scholarly journals Participation in Recreational Athletics After Operative Fixation of Tibial Plateau Fractures: Predictors and Functional Outcomes of Those Getting Back in the Game

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774391 ◽  
Author(s):  
David N. Kugelman ◽  
Abdullah M. Qatu ◽  
Jack M. Haglin ◽  
Sanjit R. Konda ◽  
Kenneth A. Egol
Keyword(s):  
Postoperative Complications ◽  
Alcohol Consumption ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Severe Injuries ◽  
White Race ◽  
Operative Fixation

Background: Tibial plateau fractures can be devastating traumatic injuries to the knee, particularly in active athletes. Purpose/Hypothesis: The purpose of this study was to report on the return to participation in recreational athletics after operatively managed tibial plateau fractures. In addition, this study assessed factors associated with the ability to return to participation in recreational athletics after tibial plateau fractures treated with open reduction internal fixation and compared final outcomes between patients who were able to return to recreational athletics and those who could not. The hypothesis was that returning to participation in recreational athletics would be dependent on the time from surgery after operative fixation of tibial plateau fractures. Less severe injuries would be associated with a quicker return to athletics. Study Design: Case-control study; Level of evidence, 3. Methods: All tibial plateau fractures treated by 1 of 3 surgeons at a single academic institution over an 11-year period were prospectively followed. Final outcomes were evaluated using the Short Musculoskeletal Function Assessment at latest follow-up. All complications were recorded at each follow-up. Differences between the groups were compared using Student t tests for continuous variables. Chi-square analysis was used to determine whether differences between categorical variables existed. Logistic regression was performed to assess independent variables associated with returning to participation in recreational athletics. Results: A total of 169 patients who underwent operative management of their tibial plateau fracture reported participation in recreational athletics before their injury. By the 6-month time point, 48 patients (31.6%) had returned to participation in recreational athletics, and at final follow-up (mean, 15 months), 89 patients (52.4%) had returned to participation in recreational athletics. Predictors of returning to recreational athletics included white race, female sex, social alcohol consumption, younger age, increased range of motion (ROM), low-energy Schatzker patterns (I-III), injuries not inclusive of orthopaedic polytrauma or open fractures, and no postoperative complications. White race, social alcohol consumption, and increased ROM were associated with returning to athletics at both 6-month and final follow-up. Lack of a venous thromboembolism was associated with returning to athletics at final follow-up. Patients who returned to recreational athletics had associations with better functional outcomes and emotional status than those who did not. Conclusion: The number of patients who returned to participation in recreational athletics gradually increased over time after operative fixation of tibial plateau fractures. Less severe injuries and a lack of postoperative complications were associated with a quicker return to athletics. Predictors of returning to participation in recreational athletics after operatively managed tibial plateau fractures can be used to target patients at risk of not returning to play to provide interventions aimed at improving their recovery, such as early knee range of motion, muscle strengthening, and participation in low-impact activities.

A Comparative Study of Clinical Outcomes and Functional Status after Knee Fracture and Knee Fracture Dislocation

2021 ◽  
Author(s):  
Mackenzie L Bird ◽  
Kristofer E Chenard ◽  
Leah J Gonzalez ◽  
Sanjit R Konda ◽  
Philipp Leucht ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Arterial Injury ◽  
Tibial Plateau Fractures ◽  
Knee Fracture ◽  
Plateau Fracture

