scholarly journals 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 ◽  
Vol 9 (8) ◽  
pp. e026962
Author(s):  
Tanguy Vendeuvre ◽  
Olivier Monlezun ◽  
Claire Brandet ◽  
Pierre Ingrand ◽  
Isabelle Durand-Zaleski ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Tibial Plateau Fractures ◽  
Plateau Fracture ◽  
Randomised Controlled ◽  
Conventional Open Surgery

IntroductionFractures 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 analysisThis 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 disseminationThis 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 numberClinicaltrial.gov:NCT03444779.

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.

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.

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 Arthroscopy-Assisted Reduction Percutaneous Internal Fixation Versus Open Reduction Internal Fixation for Tibial Plateau Fracture: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110278
Author(s):  
Liangjun Jiang ◽  
Erman Chen ◽  
Lu Huang ◽  
Cong Wang
Keyword(s):  
Systematic Review ◽  
Internal Fixation ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Open Reduction Internal Fixation ◽  
Radiological Evaluation ◽  
Plateau Fracture ◽  
Mean Differences ◽  
Percutaneous Internal Fixation

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 I 2 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; I 2 = 15%; P = .0005), shorter hospital stay (MD = –2.37; 95% CI, –2.92 to –1.81; I 2 = 0%; P < .001), and more intra-articular lesions found intraoperatively (OR = 3.76; 95% CI, 1.49 to 9.49; I 2 = 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.

scholarly journals A study of minimally invasive percutaneous plate osteosynthesis for tibial plateau fractures

2017 ◽  
Vol 4 (1) ◽  
pp. 92
Author(s):  
Ujwal S. Ramteke ◽  
Vidyadhar Telang ◽  
Nadir Shah ◽  
Ayush Singh ◽  
Hitesh Mangukiya ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Weight Bearing ◽  
Full Range ◽  
Tibial Plateau Fractures ◽  
Type I ◽  
X Rays ◽  
Age Group ◽  
Schatzker Type ◽  
Plateau Fracture

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">Fractures of proximal tibia involve a major weight-bearing joint and are serious injuries, which, if not treated well, result in functional impairment. To preserve normal knee function one must strive to maintain joint congruity, preserve the normal mechanical axis, ensure joint stability and restore a full range of motion. This is a formidable task to accomplish, especially in the face of associated medical conditions of the patients</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">In our study, 30 cases were selected. Selection of cases were done on the basis of X-rays. Schatzker type I, II, III, IV, V &amp; VI included in study. Criteria for acceptable reduction 1) &lt;5 mm of articular step; 2) &lt;5 mm of articular depression. Each case is referred to one set of tibial plateau fracture, showing distribution of tibia plateau fractures that we treated with MIPPO. Clinical follow-up examination was performed at 4, 6, 10, 12 weeks and 3, 6 months. Clinico-radiological assessment was done at 3 month and grading was done. Patients were evaluated according to grading minimum 3 months after injury</span>.</p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">Our study of 30 tibial plateau fractures confirms that the MIPPO technique is an excellent treatment modality in case of tibial plateau fractures. We observed these fractures mainly in age group of 30-40 years, which were involved in road traffic accident. Tibial plateau fractures seen in elder age group were mainly due to abnormal loading patterns on the leg. We have found oblique views very much informative especially for posterolateral or posteromedial displacement, articular depression which helps to plan the position and direction of screws to be used for fixation</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">In view of the excellent results obtained with this technique, we advocate MIPPO over conventional open reduction and internal fixation technique for tibial plateau fracture fixation</span><span lang="EN-IN">.</span></p>

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.

Sign in / Sign up

Export Citation Format

Share Document