scholarly journals Quantitative 3D measurements of tibial plateau fractures

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
N. Assink ◽  
J. Kraeima ◽  
C. H. Slump ◽  
K. ten Duis ◽  
J. P. P. M. de Vries ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Articular Surface ◽  
Correlation Coefficients ◽  
3D Models ◽  
Fracture Analysis ◽  
Classification Systems ◽  
Tibial Plateau Fractures ◽  
3D Measurements ◽  
Plateau Fracture ◽  
2D And 3D

Abstract Fracture gap and step-off measurements on 2DCT-slices probably underestimate the complex multi-directional features of tibial plateau fractures. Our aim was to develop a quantitative 3D-CT (Q3DCT) fracture analysis of these injuries. CT-based 3D models were created for 10 patients with a tibial plateau fracture. Several 3D measures (gap area, articular surface involvement, 3D displacement) were developed and tested. Gaps and step-offs were measured in 2D and 3D. All measurements were repeated by six observers and the reproducibility was determined by intra-class correlation coefficients. Q3DCT measurements demonstrated a median gap of 5.3 mm, step-off of 5.2 mm, gap area of 235 mm2, articular surface involvement of 33% and 3D displacement of 6.1 mm. The inter-rater reliability was higher in the Q3DCT than in the 2DCT measurements for both the gap (0.96 vs. 0.81) and step-off (0.63 vs. 0.32). Q3DCT measurements showed excellent reliability (ICC of 0.94 for gap area, 1 for articular surface involvement and 0.99 for 3D displacement). Q3DCT fracture analysis of tibial plateau fractures is feasible and shows excellent reliability. 3D measurements could be used together with the current classification systems to quantify the true extent of these complex multi-directional fractures in a standardized way.

scholarly journals Unusual medial tibial plateau fracture fixation using dual plating

2019 ◽  
Vol 5 (6) ◽  
pp. 1113
Author(s):  
Shradha Bora S. ◽  
Senthil L. ◽  
Thiyagarajan U. ◽  
Pradeep J. P. ◽  
Gokul Raj D.
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Articular Surface ◽  
Oxford Knee Score ◽  
Tibial Plateau Fractures ◽  
Medial Tibial Plateau ◽  
Proximal Tibial Fractures ◽  
Dual Plating ◽  
Plateau Fracture ◽  
Safe Technique

<p class="abstract"><strong>Background:</strong> Medial tibial plateau fractures is a subtype of proximal tibial fractures that involve the articular surface and can present in several distinct patterns. Purpose of this study was to assess the clinical outcome of stabilizing these biplanar medial tibial plateau fractures using dual plating technique through a single incision.</p><p class="abstract"><strong>Methods:</strong> Between 2017 to 2019, 12 men and 8 women with closed medial tibial plateau fracture who underwent reconstruction using two plates through a posteromedial approach were included in the study group. The fractures were classified using the three column concept of Lou.<strong></strong></p><p class="abstract"><strong>Results:</strong> One patient had an articular step off that was unacceptable and two patients had an acceptable articular step off. Functional assessment was done using the objective scoring of Oxford knee score criteria and radiological assessment was done using the Rasmussen modified score.</p><p class="abstract"><strong>Conclusions:</strong> Biplanar reconstruction using dual plates is a reliable and safe technique to reconstruct complex medial tibial plateau fractures.</p>

scholarly journals Tibial Plateau Fracture Following Low Energy Fall in the Rocky Mountains

2019 ◽  
Vol 12 (3) ◽  
pp. 91-93
Author(s):  
Alexandra V. Arvanitakis ◽  
Kerry C. Mian ◽  
Raymond Kreienkamp ◽  
Charles E. Rhoades
Keyword(s):  
Rocky Mountains ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Weight Bearing ◽  
High Energy ◽  
Classification Systems ◽  
Tibial Plateau Fractures ◽  
Mechanism Of Injury ◽  
Direct Trauma ◽  
Plateau Fracture

