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

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.

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

10.21203/rs.3.rs-300168/v1 ◽

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.

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

10.21203/rs.3.rs-141481/v1 ◽

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

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

10.21203/rs.3.rs-33677/v1 ◽

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

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Treatment of Tibial Plateau Fractures Involving Posterolateral Column Through the Extended Anterolateral Approach

10.21203/rs.3.rs-198072/v1 ◽

2021 ◽

Author(s):

Wenwen Mao ◽

Li Li ◽

Gang Chen ◽

Ming Zhang ◽

Yousen Zhu ◽

...

Keyword(s):

Tibial Plateau ◽

Stress Test ◽

Locking Compression Plate ◽

Tibial Plateau Fractures ◽

Anterolateral Approach ◽

Type Ii ◽

Schatzker Type ◽

Compression Plate ◽

Type V

Abstract ObjectiveTo summarize the surgical technique and the clinical effects of extended anterolateral approach for the treatment of Schatzker type II and Schatzker type V/VI which involving the posterolateral column tibial plateau.MethodsFrom January 2015 through December 2018, a total of 28 patients with tibial plateau fracture involving posterolateral column were included in this study. Among them, 16 patients were Schatzker type II treated via extended anterolateral approach with lateral tibial locking compression plate fixation.12 patients were Schatzker type V or VI treated via extended anterolateral combine with medial approach by lateral tibial locking compression plate plus medial locking compression plate fixation. All cases were followed up for 15~31 months, with an average follow‐up of 22.5±3.7 months. During the follow-up, the tibial plateau angle (TPA), lateral posterior angle (PA) and Rasmussen radiological criteria were used to evaluate the effect of fracture reduction and fixation; the Hospital for Special Surgery (HSS) and the range of motion were used to evaluate knee function; the Lachman and knee Valgus (Varus) stress test were used to evaluate anteroposterior and lateral stability of the knee.ResultsAll fractures healed. At the 12-month follow-up: in Schatzker type II group a mean TPA of 86.38±3.92°, a mean PA of 7.43±2.68°, and Rasmussen radiological score with an average of 16.00±2.06 points, scores were excellent in 6 cases and good in 10 cases, as a result the excellent and good rate was 100%; while in in Schatzker type V/VI group a mean TPA of 84.91±3.51°, a mean PA of 9.68±4.01°, and Rasmussen radiological score with an average of 15.33±2.99 points, scores were excellent in 4 cases and good in 6 cases, as a result the excellent and good rate was 83.33%. During the one-year follow-up, when re-measured postoperative PA, TPA, Rasmussen score of the two groups did not change significantly (P > 0.05). At the last follow‐up, in Schatzker type II group, the the knee flexion angle was 110° ~135°, with an average of 125°±8.56°,a mean of HHS score 88.37±10.01 points, scores were excellent in 9 cases and good in 5 cases, as a result the excellent and good rate was 100%; in Schatzker type V/VI group, the the knee flexion angle was 100° ~130°, with an average of 120°±11.25°,a mean of HHS score 82.17±10.76 points, scores were excellent in 5 cases and good in 3 cases, as a result the excellent and good rate was 66,67%.In addition, up to the last follow-up, Lachman and knee Valgus (Varus) stress test results of the two groups were negative. No complications were found.ConclusionsAlthough there are many ways to treat posterolateral tibial plateau fractures, When choosing one or more combined approach, we must consider the condition of soft tissue injury, the shape of the whole platform fracture including the posterolateral bone block and the available fixation methods. The best approaches should provide maximum exposure of the platform, enough space for reduction and fixation, and minimum damage to the surrounding structures. For anterolateral platform fractures combine with isolated posterolateral fracture fragments, the extended anterolateral approach is more suitable as a single approach. For multiple column tibial plateau fractures a dual approach (extended anterolateral combined with medial approach) can be used to enter the whole plateau area.

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Arthroscopic-Guided Balloon Tibioplasty in Schatzker III Tibial Plateau Fracture

Joints ◽

10.1055/s-0039-1697607 ◽

2018 ◽

Vol 06 (04) ◽

pp. 220-227 ◽

Cited By ~ 1

Author(s):

Fabrizio Cuzzocrea ◽

Eugenio Jannelli ◽

Alessandro Ivone ◽

Simone Perelli ◽

Alberto Fioruzzi ◽

...

