Surgical Treatment of Posterior Tibial Plateau Fractures

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 anteroposterior 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 achieved in 12 patients and bone union was present in all patients. A posterior inverted-L approach was used in 9 patients 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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Long-term radiographic appearance of calcium-phosphate synthetic bone grafts after surgical treatment of tibial plateau fractures

Injury ◽

10.1016/j.injury.2017.10.030 ◽

2017 ◽

Vol 48 (12) ◽

pp. 2807-2813 ◽

Cited By ~ 3

Author(s):

Alexander Hanke ◽

Martin Bäumlein ◽

Siegmund Lang ◽

Boyko Gueorguiev ◽

Michael Nerlich ◽

...

Keyword(s):

Surgical Treatment ◽

Calcium Phosphate ◽

Tibial Plateau ◽

Bone Grafts ◽

Tibial Plateau Fractures ◽

Radiographic Appearance ◽

Synthetic Bone ◽

Synthetic Bone Grafts

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Challenging Surgical Treatment of Displaced Articular Tibial Plateau Fractures: Do Early Knee Radiographic Features Have a Predictive Value of the Mid‐Term Clinical Functional Outcomes?

Orthopaedic Surgery ◽

10.1111/os.12577 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1149-1162 ◽

Cited By ~ 2

Author(s):

Carlo Biz ◽

Giacomo Maso ◽

Marisa Gambato ◽

Elisa Belluzzi ◽

Assunta Pozzuoli ◽

...

Keyword(s):

Surgical Treatment ◽

Predictive Value ◽

Functional Outcomes ◽

Tibial Plateau ◽

Tibial Plateau Fractures ◽

Radiographic Features

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Updated Three-Column Concept in surgical treatment for tibial plateau fractures – A prospective cohort study of 287 patients

Injury ◽

10.1016/j.injury.2016.04.026 ◽

2016 ◽

Vol 47 (7) ◽

pp. 1488-1496 ◽

Cited By ~ 52

Author(s):

Yukai Wang ◽

Congfeng Luo ◽

Yi Zhu ◽

Qilin Zhai ◽

Yu Zhan ◽

...

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Tibial Plateau ◽

Tibial Plateau Fractures

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Spinal Anesthesia Improves Early Pain Levels After Surgical Treatment of Tibial Plateau Fractures

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000000773 ◽

2017 ◽

Vol 31 (3) ◽

pp. 164-167 ◽

Cited By ~ 2

Author(s):

Arthur Manoli ◽

Arthur Atchabahian ◽

Roy I. Davidovitch ◽

Kenneth A. Egol

Keyword(s):

Surgical Treatment ◽

Spinal Anesthesia ◽

Tibial Plateau ◽

Tibial Plateau Fractures

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

The Journal of Knee Surgery ◽

10.1055/s-0037-1606561 ◽

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.

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

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.904 ◽

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)

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