Management and incidence of tibial tubercle fractures in bicondylar fractures of the tibial plateau

Aims Tibial plateau fractures (TPFs) are complex injuries around the knee caused by high- or low-energy trauma. In the present study, we aimed to define the distribution and frequency of TPF lines using a 3D mapping technique and analyze the rationalization of divisions employed by frequently used classifications. Methods In total, 759 adult patients with 766 affected knees were retrospectively reviewed. The TPF fragments on CT were multiplanar reconstructed, and virtually reduced to match a 3D model of the proximal tibia. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a tibia template. Results The cohort included 405 (53.4%) cases with left knee injuries, 347 (45.7%) cases with right knee injuries, and seven (0.9%) cases with bilateral injuries. On mapping, the hot zones of the fracture lines were mainly concentrated around the anterior cruciate ligament insertion, posterior cruciate ligament insertion, and the inner part of the lateral condyle that extended to the junctional zone between Gerdy’s tubercle and the tibial tubercle. Moreover, the cold zones were scattered in the posteromedial fragment, superior tibiofibular syndesmosis, Gerdy’s tubercle, and tibial tubercle. TPFs with different Orthopaedic Trauma Association/AO Foundation (OTA/AO) subtypes showed peculiar characteristics. Conclusion TPFs occurred more frequently in the lateral and intermedial column than in the medial column. Fracture lines of tibial plateau occur frequently in the transition zone with marked changes in cortical thickness. According to 3D mapping, the four-column and nine-segment classification had a high degree of matching as compared to the frequently used classifications. Cite this article: Bone Joint Res 2020;9(6):258–267.

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Closed infected tibial plateau fracture and tibial tubercle avulsion: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2020.06.096 ◽

2020 ◽

Vol 72 ◽

pp. 624-627

Author(s):

Chaiwat Chuaychoosakoon ◽

Wachiraphan Parinyakhup

Keyword(s):

Case Report ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Tibial Tubercle ◽

Plateau Fracture

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Tratamiento de las fracturas complejas de platillo tibial con compromiso de la tuberosidad anterior de la tibia.[Treatment of complex tibial plateau fracture associated with anterior tibial tubercle involvement].

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

10.15417/issn.1852-7434.2018.83.4.831 ◽

2018 ◽

Vol 83 (4) ◽

pp. 268-273

Author(s):

Sebastián Pereira ◽

Gabriel Vindver ◽

Fernando Bidolegui

Keyword(s):

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Tibial Tubercle ◽

Anterior Tibial ◽

Plateau Fracture

Introducción: Las fracturas de ambos platillos tibiales ocurren por traumatismos de alta energía. A veces, pueden comprometer el tubérculo anterior de la tibia. Ni la clasificación de Schatzker ni la de la AO/OTA consideran la presencia de este fragmento. El objetivo de este estudio fue describir la incidencia y el manejo quirúrgico de este tipo de fracturas.Materiales y Métodos: Se realizó un estudio retrospectivo, entre 2009 y 2017, que incluyó 48 fracturas de ambos platillos tratadas con reducción y osteosíntesis, 10 presentaban un fragmento de la tuberosidad anterior asociado. Siete pacientes eran hombres y 3, mujeres. La edad promedio era de 33.5 años. Nueve fueron estabilizadas inicialmente con tutor externo. El fragmento de la tuberosidad se fijó con 2 tornillos de 3,5 mm (9 casos) y con una placa 1/3 de tubo (un caso). Un paciente tenía una fractura expuesta. El seguimiento mínimo fue de 12 meses.Resultados: En todos, se logró la consolidación ósea. No hubo infecciones. El rango de movilidad de la rodilla logrado fue de 10º de extensión (rango 0-20º) a 120º de flexión (rango 90-140º). En un caso fue necesario retirar el material de osteosíntesis. Un paciente requirió artroscopia para tratar una lesión meniscal.Conclusiones: El 20,8% de las fracturas de ambos platillos tibiales presenta un fragmento de la tuberosidad anterior de la tibia, según nuestra serie. La fijación de este fragmento con tornillos de 3,5 mm o una placa 1/3 de tubo bloqueada es una técnica eficaz para lograr una estabilidad adecuada del fragmento.

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Long-term outcomes of surgical treatment of patients with tibial plateau fractures repaired with Ilizarov external fixation

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-3-313-318 ◽

2021 ◽

Vol 27 (3) ◽

pp. 313-318

Author(s):

A.G. Karasev ◽

◽

A.S. Zhdanov ◽

E.O. Darvin ◽

T.Yu. Karaseva ◽

...