Keyword(s):

Ct Scan ◽

Tibial Plateau ◽

Case Series ◽

Clinical Score ◽

Joint Surface ◽

X Rays ◽

Level Of Evidence ◽

Significant Difference ◽

The Mean

Abstract Purpose The study aims to present the results at a mean 28-months follow-up of arthroscopic-guided balloon tibioplasty and to spot some technical tricks and some practice using tools and materials. Methods The study relates to six patients with tibial plateau fractures type Schatzker III with tibial plateau depression more than 4 mm at preoperative computed tomography scan (CT-scan). The follow-up period ranged from 22 to 33 months, with a mean of 28 months. No patients were lost to follow-up. The patients were evaluated clinically using the Rasmussen score system and Lysholm score systems at 6 to 12 and 24 months, postoperatively. Radiographic evaluations (standard X-rays) were done preoperatively at 1, 3, and 12 months postoperatively while a CT-scan with 3D reconstruction was performed preoperatively, at the first day and 6 months, postoperatively. Results The mean Rasmussen clinical score at 6 months postoperatively was 26.3 while at 1-year postoperatively the mean Rasmussen clinical score was 28.33. At 2-year postoperatively the mean Rasmussen clinical score was 28.83. Statistically significant difference was found in 6-months and 2-years results (p < 0.05). CT-scan achieved the first postoperative day showed the recovery of approximately 70% of the area of the interested tibial plateau, restoring of the joint surface without articular bone free fragments. Conclusion The described surgical procedure, if correctly performed with proper indications (Schatzker III), respect the principles mentioned above and the clinical and radiological results confirm our purpose. Level of Evidence This is a therapeutic case series, level IV study.

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A new anterolateral surgical approach for total hip replacement

Joints ◽

10.11138/jts/2016.4.3.148 ◽

2016 ◽

Vol 04 (03) ◽

pp. 148-152

Author(s):

Giovanni Grano ◽

Maria Pavlidou ◽

Alberto Todesco ◽

Augusto Palermo ◽

Luigi Molfetta

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Case Series ◽

Hip Dislocation ◽

Harris Hip Score ◽

Anterolateral Approach ◽

X Rays ◽

Level Of Evidence ◽

Total Hip

Purpose: the purpose of the present paper is to present the short-term results of a “detachment-free” (DF) anterolateral approach for primary total hip replacement (THR) performed in a large series of patients. Methods: two hundred patients submitted to primary THR were retrospectively reviewed for the present study. In all cases, the surgery was performed using a minimally invasive DF anterolateral approach, which entails no disconnection of tendons and no muscle damage. The study population consisted of 96 men (48%) and 104 women (52%), with an average age of 69.4 years (range 38-75). Clinical and radiographic follow-up was performed after 12 months. Results: the clinical results, evaluated using the Harris Hip Score, were excellent in 95% of the cases and good in 5%; no cases had fair or poor results. X-rays taken at 3, 6 and 12 months after surgery did not show heterotopic ossification, mobilization of the prosthetic components, or hip dislocation. No infections, deep vein thrombosis, or failure of the gluteal muscles were reported. Conclusions: the DF anterolateral approach for THR proved safe and provided effective results at shortterm follow-up. Level of evidence: Level IV, therapeutic case series.

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Tibial plateau fractures osteosynthesis—a case series of 88 patients evaluating surgical approaches, results and complications

Annals of Joint ◽

10.21037/aoj-20-95 ◽

2021 ◽

Vol 0 ◽

pp. 0-0

Author(s):

José Lito Mónico ◽

Renato Andrade ◽

Pedro Matos ◽

Lisete Mónico ◽

João Cura Mariano ◽

...

Keyword(s):

Tibial Plateau ◽

Case Series ◽

Tibial Plateau Fractures ◽

Surgical Approaches

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Retrospective Evaluation of the Results of Arthroscopy Assisted Reduction and Osteosynthesis of Tibial Plateau Fractures and the Role of the Arthroscopy at Tibial Plateau Fractures

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00282 ◽

2014 ◽

Vol 2 (11_suppl3) ◽

pp. 2325967114S0028

Author(s):

Hasan Ozturk ◽

Mahmut Tuzlu ◽

Ahmet Savran ◽

Bayram Kose

Keyword(s):

