Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm

2020 ◽  
Author(s):  
Vincenzo Giordano ◽  
Robinson Esteves Pires ◽  
Frederico Silva Pimenta ◽  
Túlio Vinícius de Oliveira Campos ◽  
Marco Antônio Percope de Andrade ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Preoperative Planning ◽  
Proximal Tibia ◽  
Tibial Plateau Fracture ◽  
Treatment Algorithm ◽  
High Energy ◽  
Current Evidence ◽  
Force Magnitude ◽  
Plateau Fracture ◽  
Shear Type

AbstractHigh-energy fractures of the proximal tibia with extensive fragmentation of the posterolateral (PL) quadrant of the tibial plateau are challenging to manage. Herein, we present a review of the literature on the patterns and options of approach and fixation of the PL fragment of the tibial plateau to optimize the treatment of this specific injury pattern. We searched PubMed (1980–May 2020) to identify and summarize the most relevant articles evaluating both the morphology and treatment recommendations, including the choice of approach and fixation strategy, for the PL tibial plateau fracture. We found PL fragment can present in several patterns as a pure split, split depression, contained pure depression, and noncontained depression (rim crush), which are mostly determined by the position of the knee and the force magnitude applied during the course of the accident. Based on previous concepts described by Schatzker and Kfuri, we suggest a simplified treatment algorithm highlighting the two concepts (buttressing and containment) used for plating the PL tibial plateau fragments. Based on the available current evidence, we propose an algorithm for these two morphological types of PL tibial plateau fracture. Shear-type fractures need buttressing (the “rule of thumb”), whereas noncontained peripheral rim-type fractures need peripheral repair and containment. Contained pure depression fractures are not frequent and need percutaneous-assisted elevation and subchondral rafting, either controlled by fluoroscopy or arthroscopically. It is believed that such an approach would simplify their assessment and preoperative planning and would assist the clinicians to appreciate and manage more consistently these complex injuries.

scholarly journals The Application of 3D Printing Technology in the Classification and Preoperative Planning of Complex Tibial Plateau Fractures

2020 ◽  
Author(s):  
Fuyang Chen ◽  
Chenyu Huang ◽  
Chen Ling ◽  
Jinming Zhou ◽  
Yufeng Wang ◽  
...  
Keyword(s):  
3D Printing ◽  
Tibial Plateau ◽  
3D Model ◽  
Preoperative Planning ◽  
Tibial Plateau Fracture ◽  
Tibial Plateau Fractures ◽  
Printing Technology ◽  
3D Printing Technology ◽  
Plateau Fracture ◽  
3D Printed

Abstract Background: Tibial plateau fracture is one of the common intra-articular fractures in clinic. And its accurate classification and treatment is a difficult problem for orthopedic surgeons. Our research aims to investigate the application value of 3D printing in the classification and preoperative planning of complex tibial plateau fractures.Methods: 28 cases of complex tibial plateau fractures diagnosed and treated in our hospital from January, 2017 to January, 2019.01 were analyzed. Preoperative spiral CT scan was performed and then DICOM data were input into the computer. We use Mimics to process data. And 3D printing technology was applied to print the 3D model of fracture (1:1). Combined with the 3D printed model, the tibial plateau fractures were subdivided into seven types according to the geometric plane of the tibial plateau. The surgical approach was determined on the 3D printed model. And then simulated operations such as accurate reduction of fracture and selection of plate placement were performed.Results: The reconstructed 3D model of tibial plateau fracture can accurately reflect the direction of fracture displacement and the degree of plateau collapse. Also, it and can help with the preoperative surgical design of tibial plateau fracture. The intraoperative fracture details were basically the same as the 3D printed model. And the fracture surface of the tibial plateau was well improved in all 28 cases.Conclusion: 3D printing technology can be used to guide the classification and preoperative planning of complex tibial plateau fractures.

Tibial plateau fracture: anatomy, diagnosis and management

2020 ◽  
Vol 81 (10) ◽  
pp. 1-9
Author(s):  
Branavan Rudran ◽  
Christopher Little ◽  
Anatole Wiik ◽  
Kartik Logishetty
Keyword(s):  
Surgical Management ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Lateral Condyle ◽  
Mechanism Of Injury ◽  
Schatzker Classification ◽  
Plateau Fracture

