The Tibial Plateau Map: Fracture Line Morphology of Intra-Articular Proximal Tibial Fractures

The purpose of this study was to characterize the patterns of a large series of tibial plateau fractures with the use of fracture mapping, with regard to different fracture types using the OTA/AO and Schatzker classification. Patients with intra-articular fractures of the tibial plateau were evaluated, using the OTA/AO and Schatzker classification on CT scans. For fracture mapping, the axial slice that completely displayed the tibial joint plane was first identified, then matched to a template congruently, and the fracture lines were identified and reproduced. In addition to epidemiological data (age and gender), the trauma mechanism (high-energy, low-energy, and pathological fracture) was recorded. In total, 271 patients with 278 intra-articular fractures of the tibial head were analyzed, including seven patients with both sides affected. The mean age was 49.1 years (men 46.3 years, women 53.5 years). The majority of fractures was caused by high-energy trauma. No significant difference could be shown with respect to trauma mechanism and resulting fracture type in terms of OTA/AO ( p = 0.352 ) or Schatzker classification ( p = 0.884 ). A significant difference could be found with respect to gender and resulting fracture type in terms of OTA/AO ( p = 0.031 ). 170 (61.2%) were OTA/AO type B fractures, and 108 (38.8%) were type C fractures. Using the Schatzker classification, we found 53 type I (19.1%), 60 type II (21.6%), 27 type III (9.7%), 32 type IV (11.5%), 16 type V (5.8%), and 90 type VI (32.4%) fractures. The main affection was found in the lateral and intermedial column of the tibial plateaus, concerning both OTA/AO and Schatzker classification. The variability of intra-articular tibial head fractures is very high. In consequence, an individual analysis of fracture patterns and therapy planning by using CT scans is crucial.

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How Did the Restrictions Effect the Orthopaedic Trauma Surgery During Covid-19 Pandemic at a Level 1 Tertiary Trauma Hospital?

10.21203/rs.3.rs-102396/v1 ◽

2020 ◽

Author(s):

Bulent Kilic ◽

Deniz Gulabi ◽

Anıl Agar ◽

Halil Buyukdogan ◽

Adem Sahin ◽

...

Keyword(s):

Trauma Surgery ◽

High Energy ◽

Control Group ◽

Time Interval ◽

Orthopaedic Trauma ◽

Fracture Type ◽

Trauma Mechanism ◽

Number Of Patients ◽

Significant Difference ◽

Fracture Types

Abstract BackgroundThe aim of the study was to evaluate and compare the demographic characteristics, the trauma mechanism, and fracture types between patients under 20 years of age, 20-65 years of age, and over 65 years of age between the COVID-19 pandemic and the pre-pandemic period.MethodsPatients who were hospitalized and treated for orthopedic treatment between 10 March and 1 June during the pandemic period were retrospectively analyzed. Control group consisted of patients admitted to the hospital in the same time interval in 2019.The patients were divided into three groups, under 20 years of age, between 20-65 years of age, and over 65 years of age. The patients’ data included age, gender, trauma mechanism, fracture type, any COVID-19 radiological or clinical symptoms.ResultsThe number of patients > 65 years old admitted to orthopaedic trauma center were high at pandemic interval compared to pre-pandemic time. When the groups were compared for patients of 20-65 years old; there was a significant difference for the fracture type (p<0.05). Lower extremity fractures were high at pre-pandemic group whereas multiple traumas were high at pandemic group. For sub-group 20-65 ages, low energy traumas were higher at pre-pandemic group whereas high energy traumas were more frequent at pandemic group.ConclusionWe observed a decrease in fracture admission to ortopaedic trauma centers during COVID-19 pandemic for subgroups of < 20 years old and 20-65 years old ages, whereas there was a significant increase for > 65 years old age, most of them related to the osteoporotic hip fractures. So that older age group should be encouraged to mobilized at home and have permission to walk and make physical activity to avoid osteoporosis for a limited time daily.