AbstractThe aim of this study was to compare outcomes of tibial plateau fracture dislocations (FD) with tibial plateau fractures alone. This study was an analysis of a series of tibial plateau fractures, in which FD was defined as a fracture of the tibial plateau with an associated loss of congruent joint reduction and stability of the knee, and classified by the Moore system. Patient data collected included demographics, injury information, and functional outcomes (short musculoskeletal function assessment [SMFA] score and Pain by the visual analog scale). Clinical outcomes at follow-up were recorded including knee range of motion, knee stability and development of complications. There were a total of 325 tibial plateau fracture patients treated operatively, of which 22.2% were identified as FD (n = 72). At injury presentation there was no difference with regard to nerve injury or compartment syndrome (both p > 0.05). FD patients had a higher incidence of arterial injury and acute ligament repair (both p < 0.005). At a mean follow-up of 17.5 months, FD patients were similar with regard to pain, total SMFA scores, and return to sports than their non-FD counterparts (p = 0.884, p = 0.531, p = 0.802). FD patients were found to have decreased knee flexion compared with non-FD patients by 5 degrees (mean: 120 and 125 degrees) (p < 0.05). FD patients also had a higher incidence of late knee instability and subsequent surgery for ligament reconstruction (p < 0.005 & p < 0.05). However, there was no difference in neurological function between groups at follow-up (p = 0.102). Despite the higher incidence of ligamentous instability and decreased range of motion, FD patients appear to have similar long-term functional outcomes compared with non-FD of the tibial plateau. While FD patients initially presented with a higher incidence of arterial injury, neurovascular outcomes at final follow-up were similar to those without a dislocation.

scholarly journals Comparison of Functional Outcomes of Tibial Plateau Fractures Treated with Nonlocking and Locking Plate Fixations: A Nonrandomized Clinical Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Mohammad Ali Tahririan ◽  
Seyyed Hamid Mousavitadi ◽  
Mohsen Derakhshan
Keyword(s):  
Functional Outcomes ◽  
Tibial Plateau ◽  
Locking Plate ◽  
Plate Fixation ◽  
Tibial Plateau Fractures ◽  
Plate Method ◽  
Plate Group ◽  
Plateau Fracture ◽  
The Mean

Fixation of tibial plateau fractures with plate has been widely used. This prospective study was planned to compare locking plate fixation of tibial plateau fracture with nonlocking methods in terms of their functional outcomes. The subjects of the study were selected from consecutive patients suffering from tibial plateau fractures referred to Kashani Hospital in Isfahan, Iran, between 2012 and 2013 and were candidate for surgery. The final included patients were assigned to two groups, those who were treated with locking plate (n=20) and those who were treated with nonlocking plates (N=21). The mean duration of follow-up was 13.4 months (ranging between 10 and 17 months). The mean of knee scores was significantly higher in locking plate group than in nonlocking plate group at the follow-up time (80.20±10.21 versus 72.52±14.75, P=0.039). Also, the mean VAS pain severity score was significantly lower in locking plate group compared with nonlocking plate group (4.45±2.50 versus 6.00±2.59, P=0.046). This study confirmed superiority of the locking plate method over nonlocking plate method with regard to knee score as well as VAS pain score.

scholarly journals Treatment of Posterolateral Tibial Plateau Fractures With a Rotational Support Plate and Special Pressurizer: a Technical Note and 12 Cases 

2021 ◽  
Author(s):  
Yu-Feng Chen ◽  
Dong Ren ◽  
Lin-Dan Geng ◽  
Shuang-Quan Yao ◽  
Zhao-Hui Song ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Surgical Approaches ◽  
Bony Union ◽  
Anterolateral Approach ◽  
X Rays ◽  
Postoperative Rehabilitation ◽  
Support Plate

Abstract Background: Posterolateral tibial plateau fractures are uncommon fractures and challenging to treat. Although there are many surgical approaches and fixation methods for the treatment of these fractures, all of these methods have limitations. We designed a new rotational support plate (RSP) and a special pressurizer that can fix the fracture directly via the anterolateral approach. This method is advantageous because it leads to little trauma, involves a simple operation and has a reliable fixation effect. This study details the technique of treating these fractures with the RSP and special pressurizer and provides the outcomes.Methods: From May 2016 to January 2019, the data of 12 patients with posterolateral tibial plateau fractures treated with the RSP and special pressurizer in our hospital were retrospectively analysed. Postoperative rehabilitation was advised, knee X-rays were taken at follow-ups, and fracture healing, complications, and knee range of motion were assessed. The Hospital for Special Surgery (HSS) knee score was used to evaluate knee function at the last follow-up.Results: The average follow-up time of all patients was 16.5 months (range, 12-25 months). The average bony union time was 3.2 months (range, 3-4.5 months). At the last follow-up, the average knee range of motion was 138° (range, 107°-145°). The average HSS score was 91 (range, 64-98). Skin necrosis, incision infections, and fixation failure did not occur during the follow-up period.Conclusions: With our newly designed RSP and special pressurizer, posterolateral tibial plateau fractures can be easily and effectively reduced and fixed through the anterolateral approach, which serves as a novel treatment for posterolateral tibial plateau fractures.