Tibial plateau fractures are peri-articular knee fractures of the proximal tibia. The presentation is dependent on the mechanism of injury. The tibial plateau is the bony platform of the distal half of the knee joint, and is made up of a medial and lateral condyle separated by the intercondylar eminence. The presentation of tibial plateau fractures can vary greatly as a result of the bimodal mechanism of injury and patient characteristics. The patient should be assessed for life- and limb-threatening injuries in accordance with British Orthopaedic Association Standards of Trauma guidelines. Imaging is undertaken to understand configuration of the fracture, which is classified by the Schatzker classification. Definitive management of the fracture depends on the severity, ranging from conservative to surgical management. Surgery is required for more severe tibial plateau fractures to restore articular congruity, mechanical alignment, ligamentous stability and to permit early mobilisation. Medium-term functional outcome after tibial plateau fractures is generally excellent when anatomy and stability is restored. At least half of patients return to their original level of physical activity. Surgical management of tibial plateau fractures is not without complication. Risk factors include postoperative arthritis, bicondylar and comminuted fractures, meniscal removal, instability, malalignment and articular incongruity. Tibial plateau fractures account for 1% of all fractures, and typically occur either as a fragility fracture or secondary to a high-energy impact. These latter injuries are associated with extensive soft tissue injury, life- and limb-threatening complications and long-term sequelae. While outcomes are generally good, severe injuries are at higher risk of infection and post-traumatic arthritis requiring knee arthroplasty. This article considers the anatomy, diagnosis and evidence-based management strategies for tibial plateau fracture.

scholarly journals The Application of 3D Printing Technology in the Classification and Preoperative Planning of Complex Tibial Plateau Fractures

2021 ◽  
Author(s):  
Fuyang Chen ◽  
Chenyu Huang ◽  
chen ling ◽  
Jinming Zhou ◽  
Yufeng Wang ◽  
...  
Keyword(s):  
3D Printing ◽  
Tibial Plateau ◽  
3D Model ◽  
Preoperative Planning ◽  
Tibial Plateau Fracture ◽  
Tibial Plateau Fractures ◽  
Printing Technology ◽  
3D Printing Technology ◽  
Plateau Fracture ◽  
3D Printed

Abstract Background: Tibial plateau fracture is one of the common intra-articular fractures in clinic. And its accurate classification and treatment is a difficult problem for orthopedic surgeons. Our research aims to investigate the application value of 3D printing in the classification and preoperative planning of complex tibial plateau fractures.Methods: 28 cases of complex tibial plateau fractures diagnosed and treated in our hospital from January, 2017 to January, 2019.01 were analyzed. Preoperative spiral CT scan was performed and then DICOM data were input into the computer. We use Mimics to process data. And 3D printing technology was applied to print the 3D model of fracture (1:1). Combined with the 3D printed model, the tibial plateau fractures were subdivided into seven types according to the geometric plane of the tibial plateau. The surgical approach was determined on the 3D printed model. And then simulated operations such as accurate reduction of fracture and selection of plate placement were performed.Results: The reconstructed 3D model of tibial plateau fracture can accurately reflect the direction of fracture components displacement and the degree of plateau collapse. Also, it can help with the preoperative reconstructive plan for the tibial plateau fracture. The intraoperative fracture details were basically the same as the 3D printed model. And The fracture surface of the tibial plateau of all 28 patients was well improved in terms of restoring the anatomical structure.Conclusion: 3D printing technology can be used to guide the classification and preoperative planning of complex tibial plateau fractures.

scholarly journals An unusual shear type variant of tibial plateau fracture—A case report

Injury Extra ◽  
2006 ◽  
Vol 37 (5) ◽  
pp. 204-207 ◽  
Author(s):  
Paraskumar Mohanlal ◽  
Soosai Nathan
Keyword(s):  
Case Report ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Plateau Fracture ◽  
Shear Type

scholarly journals Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept

2019 ◽  
Vol 8 (8) ◽  
pp. 357-366 ◽  
Author(s):  
B-B. Zhang ◽  
H. Sun ◽  
Y. Zhan ◽  
Q-F. He ◽  
Y. Zhu ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Fracture Morphology ◽  
High Energy ◽  
Initial Position ◽  
Injury Mechanism ◽  
Schatzker Classification ◽  
Plateau Fracture ◽  
Fracture Assessment ◽  
The Right