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Various modalities of treatment of proximal tibial fractures: a prospective longitudinal study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20170784 ◽

2017 ◽

Vol 3 (2) ◽

pp. 259

Author(s):

Yash B. Rabari ◽

Ashish M. Somanni ◽

D. V. Prasad ◽

Krunal H. Thadeshwar

Keyword(s):

Tibial Plateau ◽

Road Traffic ◽

Tibial Plateau Fractures ◽

Clear Understanding ◽

Fracture Type ◽

Prospective Longitudinal Study ◽

Articular Fractures ◽

Tibial Condyle ◽

Schatzker Classification ◽

Prospective Longitudinal

Background: Tibial plateau fractures are one of the commonest intra-articular fractures. They result from indirect coronal or direct axial compressive forces. This makes about 1% of all fractures and 8% of the fractures in elderly. Nevertheless, tibial plateau fractures challenging remain because of their number, variety and complexity. With advancements the treatment of each fracture type is still not defined hence we have taken up this study to analyze various fracture patterns and its outcome.Methods: The study includes 40 patients having the fractures of the proximal tibial metaphyseal; metaphyseodiaphyseal with or without intra-articular extension (including upper third fractures of tibia), closed fractures, fractures with Open grade-I wounds (Gustillo Anderson Classification).The study excludes compound fractures having grade II and III (Gustillo Anderson) and Paediatric patients. The treatment method was based on the type of fracture, the amount of displacement , the amount of depression and surrounding skin condition of the tibial plateau. We used the Schatzker classification because it is closest to describing the specific fracture type and it is easy to apply.Results: In this study there were 40 patients with mean age of 39.18 (median 38.5 and min – max 25 to 55) with 25 male (62.5%) and 15 (37.5%) female with significant male preponderance. In this study road traffic accident was the commonest mode of injury (65%) and produced different types of fractures, followed by fall from height (22.5%), injury while playing sports (12.5%).Conclusions: The correct method of management of tibial condylar fractures depends on good clinical judgment. If rational treatment is to be instituted the surgeon must have sound knowledge of the personality of the injury and a clear understanding of the knee examination, imaging studies and must be familiar with variety of techniques available at present for treating tibial condyle fractures.

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Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

10.21203/rs.3.rs-33674/v2 ◽

2020 ◽

Author(s):

Yilun Yao ◽

Xiaoshu Wu ◽

Lei Wu ◽

Lei Yang ◽

Chunzhi Jiang ◽

...

Keyword(s):

Tibial Plateau ◽

Clinical Analysis ◽

Tibial Plateau Fractures ◽

Artery Injury ◽

Type Iv ◽

Schatzker Type ◽

Schatzker Classification ◽

Tibial Head ◽

Type V

Abstract Background To explore the association between the classification for tibial plateau fractures (TPF) and the popliteal artery injury (PAI).Methods 22 TPF patients accompanied by PAI who were treated from May 2012 to July 2019 were retrospectively analyzed. There were 19 males and 3 females with an average age of 49.43 years. The Schatzker classification and three-column classification were performed for TPF. The severity of extremity injury was evaluated using the mangled extremity severity score (MESS). Except 3 patients treated with amputation, the remaining patients underwent surgical repair of popliteal artery and fracture external fixation. The outcome was evaluated using the Rasmussen score for tibial head fractures.Results There were 10 cases of Schatzker type IV fractures, 1 case of type V fractures and 11 cases of type VI fractures. Based on the three-column classification, the posterior column was involved in 22 cases, 2 columns in 15 cases and 3 columns in 6 cases. The MESS was 6-10 points, with an average of 7.59 points. Except 1 case directly receiving amputation, 3 cases of segment P1 injury was observed via preoperative DSA + intraoperative exploration, while segment P2 in 6 cases and segment P3 in 12 cases. Popliteal artery was found completely ruptured in 11 cases, partially ruptured in 1 case, and severely contused with thrombosis in 10 cases. The Rasmussen score was given to 19 patients at the last follow-up, except for the cases undergoing amputation. The outcome was satisfied in 14 cases, unsatisfied in 5 cases.Conclusion: In patients with complex TPF, the risk of PAI becomes higher with the increase of Schatzker classification level. Knee CT scan is helpful in determining the severity of fractures and evaluating PAI. Based on the three-column classification, PAI should be suspected when the fractures involve the medial and posterior column.PAI is mainly in the segment P3, and artery rupture or severe contusion with extensive thrombosis may occur.

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Tibial plateau fracture: anatomy, diagnosis and management

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0339 ◽

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.