Tibial plateau fractures are debilitating injuries. They can occurin younger individuals who sustain a high energy trauma or, withincreasing age, lesser degrees of trauma and underlying bone pathology such as osteoporosis, metabolic bone disease, and malignancy.1Outside these cases, tibial plateau fractures are relatively uncommon.However, these fractures can occur in healthy patients who have sustained direct trauma to the knee.Fractures of the tibial plateau often are classified according to theSchatzker or AO classification systems.2,3 These systems evaluate theinvolvement of both the medial and lateral plateaus, degree of comminution, extension into the joint, and displacement (both articularsurfaces and the relationship of the diaphysis to the metaphysis).Most tibial plateau fractures occur in the lateral aspect of the tibialplateau.1 The increased frequency of lateral fractures is due to themedial tibial plateau being able to resist higher weight-bearing loaddue to the presence of more cancellous bone. More importantly, thelateral plateau has more articular surface exposed during extensioncompared to the medial plateau, which increases likelihood of injury.4The standard of care for most displaced tibial plateau fracturesis surgical management with open reduction and internal fixation(ORIF).5 Conservative management, such as leg bracing, is an optionfor fractures that are nondisplaced or in patients too fragile for surgical intervention. In the senior population, a total knee arthroplasty(TKA) is a less common option. Tibial plateau fractures, particularlymedial tibial plateau fractures, caused by direct trauma in the elderly,non-osteoporotic population are uncommon.We present the case of an active male without overt risk for severefracture (10-year fracture risk of 10% via FRAX score) who wasworking to repair a trail in the Rocky Mountains. While other injurieswere more likely given the mechanism of injury and patient risk, thiscase highlighted the importance of considering tibial plateau fracture,even in atypical settings without significant risk. Improved awarenessof this mechanism of injury will lead to more accurate diagnosis andgreater post-injury management.

scholarly journals The concept of direct approach to lateral tibial plateau fractures and stepwise extension as needed

2020 ◽  
Vol 46 (6) ◽  
pp. 1211-1219 ◽  
Author(s):  
Karl-Heinz Frosch ◽  
Alexander Korthaus ◽  
Darius Thiesen ◽  
Jannik Frings ◽  
Matthias Krause
Keyword(s):  
Prone Position ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Lateral Meniscus ◽  
Tibial Plateau Fractures ◽  
Posterolateral Approach ◽  
Central Segment ◽  
Anatomic Reduction ◽  
Lateral Plating ◽  
Lateral Plateau

AbstractMalreduction after tibial plateau fractures mainly occurs due to insufficient visualization of the articular surface. In 85% of all C-type fractures an involvement of the posterolateral-central segment is observed, which is the main region of malreduction. The choice of the approach is determined (1) by the articular area which needs to be visualized and (2) the positioning of the fixation material. For simple lateral plateau fractures without involvement of the posterolateral-central segment an anterolateral standard approach in supine position with a lateral plating is the treatment of choice in most cases. For complex fractures the surgeon has to consider, that the articular surface of the lateral plateau only can be completely visualized by extended approaches in supine, lateral and prone position. Anterolateral and lateral plating can also be performed in supine, lateral and prone position. A direct fixation of the posterolateral-central segment by a plate or a screw from posterior can be only achieved in prone or lateral position, not supine. The posterolateral approach includes the use of two windows for direct visualization of the fracture. If visualization is insufficient the approach can be extended by lateral epicondylar osteotomy which allows exposure of at least 83% of the lateral articular surface. Additional central subluxation of the lateral meniscus allows to expose almost 100% of the articular surface. The concept of stepwise extension of the approach is helpful and should be individually performed as needed to achieve anatomic reduction and stable fixation of tibial plateau fractures.