Objectives CT-based three-column classification (TCC) has been widely used in the treatment of tibial plateau fractures (TPFs). In its updated version (updated three-column concept, uTCC), a fracture morphology-based injury mechanism was proposed for effective treatment guidance. In this study, the injury mechanism of TPFs is further explained, and its inter- and intraobserver reliability is evaluated to perfect the uTCC. Methods The radiological images of 90 consecutive TPF patients were collected. A total of 47 men (52.2%) and 43 women (47.8%) with a mean age of 49.8 years (sd 12.4; 17 to 77) were enrolled in our study. Among them, 57 fractures were on the left side (63.3%) and 33 were on the right side (36.7%); no bilateral fracture existed. Four observers were chosen to classify or estimate independently these randomized cases according to the Schatzker classification, TCC, and injury mechanism. With two rounds of evaluation, the kappa values were calculated to estimate the inter- and intrareliability. Results The overall inter- and intraobserver agreements of the injury mechanism were substantial (κinter = 0.699, κintra = 0.749, respectively). The initial position and the force direction, which are two components of the injury mechanism, had substantial agreement for both inter-reliability or intrareliability. The inter- and intraobserver agreements were lower in high-energy fractures (Schatzker types IV to VI; κinter = 0.605, κintra = 0.721) compared with low-energy fractures (Schatzker types I to III; κinter = 0.81, κintra = 0.832). The inter- and intraobserver agreements were relatively higher in one-column fractures (κinter = 0.759, κintra = 0.801) compared with two-column and three-column fractures. Conclusion The complete theory of injury mechanism of TPFs was first put forward to make the TCC consummate. It demonstrates substantial inter- and intraobserver agreement generally. Furthermore, the injury mechanism can be promoted clinically. Cite this article: B-B. Zhang, H. Sun, Y. Zhan, Q-F. He, Y. Zhu, Y-K. Wang, C-F. Luo. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res 2019;8:357–366. DOI: 10.1302/2046-3758.88.BJR-2018-0331.R1.

scholarly journals Open posterior dislocation of the knee with rupture of the patellar tendon and a tibial plateau fracture

2010 ◽  
Vol 2 (1) ◽  
pp. 7 ◽  
Author(s):  
Mohammed Fahd Amar ◽  
Badr Chbani ◽  
Oussama Ammoumri ◽  
Amine Marzouki ◽  
Fawzi Boutayeb
Keyword(s):  
Patellar Tendon ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Tissue Injury ◽  
Full Range ◽  
Soft Tissue Injury ◽  
Knee Dislocation ◽  
High Energy ◽  
Plateau Fracture ◽  
Posterior Knee

Knee dislocations are rare injuries. They represent a severe soft tissue injury following high-energy blunt trauma. We report a case of open posterior knee dislocation with rupture of the patellar tendon and a fracture of the tibial plateau. The treatment was surgical and consisted of reduction of the knee dislocation, fixation of the tibial plateau fracture by lag screws, and transosseous sutures for the patellar tendon protected by a patellotibial cerclage. The result was successful with full range of motion.

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 application of 3D printing technology in the classification and preoperative planning of complex tibial plateau fractures

2021 ◽  
Author(s):  
Fuyang Chen ◽  
Chenyu Huang ◽  
Chen Ling ◽  
Jinming Zhou ◽  
Yufeng Wang ◽  
...  
Keyword(s):  
3D Printing ◽  
Tibial Plateau ◽  
3D Model ◽  
Preoperative Planning ◽  
Tibial Plateau Fracture ◽  
Tibial Plateau Fractures ◽  
Printing Technology ◽  
3D Printing Technology ◽  
Plateau Fracture ◽  
3D Printed

Abstract Background: Tibial plateau fracture is one of the common intra-articular fractures in clinic. And its accurate classification and treatment is a difficult problem for orthopedic surgeons. Our research aims to investigate the application value of 3D printing in the classification and preoperative planning of complex tibial plateau fractures.Methods: 28 cases of complex tibial plateau fractures diagnosed and treated in our hospital from January, 2017 to January, 2019.01 were analyzed. Preoperative spiral CT scan was performed and then DICOM data were input into the computer. We use Mimics to process data. And 3D printing technology was applied to print the 3D model of fracture (1:1). Combined with the 3D printed model, the tibial plateau fractures were subdivided into seven types according to the geometric plane of the tibial plateau. The surgical approach was determined on the 3D printed model. And then simulated operations such as accurate reduction of fracture and selection of plate placement were performed.Results: The reconstructed 3D model of tibial plateau fracture can accurately reflect the direction of fracture components displacement and the degree of plateau collapse. Also, it can help with the preoperative reconstructive plan for the tibial plateau fracture. The intraoperative fracture details were basically the same as the 3D printed model. And The fracture surface of the tibial plateau of all 28 patients was well improved in terms of restoring the anatomical structure.Conclusion: 3D printing technology can be used to guide the classification and preoperative planning of complex tibial plateau fractures.

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