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Arthroscopically assisted evaluation of frequency and patterns of meniscal tears in operative tibial plateau fractures: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02265-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xiangtian Deng ◽

Hongzhi Hu ◽

Yuchuan Wang ◽

Decheng Shao ◽

Yingze Zhang

Keyword(s):

Tibial Plateau ◽

Tibial Plateau Fractures ◽

Meniscal Tears ◽

Time Of Surgery ◽

Fracture Patterns ◽

Significant Difference ◽

Schatzker Classification ◽

The Status ◽

Arthroscopically Assisted ◽

Arthroscopic Examination

Abstract Background Despite tibial plateau fractures are often associated with meniscal tears, the association between meniscal tears and Schatzker classification remains unclear. The purpose of this study was to assess the frequency and patterns of meniscal tears in operatively treated tibial plateau fractures following immediate arthroscopic evaluation after internal fixation of tibial plateau fractures and to reveal the association between these concomitant meniscal tears and Schatzker classification. Methods A total of 252 consecutive patients (166 males and 86 females, mean age 46.7 (19–80) years) with operatively treated tibial plateau fractures admitted to our hospital from January 2016 to May 2019 were performed. Arthroscopic examination for frequency and patterns of meniscal tears was evaluated and documented at the time of surgery, and the association between the frequency and patterns of meniscal tears with Schatzker classification was then analyzed. Results The overall frequency of meniscal tears in TPFs was 67% (168 of 252) with 33% (84 of 252) of these being lateral meniscal tears, and 10% (26 of 252) medial meniscal tears, while 23% (58 of 252) had bilateral meniscal tears. Schatzker II was most commonly associated with meniscal tears, occurring in 72% (71 of 99) of our series. There is no significant difference between the frequency of meniscal tears and Schatzker classification (p > 0.05). The most common patterns of meniscal tears were longitudinal tears in 23% of tibial plateau fractures (59 of 252), and it occurred at a significantly higher frequency in Schatzker II with 43% (43 of 99). Schatzker IV had significantly higher prevalence of bucket-handle tears than other fracture patterns (p < 0.05), and Schatzker VI fractures had significantly higher prevalence of complex tears than other fracture patterns (p < 0.05). For other Schatzker classification, the patterns of meniscal tears demonstrated no statistical difference (p > 0.05). Conclusion The results identified that meniscal tears are commonly seen in each Schatzker classification. Although various patterns of meniscal tears occurred in tibial plateau fractures, the most common patterns were longitudinal tears. Importantly, we suggest that the status of meniscal tears associated with TPFs should be considered at the time of surgery in addition to fracture fixation.

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Plating as an operative management of intra articular fractures of the upper end of tibia: a prospective clinical study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174718 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1223

Author(s):

Namdev Gorgile ◽

Vinod Jagtap ◽

Yash Shah ◽

Vikas Rokade ◽

Girish Bartakke

Keyword(s):

Internal Fixation ◽

Tibial Plateau ◽

High Energy ◽

Early Mobilisation ◽

Anatomical Reduction ◽

Plating Technique ◽

Knee Stiffness ◽

Articular Fractures ◽

Buttress Plate ◽

Stable Internal Fixation

Background: Tibial plateau fracture management is challenging because of the severe displacement of the bony fragments, the concomitant depression and impaction of the cancellous subchondral bone, and the inevitable associated cartilage injury.Methods: A prospective cohort study of 25 patients who suffered high energy intra-articular fractures of proximal tibia was done and they were diagnosed and classified according to Schatzker’s classification. The study was done to study the outcomes of surgical management of high energy tibial plateau fractures with buttress plate, to achieve anatomical reduction and absolute stable internal fixation to prevent malunion, to achieve early mobilisation, to prevent post-operative knee stiffness and also to determine timing of operation after trauma and sequence of fixation of bicondylar fractures. All patients were treated with open reduction and internal fixation with a buttress plate either a lateral, medial or bicondylar plating.Results: Average radio-graphic bony union time was 12 weeks. Average full weight bearing time was 13 weeks. Knee stiffness improved with physiotherapy and full range was achieved on an average in 8 weeks, mean range of movement 0-124.5º was achieved. 4 patients (16%) developed infection. Conclusions: Fractures of upper end of tibia can be treated with the plating technique, to achieve anatomical reduction and stable internal fixation with 82% good functional outcome. The plating technique facilitates early mobilisation of injured joint and attains good range of movements. Minimal mal reduction does not seem to vitiate the results. The infection rate of 16% is of concern with this procedure, but responds well to antibiotics and surgical debridement.

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

Bone and Joint Research ◽

10.1302/2046-3758.88.bjr-2018-0331.r1 ◽

2019 ◽

Vol 8 (8) ◽

pp. 357-366 ◽

Cited By ~ 7

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.