Keyword(s):

External Fixation ◽

Functional Outcomes ◽

Tibial Plateau ◽

Oxford Knee Score ◽

Tibial Plateau Fractures ◽

Knee Score ◽

Long Term Outcomes ◽

Schatzker Type ◽

Bicondylar Fractures

Introduction Fractures of the tibial plateau are classified by the location of the fracture line, associated capsular ligamentous injuries to the knee and can result from different types of high – or low-energy mechanisms of injury in patients of any age with different bone quality. These factors are responsible for different long-term functional outcomes and the lack of a generally accepted algorithm for diagnosis and treatment. The objective of the study was to analyze the long-term functional outcomes in patients with tibial plateau fractures treated with the Ilizarov external fixation. Material and methods The review included long-term outcomes of 59 patients with tibial plateau fractures treated with the Ilizarov external fixator. Long-term results were evaluated in 53 patients out of 59 (89.83 %) using a subjective and objective clinical assessment system.The follow-up period ranged from 2 to 4 years. Patients were requested to complete the Oxford Knee Score questionnaire used in subjective outcome. Results Knee joint function of patients with tibial plateau fractures treated with the Ilizarov external fixation were rated as satisfactory (n = 34; 64.15 %); 16 (30.19 %) and 3 (5.66 %) patients were diagnosed with mild and moderate gonarthrosis, respectively. No infection that would affect the outcome was recorded in the study group. The mean Oxford Knee Score was 43.06 ± 3.44 (SD) in Schatzker type I split fractures of the lateral femoral condyle; 40.50 ± 5.57 (SD) in Schatzker type II split fractures combined with lateral articular surface depression; 40.71 ± 4.27 (SD) in Schatzker type III depression fractures; 42.33 ± 4.22 (SD) in Schatzker type IV medial condylar fractures; 38.50 ± 7.19 (SD) in Schatzker type V bicondylar fractures and 37.50 ± 5.17 (SD) in Schatzker type VI bicondylar fractures with dissociation of the metaphysis and diaphysis. Conclusions Tibial plateau fractures can be treated with the Ilizarov external fixation and also with the use of screws at any point of time that allows closed or open reduction of the fracture to ensure the early function of the operated limb, stable bone fixation, control of the fixation stiffness at any stage of treatment facilitating good and excellent functional outcomes.

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Assessment of Functional Outcome of Bicolumnar Dual Plating for Bicondylar Fractures of Tibial Plateau

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v19i1.40441 ◽

2022 ◽

Vol 19 (1) ◽

pp. 101-105

Author(s):

Dinesh Kumar Shrestha ◽

Dipendra KC ◽

Prateek Karki ◽

Sabin Shrestha ◽

Sushil Yogi

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Tibial Plateau ◽

College Teaching ◽

Common Peroneal Nerve ◽

Schatzker Type ◽

Dual Plating ◽

Duration Of Surgery ◽

Bicondylar Fractures

Introduction: Operative treatment of bicondylar fractures of tibial plateau is challenging and controversial. Aims: The aim of this study is to reveal the functional outcome of it by using bicolumnar dual plates and screws. Methods: This is a prospective hospital based interventional study carried out in the department of Orthopaedics of Nepalgunj Medical College Teaching Hospital. Thirty two Schatzker type V or AO (Association of Osteosynthesis) type 41 C1 & C2 fractures were treated between January 2016 and December 2019 with bicolumnar dual plating. The functional clinical outcomes were analyzed and evaluated using modified Rasmussen score. Results: Thirty two patients were included in the study. Out of which twenty four were male and eight were female. Average age was 32.21 years, eighteen were right sided and fourteen were left sided. Duration of surgery was 106 mins (range 90-120 mins) and the average duration of hospitalization was 7.81 days (range 4-14 days). Five patients of impending compartment syndrome and three patients with common peroneal nerve palsy were managed conservatively and also were included in the study. Two patients with superficial wound infection needed minimal debridement. One patient had varus angulation of 100 at third follow up after he fell from bed but surgical intervention were not needed. All fractures united. The average time for fracture healing was 21.5 weeks (range 16-32 weeks). At the Eighteen months follow up, the average knee range of motion was 1310(range 1100-1400). The functional outcome were evaluated using modified Rasmussen scoring system, which was 27.34 (range 22-30). Conclusion: Bicolumnar dual plating for bicondylar fractures of tibial plateau can provide excellent and stable fixation allowing early range of motion and gives excellent to good functional outcome.

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