Age-Related Variances in Patients with Tibial Plateau Fractures

2019 ◽  
Vol 33 (06) ◽  
pp. 611-615 ◽  
Author(s):  
Lasun O. Oladeji ◽  
John R. Worley ◽  
Brett D. Crist
Keyword(s):  
Elderly Patients ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
The Elderly ◽  
Tibial Plateau Fractures ◽  
Mechanism Of Injury ◽  
Younger Patients ◽  
Age Related ◽  
Comorbidity Burden ◽  
Plateau Fracture

AbstractTibial plateau fractures account for approximately 8% of fractures in the elderly population. Treatment strategies in the elderly are similar to those for younger patients; however, practitioners must account for the elevated comorbidity burden in this population. To date, few studies have analyzed age-based outcomes in patients with tibial plateau fractures. Therefore, the purpose of this study was to determine age-related variances in demographics, fracture characteristics, mechanism of injury, and complications. A 10-year retrospective review was conducted to identify patients who received treatment for a tibial plateau fracture. There were 351 patients (360 tibial plateau fractures) who were identified and subsequently stratified according to their age at the time of injury. Patients were classified as elderly if they were 65 years of age or older at the time of injury; all other patients were included in the control cohort. These two cohorts were analyzed using bivariate analysis to isolate for age-related variations with respect to risk factors, mechanism of injury, and complications. There were 351 patients (360 tibial plateau fractures) with a median follow-up of 1.84 ± 2.44 years who met inclusion criteria. There were a greater proportion of women in the elderly cohort as compared with the younger cohort (60.0 vs. 43.4%, p = 0.06). Elderly patients were significantly more likely to present with diabetes (33.3 vs. 16.1%, p = 0.01) or osteoporosis (14.3 vs. 1.6%, p = 0.001). Younger patients were significantly more likely to require further surgery to address ligament (12.6 vs. 0%, p = 0.008), meniscus (20.9 vs. 7.1%, p = 0.036), or cartilage pathology (13.6 vs. 0%, p = 0.005). There was no difference in the arthroplasty conversion rate (4.8% elderly vs. 7.9% control, p = 0.755). While elderly patients presented with a greater comorbidity burden, they had equivalent or better short-term outcomes when compared with their younger peers when treated with open reduction and internal fixation (ORIF). Despite the recent interest in primary total knee arthroplasty for elderly patients with tibial plateau fractures, the results of this study suggest that elderly patients may respond well when treated with ORIF following a tibial plateau fracture.

The Impact of Computed Tomography on Decision Making in Tibial Plateau Fractures

2018 ◽  
Vol 31 (10) ◽  
pp. 1007-1014 ◽  
Author(s):  
Marcello Castiglia ◽  
Marcello Nogueira-Barbosa ◽  
Andre Messias ◽  
Rodrigo Salim ◽  
Fabricio Fogagnolo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Surgical Approach ◽  
Tibial Plateau ◽  
Classification Systems ◽  
Tibial Plateau Fractures ◽  
Surgical Approaches ◽  
Plain Radiographs ◽  
Schatzker Classification ◽  
The Impact

AbstractSchatzker introduced one of the most used classification systems for tibial plateau fractures, based on plain radiographs. Computed tomography brought to attention the importance of coronal plane-oriented fractures. The goal of our study was to determine if the addition of computed tomography would affect the decision making of surgeons who usually use the Schatzker classification to assess tibial plateau fractures. Image studies of 70 patients who sustained tibial plateau fractures were uploaded to a dedicated homepage. Every patient was linked to a folder which contained two radiographic projections (anteroposterior and lateral), three interactive videos of computed tomography (axial, sagittal, and coronal), and eight pictures depicting tridimensional reconstructions of the tibial plateau. Ten attending orthopaedic surgeons, who were blinded to the cases, were granted access to the homepage and assessed each set of images in two different rounds, separated to each other by an interval of 2 weeks. Each case was evaluated in three steps, where surgeons had access, respectively to radiographs, two-dimensional videos of computed tomography, and three-dimensional reconstruction images. After every step, surgeons were asked to present how would they classify the case using the Schatzker system and which surgical approaches would be appropriate. We evaluated the inter- and intraobserver reliability of the Schatzker classification using the Kappa concordance coefficient, as well as the impact of computed tomography in the decision making regarding the surgical approach for each case, by using the chi-square test and likelihood ratio. The interobserver concordance kappa coefficients after each assessment step were, respectively, 0.58, 0.62, and 0.64. For the intraobserver analysis, the coefficients were, respectively, 0.76, 0.75, and 0.78. Computed tomography changed the surgical approach selection for the types II, V, and VI of Schatzker (p < 0.01). The addition of computed tomography scans to plain radiographs improved the interobserver reliability of Schatzker classification. Computed tomography had a statistically significant impact in the selection of surgical approaches for the lateral tibial plateau.