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Association of scapholunate dissociation and two-part articular fractures of the distal radius

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419826490 ◽

2019 ◽

Vol 44 (5) ◽

pp. 468-474 ◽

Cited By ~ 5

Author(s):

Grace T.W. Sun ◽

Simon B.M. MacLean ◽

Justin J. Alexander ◽

Richard Woodman ◽

Gregory I. Bain

Keyword(s):

Distal Radius ◽

Ct Scans ◽

Distal Radial Fracture ◽

Fracture Type ◽

Radial Fracture ◽

Scapholunate Dissociation ◽

Distal Radial Fractures ◽

Level Of Evidence ◽

Articular Fracture ◽

Articular Fractures

Scapholunate dissociation may occur in association with distal radial fractures and is easily missed at initial presentation. The aim of this study was to examine variances in the scapholunate distance with respect to subtypes of two-part partial articular distal radial fractures. Axial computed tomography (CT) scans of acute two-part intra-articular radial fractures were assessed retrospectively from 80 patients and compared to 20 controls. From each scan, two images were analysed to identify the scaphoid, lunate and articular fracture line in the distal radius for fracture type categorization. The images were overlaid on a standardized distal radius template and the scapholunate distance measured. Significant increase in the scapholunate distance was noted in fracture subtypes: radial styloid oblique; dorsal ulnar column; sagittal ulnar column; and volar coronal. We conclude that these findings support the need for a higher index of suspicion for scapholunate dissociation in these distal radial fracture subtypes. Level of evidence: III

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Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-200986 ◽

2021 ◽

pp. 1-9

Author(s):

Lucas Sousa Macedo ◽

Renato Polese Rusig ◽

Gustavo Bersani Silva ◽

Alvaro Baik Cho ◽

Teng Hsiang Wei ◽

...

Keyword(s):

Computed Tomography ◽

Upper Limb ◽

Computed Tomography Angiography ◽

Lower Limb ◽

High Energy ◽

Lower Limbs ◽

Added Value ◽

Vascular Lesions ◽

Limb Injuries ◽

Significant Difference

BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.

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PSIII-5 Effects of ingredient composition of oral drenches in small piglets post-farrowing on average daily gain and pre-wean mortality

Journal of Animal Science ◽

10.1093/jas/skaa054.416 ◽

2020 ◽

Vol 98 (Supplement_3) ◽

pp. 238-238

Author(s):

Olivia Harrison ◽

Samantha Tauer ◽

Brent Frederick

Keyword(s):

Birth Weight ◽

Average Daily Gain ◽

High Energy ◽

Experimental Unit ◽

Swine Industry ◽

Bioactive Proteins ◽

Randomized Design ◽

Significant Difference ◽

Key Factor ◽

Daily Gain

Abstract Number of pigs born alive has been a key factor of the increasing efficiency of the U.S. swine industry. However, with increased pigs in the uterus, birth weight has been negatively impacted, with more small or at-risk pigs being born per litter. In order to overcome these changes, a study testing three commercial oral drenches against a control to determine which would increase average daily gain and decrease preweaning mortality. In a completely randomized design, 877 one-day-old suckling pigs from a high-health farm were selected for the experiment if they appeared to be in the bottom 20% of bodyweight compared to their contemporaries. Selected pigs were given one of four drenching treatments: 1) none (control), 2) bioactive proteins (BP), 3) high energy sugars (HES), and 4) immunoglobulins (IgY). Pigs were weighed on d 1 and d 19 of age (weaning), with mortality tracked during the suckling period. Data were analyzed using SAS v 9.4 (Cary, NC), with pig as the experimental unit and an accepted alpha of 0.05. Treatment had no detected effect on birth weight, weaning weight, ADG, or mortality (P = 0.79, 0.96, 0.86, 0.38 respectively). Likewise, statistical contrasts were used to determine there was no detected impact (P > 0.10) of drench, regardless of type, compared to the control in any measured response criteria. Interesting, pigs drenched with BP or IgY had numerically lower preweaning mortality (11.2 and 11.5% respectively), than those administered the control or HES (15.4 and 15.2%, respectively). In conclusion, this experiment showed no significant difference in the performance between piglets given no product vs. those drenched with bioactive proteins, high energy sugars, or immunoglobulins. However, additional research is warranted with greater replication or disease stressors to better understand if oral drenches may improve preweaning performance or mortality in different situations.

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