scholarly journals Three-column Subdivision for Isolated Posterolateral Tibial Plateau Fractures and Perspective Surgical Approachs

2021 ◽  
Author(s):  
Jae Ang Sim ◽  
Ji Hyeon Park ◽  
Young Gon Na ◽  
Byung Hoon Lee
Keyword(s):  
Range Of Motion ◽  
Surgical Approach ◽  
Postoperative Period ◽  
Supine Position ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Surgical Approaches ◽  
Anterolateral Approach ◽  
Plateau Fracture

Abstract BackgroundManagement of the tibial plateau fracture involving posterolateral compartment is technically challenging. This study aimed to introduce a computed tomography-based classification of the posterolateral compartment of tibial plateaus based on the fibula and to propose the individualized surgical approaches for each zone; and 2) to determine the surgical approach based on the classification, would achieve a safe and effective reduction and can improve postoperative clinical outcomes.MethodsEighteen cases of tibia plateau fracture involved the isolated posterolateral compartment in a single institution were retrospectively analyzed. The posterolateral compartment of tibial plateau was segmented into three zones based on the fibular position and individualized surgical approach was proposed for each zone. In anterior Zone I, surgical treatment was performed using an extended anterolateral approach and patient was placed in the supine position; In middle Zone II, using the transfibular approach in the supine position; In posterior Zone III, using the posteromedial approach in prone. Articular reduction (intra-articular step off in CT images) and mechanical medial proximal tibial angle (mMPTA) in simple radiographs taken in the immediate postoperative period and clinical outcomes of the Lysholm knee scoring scale and range of motion were evaluated at postoperative 1-year follow-up,ResultsIn all cases, anatomical articular reduction (intra-articular step off < 2 mm) was achieved, maintained for the follow-up period. The average mMPTA was increased from 87.6º before surgery to 88.2º in immediate postoperative period (p = 0.060), and maintained for the follow-up period (mean 89.9º at one-year follow-up). At the 1-year follow-up, the knee range of motion averaged 140 degrees and the Lysholm knee function scored 95.0 points.ConclusionAn individualized surgical approach and fixation according to three-zone subdivision for isolated posterolateral tibial plateau fractures provided an effective and safe method to treat posterolateral tibial plateau fractures.Level of evidence: Therapeutic study, IV

scholarly journals Treatment of posterolateral tibial plateau fractures with a rotational support plate and special pressurizer: technical note and retrospective case series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu-Feng Chen ◽  
Dong Ren ◽  
Lin-Dan Geng ◽  
Shuang-Quan Yao ◽  
Zhao-Hui Song ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tibial Plateau ◽  
Case Series ◽  
Tibial Plateau Fractures ◽  
Surgical Approaches ◽  
Bony Union ◽  
Anterolateral Approach ◽  
X Rays ◽  
Support Plate