Mapping recovery in simple and complex tibial plateau fracture fixation

2019 ◽  
Vol 101-B (8) ◽  
pp. 1009-1014 ◽  
Author(s):  
D. N. Ramoutar ◽  
K. Lefaivre ◽  
H. Broekhuyse ◽  
P. Guy ◽  
P. O’Brien
Keyword(s):  
Functional Outcome ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Short Form ◽  
Tibial Plateau Fractures ◽  
Functional Score ◽  
Complex Group ◽  
Sf 36 ◽  
Functional Scores ◽  
Plateau Fracture

Aims The aim of this study was to determine the trajectory of recovery following fixation of tibial plateau fractures up to five-year follow-up, including simple (Schatzker I-IV) versus complex (Schatzker V-VI) fractures. Patients and Methods Patients undergoing open reduction and internal fixation (ORIF) for tibial plateau fractures were enrolled into a prospective database. Functional outcome, using the 36-Item Short Form Health Survey Physical Component Summary (SF-36 PCS), was collected at baseline, six months, one year, and five years. The trajectory of recovery for complex fractures (Schatzker V and VI) was compared with simple fractures (Schatzker I to IV). Minimal clinically important difference (MCID) was calculated between timepoints. In all, 182 patients were enrolled: 136 (74.7%) in simple and 46 (25.3%) in complex. There were 103 female patients and 79 male patients with a mean age of 45.8 years (15 to 86). Results Mean SF-36 PCS improved significantly in both groups from six to 12 months (p < 0.001) and one to five years (simple, p = 0.008; complex, p = 0.007). In both groups, the baseline scores were not reached at five years. The SF-36 PCS was significantly higher in the simple group compared with the complex group at both six months (p = 0.007) and 12 months (p = 0.01), but not at five years (p = 0.17). Between each timepoint, approximately 50% or more of the patients in each group achieved an MCID in their score change, indicating a significant clinical change in condition. The complex group had a much larger drop off in the first six months, with comparable proportions achieving MCID at the subsequent time intervals. Conclusion Tibial plateau fracture recovery was characterized overall by an initial decline in functional outcome from baseline, followed by a steep improvement from six to 12 months, and ongoing recovery up to five years. In simple patterns, patients tended to achieve a higher functional score by six months compared with the complex patterns. However, comparable functional scores between the groups achieved only at the five-year point suggest later recovery in the complex group. Function does not improve to baseline by five years in either group. This information is useful in counselling patients about the course of prospective recovery. Cite this article: Bone Joint J 2019;101-B:1009–1014.

Efficacy of a Biphasic Ceramic Bone Substitute in Management of Complex Tibial Plateau Fractures — Clinical and Radiologic Medium-Term Results

2014 ◽  
Vol 614 ◽  
pp. 190-195
Author(s):  
Paul Dan Sirbu ◽  
Grigore Berea ◽  
Tudor Petreus ◽  
Rares Sova ◽  
Razvan Tudor ◽  
...  
Keyword(s):  
Bone Substitute ◽  
Tibial Plateau ◽  
Plate Fixation ◽  
Tibial Plateau Fractures ◽  
Medium Term ◽  
Promising Alternative ◽  
Plateau Fracture ◽  
Primary Bone ◽  
Fast Healing ◽  
Biphasic Ceramic

