scholarly journals Treatment of Isolated Posterolateral Tibial Plateau Fracture with a Horizontal Belt Plate through the Anterolateral Supra-Fibular-Head Approach

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Sunjun Hu ◽  
Shiyi Chen ◽  
Shimin Chang ◽  
Wenfeng Xiong ◽  
Rujan Tuladhar
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Plate Fixation ◽  
Weight Bearing ◽  
Case Series ◽  
Operation Time ◽  
Fibular Head ◽  
Plateau Fracture ◽  
One Year ◽  
Partial Weight

The posterolateral tibial plateau fracture was not easy to be exposed and fixed with usual techniques. The aim of this study was to investigate the biomechanical stability and clinical outcome of the isolated posterolateral tibial plateau fracture fixed with a single horizontal belt plate through the anterolateral supra-fibular-head approach. Fracture models were created by 18 synthetic tibias and fixed with three different fixation modes. Each group was fixed and tested on the loading machine, and final vertical displacement of the fragment was detected and calculated. Clinically, a retrospective analysis of 12 cases of posterolateral tibial plateau fracture from January 2013 to December 2017 was performed. There were 8 males and 4 females, aged 33-72 years, with an average age of 49.6 years. Isolated posterolateral tibial plateau fractures were identified according to preoperative X-ray and computed tomography scan. Through the modified anterolateral supra-fibular-head approach, the fracture was reduced and fixed by a prebending T-shaped distal radius plate and rafting screws, with bone substitute grafting or autogenous iliac bone implantation. Patients were followed up to a minimum one year of time period, and the outcome was evaluated clinically and radiologically. The biomechanical study shows that horizontal belt plate fixation for the isolated PL tibial plateau fracture can provide sufficient stability, allowing early knee functional exercise and partial weight bearing. For clinical case series, the average operation time in this group was 73.3 ± 10.2   mins (range: 55-90), and the average duration of hospitalization was 9.1 ± 3.3 days (range: 5-16). Patients were followed up for 12-24 months with an average of 16.5 months, and all patients achieved radiological fracture union after an average of 13.7 weeks. At one year after operation, the average knee score of the Hospital for Special Surgery (HSS) scale was 93.2 ± 4.2 points(range: 90-98), the average score of SMFA was 21.1 ± 5.6 points (range: 14-31), and the average knee range of motion (ROM) was 121.48 ° ± 8.88 ° (range: 105°-135°). There were 8 cases that were very satisfied and 3 cases that were satisfied with the operation. For an isolated posterolateral tibial plateau fracture, the supra-fibular-head approach can fully expose the fracture site; the horizontal belt plate fixation of the fracture is stable and reliable to allow for early-stage knee rehabilitation, and the outcome of medium-term clinical follow-up was satisfactory.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods: </strong>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.</p><p class="abstract"><strong>Results: </strong>In this study, for majority (51%) patients &lt;12 weeks were in needed for union. Besides these, for 23.40% and 21.28% patients, time for union were 12-14 and &gt;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.</p><p class="abstract"><strong>Conclusions:</strong> 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.  </p>

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 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 REHABILITATION OF A 60-YEAR-OLD WOMAN’S TIBIAL PLATEAU FRACTURE

2021 ◽  
Vol 10 (4) ◽  
pp. 3229-3232
Author(s):  
Mithushi Deshmukh
Keyword(s):  
Knee Joint ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Weight Bearing ◽  
Full Range ◽  
The Body ◽  
Normal Functioning ◽  
Tibial Condyle ◽  
Plateau Fracture ◽  
Condyle 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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