Abstract Background In tibial plateau fractures, the posterolateral segment of the tibia plateau is frequently affected and challenging to treat. Although there are many surgical approaches and fixation methods for the treatment of these fractures, all of these methods have limitations. We designed a new rotational support plate (RSP) and a special pressurizer that can fix the fracture directly via the anterolateral approach. This method is advantageous because it leads to little trauma, involves a simple operation, and has a reliable fixation effect. This study details the technique of treating these fractures with the RSP and special pressurizer and provides the outcomes. Methods From May 2016 to January 2019, the data of 12 patients with posterolateral tibial plateau fractures treated with the RSP and special pressurizer in our hospital were retrospectively analyzed. Postoperative rehabilitation was advised, knee X-rays were taken at follow-ups, and fracture healing, complications, and knee range of motion were assessed. The Hospital for Special Surgery (HSS) knee score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to evaluate knee function at the last follow-up. Results The average follow-up time of all patients was 16.5 months (range, 12–25 months). The average bony union time was 3.2 months (range, 3–4.5 months). At the last follow-up, the average knee range of motion was 138° (range, 107–145°). The average HSS score was 91 (range, 64–98). The average KOOS Symptoms score was 90 (range, 75–96). The average KOOS Pain score was 91 (range, 72–97). The average KOOS ADL score was 91 (range, 74–97). The average KOOS sport/recreation score was 83 (range, 70–90). The average KOOS QOL score was 88 (range, 69–93). Skin necrosis, incision infections, and fixation failure did not occur during the follow-up period. Conclusions With our newly designed RSP and special pressurizer, posterolateral tibial plateau fractures can be easily and effectively reduced and fixed through the anterolateral approach, which serves as a novel treatment for posterolateral tibial plateau fractures.

scholarly journals Three-column Subdivision for Isolated Posterolateral Tibial Plateau Fractures and Perspective Surgical Approachs

2020 ◽  
Author(s):  
Jae Ang Sim ◽  
Ji Hyeon Park ◽  
Young Gon Na ◽  
Byung Hoon Lee
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Surgical Approach ◽  
Postoperative Period ◽  
Supine Position ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Anterolateral Approach ◽  
Plateau Fracture

Abstract Background: Management of the tibial plateau fracture involving posterolateral compartment is technically challenging. This study aimed to introduce a computed tomography-based classification of the posterolateral compartment of tibial plateaus based on the fibula and to propose the individualized surgical approaches for each zone; and 2) to determine the surgical approach based on the classification, would achieve a safe and effective reduction and can improve postoperative clinical outcomes.Methods: Eighteen cases of tibia plateau fracture involved the isolated posterolateral compartment in a single institution were retrospectively analyzed. The posterolateral compartment of tibial plateau was segmented into three zones based on the fibular position and individualized surgical approach was proposed for each zone. In anterior Zone I, surgical treatment was performed using an extended anterolateral approach and patient was placed in the supine position; In middle Zone II, using the transfibular approach in the supine position; In posterior Zone III, using the posteromedial approach in prone. Articular reduction (intra-articular step off in CT images) and mechanical medial proximal tibial angle (mMPTA) in simple radiographs taken in the immediate postoperative period and clinical outcomes of the Lysholm knee scoring scale and range of motion were evaluated at postoperative 1-year follow-up,Results: In all cases, anatomical articular reduction (intra-articular step off < 2mm) was achieved, maintained for the follow-up period. The average mMPTA was increased from 87.6º before surgery to 88.2º in immediate postoperative period (p = 0.060), and maintained for the follow-up period (mean 89.9º at one-year follow-up). At the 1-year follow-up, the knee range of motion averaged 140 degrees and the Lysholm knee function scored 95.0 points.Conclusion: An individualized surgical approach and fixation according to three-zone subdivision for isolated posterolateral tibial plateau fractures provided an effective and safe method to treat posterolateral tibial plateau fractures. Level of evidence: Therapeutic study, IV

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

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.

scholarly journals Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not have Worse Radiological and Functional Outcomes than Accidental Fallers

2020 ◽  
Author(s):  
Yi-Hsun Yu ◽  
Ying-Chao Chou ◽  
Yung-Heng Hsu ◽  
I-Jung Chen ◽  
Lien-Chung Wei
Keyword(s):  
Functional Outcomes ◽  
Injury Severity ◽  
Adjustment Disorder ◽  
Acetabular Fractures ◽  
Clinical Parameters ◽  
Severe Injuries ◽  
Severity Scores ◽  
Surgical Treatments ◽  
Major Diagnosis

Abstract Background: Individuals who fell from heights of >6 m accidentally or intentionally can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods: Between 2014 and 2017, individuals who fell from heights of >6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments were enrolled. The fallers were divided into the intentional and accidental fallers, and their clinical parameters were statistically evaluated and compared.Results: Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. Conclusions: The intentional fallers with pelvic and acetabular fractures might be accompanied by more severe injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers.

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