The purpose of this retrospective study is to evaluate the efficacy of a biphasic synthetic ceramic bone substitute (Eurocer) combined with plate fixation in treating collapse tibial plateau fractures. 32 patients were included in the study. The surgical protocol consisted of: elevation of the articular depression through a limited cortical window using a curved bone compactor and image intensification, filling the defect with Eurocer granules and fixation with plates. Clinical and radiologic follow-up after 36 to 48 months revealed uneventful primary bone healing, excellent osseous integration of Eurocer and a mean Neer score of 87, 5 points. We conclude that Eurocer400® combined with plate fixation in managing collapsed tibial plateau fracture is a promising alternative in this difficult lesion regarding a fast healing, a good quality osseointegration, preventing secondary collapse and improving medium term results.

Postoperative Computed Tomography Evaluation of Posterior Tibial Plateau Fractures: Mean 7-Year Clinical Follow-Up

2017 ◽  
Vol 31 (07) ◽  
pp. 670-676
Author(s):  
Dongzhe Li ◽  
Yu Liang ◽  
Kunlong Ma ◽  
Chang Zou ◽  
Yue Fang
Keyword(s):  
Computed Tomography ◽  
Clinical Outcomes ◽  
Tibial Plateau ◽  
Rank Correlation ◽  
Correlation Coefficients ◽  
Tibial Plateau Fractures ◽  
Short Musculoskeletal Function Assessment ◽  
Posterior Tibial ◽  
Spearman’S Rank Correlation ◽  
Spearman’S Rank Correlation Coefficient

AbstractThe aim is to assess the association between computed tomography (CT) findings and clinical outcomes in posterior tibial plateau fractures (TPF). This is a retrospective analysis of the records of 23 patients with posterior TPF treated at our institution between 2004 and 2011. Two indices of residual articular displacement of posterior TPF (gap and step-off) were measured from CT images, and clinical outcomes were assessed using the Short Musculoskeletal Function Assessment (SMFA) questionnaire. Spearman's rank correlation coefficient analysis was used to evaluate the correlations between the postoperative posterior TPF radiological findings and the clinical outcomes. Both the intraobserver and the interobserver correlation coefficients were high (0.90 and 0.92, respectively), indicating excellent agreement between the reviewers for the assessment of residual displacement via CT scans. Additionally, residual articular step displacement showed a strongly negative correlation with clinical outcomes (R = 0.700, p = 0.036), whereas the residual gap displacement did not (R = 0.400, p = 0.505). More importantly, the medial posterior step displacement was significantly correlated with the clinical outcomes (p = 0.040), whereas the lateral posterior step displacement was not (p = 0.618). Based on the data of this study, the higher the step-off deformity of the medial posterior tibial plateau, the worse the SMFA. More attention should be paid to this factor when treating medial posterior TPF.

scholarly journals FIXATION OF POSTERIOR TIBIAL PLATEAU FRACTURE AND ITS OUTCOME: A COMPARATIVE STUDY

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Hrishikesh Saodekar ◽  
Kamal Agrawal
Keyword(s):  
Functional Outcome ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Plate Fixation ◽  
Tibial Plateau Fractures ◽  
Fracture Union ◽  
Posterior Tibial ◽  
Plateau Fracture ◽  
Group A ◽  
Group B

