who underwent surgery for CPN injury and provide a tool for clinicians to assess the patients’ prognosis. Methods: This is a retrospective cohort study of all patients who underwent neural exploration for injured CPN from 2009 to 2019. A total of 387 patients with postoperative follow-up more than 12 months were included in the final analysis. We used univariate logistics regression analyses to explore explanatory variables which were associated with recovery of neurological function. By applying multivariable logistic regression analysis, we determined variables incorporated into clinical prediction model, developed a nomogram by the selected variables, and then assessed discrimination of the model by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results: The case group included 67 patients and the control group 320 patients. Multivariate logistic regression analysis showed that area (urban vs rural, OR=3.35), occupation(“blue trouser” worker vs “white-trouser” worker, OR=4.39), diabetes (OR=11.68), cardiovascular disease (OR=51.35), knee joint dislocation (OR=14.91), proximal fibula fracture (OR=3.32), tibial plateau fracture (OR=9.21), vascular injury (OR=5.37) and hip arthroplasty (OR=75.96) injury increased the risk of poor motor functional recovery of injured CPN, while high preoperative muscle strength (OR=0.18) and postoperative knee joint immobilization (OR=0.11) decreased this risk of injured CPN. AUC of the nomogram was 0.904 and 95% CI was 0.863-0.946. Conclusions: Area, occupation, diabetes, cardiovascular disease, knee joint dislocation, proximal fibula fracture, tibial plateau fracture, vascular injury and hip arthroplasty injury are independent risk factors of motor functional recovery of injured CPN, while high preoperative muscle strength and postoperative knee joint immobilization are protective factor of motor functional recovery of injured CPN. The prediction nomogram can provide a tool for clinicians to assess the prognosis of injured CPN.

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