Compartment Syndrome ◽

Tibial Plateau ◽

Plate Osteosynthesis ◽

Case Series ◽

Tibial Plateau Fractures ◽

Joint Surface ◽

Functional Score ◽

Control Group ◽

Schatzker Classification

Objectives: Aim of this study is to compare the medium and long term functional and radiological results of 31 patients with tibial plateau fractures, treated by same surgeon with arthroscopy assisted reduction and osteosynthesis between 2006 and 2013. Methods: This study is designed as evaluation of retrospective case series. 52 patients who has administered Tepecik Education and Research Hospital or Private Izmir Hospital between 2006 and 2013 with tibial plateau fracture and treated by same surgeon with arthroscopic assisted reduction and osteosynthesis is evaluated. Patients with insufficient data and cannot continue follow-up are excluded. 31 patient is included to study meeting our criteria. Injury mechanism, physical examination findings, operation records, concomitant intra articular pathologies, need for allograft or autograft and radiological investigations are retrospectively obtained from hospital medical record system. Preoperative evaluation depends on Schatzker Classification. Patients with floating knee, ipsilateral tibia diaphysis fracture, distal femoral intraarticular fracture, compartment syndrome or neurovascular injury is excluded from study. We didn’t take Schatzker Class is not an exclusion criteria. Results are investigated with Rasmussen radiological and clinical scores statistically. Results: 31 patients (23 male, 7 female) with mean age of 46,3 (min. 18- max. 67) is included our study with the mean follow-up of 45 months. Simultaneous meniscus lesion is detected in 15 patients and repair or partial meniscectomy is performed depending on the lesion. 10 patients need for allograft or autografting for joint surface restoration. Medial and/or lateral plate osteosynthesis is performed depending on fracture configuration. Final average Rasmussen functional score is calculated 25,7 and final average Rasmussen radiological score as 16,5. Secondary arthroscopic debridement is needed in 3 patients with arthrofibrosis. Conclusion: First arthroscopy assisted intra-articular fracture treatment is done in 1993 at knee joint and technique is improved with years. With the published satisfactory results of arthroscopy assisted series, current treatment of choice in tibial plateau fractures became arthroscopy assisted osteosynthesis, same as our routine application in our clinics. Advantages of arthroscopy is opportunity of treatment of concomitant intra articular pathologies, differentiation of these lesions as acute or degenerative and chronic more objective than any other imaging modality, detection of chondral injury more accurate and control of anatomical reduction of fracture lines. Downside of our study is lack of control group. Our conclusion is arthroscopy assistance in tibial plateau fractures improves results without increase in compartment syndrome or other complication rate when compared to literature.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117743916 ◽

2017 ◽

Vol 5 (12) ◽

pp. 232596711774391 ◽

Cited By ~ 4

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.

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A Novel Method of the Treatment for Posterolateral Tibial Plateau Fractures

The Journal of Knee Surgery ◽

10.1055/s-0039-1688918 ◽

2019 ◽

Vol 33 (10) ◽

pp. 1010-1019

Author(s):

Dong Ren ◽

Yueju Liu ◽

Yanxi Chen ◽

Jian Lu ◽

Zhaohui Song ◽

...

Keyword(s):

Knee Flexion ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Vertical Displacement ◽

Knee Extension ◽

Tibial Plateau Fractures ◽

Posterolateral Approach ◽

Anterolateral Approach ◽

Plateau Fracture

AbstractReduction and fixation of posterolateral tibial plateau fracture via a posterolateral approach is challenging, and the posterolateral approach itself may injure the posterolateral ligament complex of the knee and can result in knee instability. We developed a new curved support plate (CSP) that can pass, via traditional anterolateral approach, through the superior tibiofibular interval and effectively support the posterolateral fragments. The purpose of our study was to determine the biomechanical reliability of the new plate and report the preliminary efficacy of the CSP for posterolateral tibial plateau fracture. In the biomechanical experiment, 40 synthetic tibias were used to create posterolateral shearing tibial fracture models, which were randomly assigned to groups A to D. Vertical displacement of the posterolateral fragments was measured under axial loads of 500 to 1,500 N. The new plate and 3.5-mm lateral locking plate exhibited similar control over fragment displacement. From June 2016 to August 2017, eight patients with posterolateral tibial plateau fracture underwent treatment with the CSP. Hospital for Special Surgery (HSS) knee score, knee flexion and extension ranges of motion, and complications were recorded to evaluate treatment effects. Eight patients (five men and three women, mean age 44 years [range, 23–66 years]) were enrolled in the study. Mean follow-up time was 13 months (range, 7–19 months). All patients achieved radiographic bone union by 3.3 months (range, 3–4 months) postoperatively. There were no complications of neurovascular injury, deep vein thrombosis, infection, and implant loosening throughout the follow-up period. At final follow-up, mean HSS score was 92.6 (88–96), with a mean knee flexion of 131.25 degrees (120–135 degrees) and a mean knee extension of 1 degree (0–5 degrees). Fixation of posterolateral tibial plateau fracture was easily and successfully achieved using our newly designed CSP, which may provide a new choice for posterolateral tibial plateau fractures.

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