Introduction: Tibial plateau fractures are complex injuries of proximal tibia which are produced by high- or low-energy trauma and principally affect young adult population. These fractures usually have associated soft-tissue lesions affecting the treatment. Posterior tibial plateau fractures (PTPF), may be medial or lateral, are common and they occur in about 28.8% patients as a part of bicondylar tibial plateau fractures. These fractures are difficult to reduce, therefore articular incongruity was not found to be detrimental factor in final functional outcomes. Studies have supported the fact that residual articular incongruence is well tolerated by proximal tibial plateau fracture in the form of minimal functional limitation or onset of arthrosis.  Anterolateral and anteromedial surgical approaches do not show adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is advised to reduce and fix the fracture through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement. Material and Methods: This comparative prospective cohort study on done on 50 adult patients. Two groups were formed: Group A – double-plate fixation with both posterior and anterolateral  having 25 participants and Group B – single anterolateral plate fixation having 25 participants in PTPFs were followed up to 1 year. For Group A, the reduction was done under direct vision and assisted with fluoroscopy in two planes. The reduction was assessed with submeniscal approach. In Group B posterior fragment was reduced by screws through the anterolateral plate followed by CT scan. Patients were evaluated by radiographs every 6 weeks till fracture union is evident. Fracture union was assessed by cortical continuity and progressive loss of fracture line on X-rays. Functional status at 1-year postoperative CT scanogram was done at final follow up to record articular subsidence, nonunion, coronal, or sagittal deformities. Knee functions were assessed by the International Knee Documentation Committee 2000 subjective knee evaluation form and objective functional Knee Society Score (KSS). Results: There were 22 male and 3 female in Group A while in Group B there were 20 male and 5 female. Right tibial fracture was observed in 15 cases and left in 10 cases in group A while in Group B right fracture was seen in 17 cases and in 8 cases left sided fracture. 23 cases each in group A and B were associated with RTA. Operative time (minutes) in group A and group B was 124 ± 26.7 and 79.52± 16.22 respectively. Total mean hospitalization days were 9.4±2.6 in group A and 8.2±1.5 in group B. Union time in group A was 14.6±3.4 weeks while in group B was 15.4±3.2. Statistically significant correlation was observed in group A and B with respect to KSS clinical outcome and KSS functional outcome. Flexion deformity was observed in 3 (12%) cases in group A and in 6 (24%) cases in group B. Conclusion:  PTPF can achieve an early and satisfactory functional outcome. Rehabilitation and fracture healing are better in PTPF. Keywords: Tibial plateau fractures, PTPF, Open reduction and internal fixation (ORIF)

scholarly journals Arthroscopic Assisted Reduction and Internal Fixation of Tibial Plateau Fractures

2019 ◽  
Vol 7 (7) ◽  
pp. 1133-1137 ◽  
Author(s):  
Sherif Hamdy Mohamed Zawam ◽  
Ahmed Mahmoud Gad
Keyword(s):  
Internal Fixation ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Knee Injuries ◽  
Tibial Plateau Fractures ◽  
Type I ◽  
Type Ii ◽  
University Hospitals ◽  
Type Iii ◽  
Schatzker Type

BACKGROUND: Tibial plateau fractures present an important entity in orthopaedic fractures. Arthroscopic-assisted reduction and internal fixation is a good alternative to ORIF as it has the advantage of direct visualisation of the articular surface of the plateau, direct assessment of the reduction of the articular surface, and managing any associated intra-articular pathology. AIM: Our study aim is to determine the results of arthroscopic assisted reduction and internal fixation of tibial plateau fractures. METHODS: This study involved 25 patients with tibial plateau fractures presenting to the emergency department of Cairo University Hospitals between the periods of November 2016 and May 2017. The patients were followed up for an average of 14 months (11-18 months). According to Schatzker’s classification, five patients had type I, eleven had type II, and nine patients had type III fractures. RESULTS: The average time to full union in Schatzker type I was 9.1 weeks, in type II was 10.2 weeks, and in type III it was 9.4. The mean clinical Rasmussen score among the 25 patients was 26 (range, 24-30). A group of 19 patients (76%) had excellent results, (4 type I, 8 types II, and 7 types III) 6 patients (24 %) had good results (1 type I, 3 types II, 2 types III). Radiologic results were excellent in (14 cases) 56.0% and good results (11 cases) 44%. CONCLUSION: Arthroscopic assisted reduction and fixation of tibial plateau fractures have the advantages of checking the adequacy of reduction, avoiding the need for detachment of the meniscus, and allowing for accurate diagnosis and management of associated knee injuries. Therefore, we recommend that arthroscopic assisted reduction and fixation of tibial plateau fractures should be used more often.

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