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

2019 ◽  
Vol 8 (8) ◽  
pp. 357-366 ◽  
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.

Tibial plateau fracture: anatomy, diagnosis and management

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.

Frequency and Fracture Morphology of the Posteromedial Fragment in Bicondylar Tibial Plateau Fracture Patterns

2008 ◽  
Vol 22 (3) ◽  
pp. 176-182 ◽  
Author(s):  
David P Barei ◽  
Timothy J OʼMara ◽  
Lisa A Taitsman ◽  
Robert P Dunbar ◽  
Sean E Nork
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Fracture Morphology ◽  
Fracture Patterns ◽  
Plateau Fracture ◽  
Bicondylar Tibial Plateau

A PROSPECTIVE STUDY EVALUATING ASSOCIATION BETWEEN TIBIAL PLATEAU FRACTURE MORPHOLOGY WITH LIGAMENT AND MENISCAL INJURY AROUND KNEE.

2021 ◽  
pp. 33-35
Author(s):  
Manoj Kumar ◽  
Bharat Bhushan ◽  
Arun Vaishy ◽  
Rajendra Fageria ◽  
Ramakishan Ramakishan
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Soft Tissue Injuries ◽  
Fracture Morphology ◽  
Tibial Plateau Fractures ◽  
Meniscal Injury ◽  
Classi Cation ◽  
Plateau Fracture ◽  
A Prospective Study

INTRODUCTION: In the modern world,due to advent of high speed motor vehicles , high energy trauma commonly involves the knee joint and results in complex tibial plateau fractures and associated ligament and meniscal injuries . Proper diagnosis and management of these injuries reduced the chances of degenerative changes around knee joint later on. MATERIAL AND METHOD: A prospective study was conducted in the Department of Orthopaedics in a tertiary health care center of western rajasthan from January 2018 to December 2020 . A total of eighty patients( 62 males: 18 females) with tibial plateau fractures and associated soft tissue injuries were included .Patients were assessed both clinically and radiologically and “ SCHATZKER'S classication was used to classify the tibial plateau fractures. Pre-operatively in every case CT-scan was used to study fracture pattern and MRI was done to see fracture morphology and associated soft tissue injuries. RESULT: A total 80 patient was included in our study,out of which 73 (91.25%) having ligaments( Cruciate and Collaterals) and meniscal injury . Injury to the lateral meniscus was found most frequently in Schatzker II fracture (p<0.0006) and medial meniscus in schatzker IV (p< 0.011). Variable association was shown by ACL and PCL injuries with tibial plateu fracture morphology ,but as the grade of designation increases within schatzker classication as does the frequency of cruciate ligament tear. Overall incidence of LCL rupture occurred least frequently in Schatzker II fractures (7 of 34; 20.5%), which was statistically signicant (P < 0.01). Complete MCL tear occurred in 27( 33.7%) of all fractures and in 41% of Schatzker II fractures. PLC tear had shown signicant association with medial tibial plateu fracture (schatzker IV). CONCLUSION: The likelihood of the cruciate , collateral ligament and PLC injury increases as the grade of designation within schatzker classication (schatzker I-VI). PLC injury had a signicant association with medial tibial plateu fracture (schatzker IV) and MCL had a signicant association with lateral tibial plateau fracture .

Patient function continues to improve over the first five years following tibial plateau fracture managed by open reduction and internal fixation

2020 ◽  
Vol 102-B (5) ◽  
pp. 632-637 ◽  
Author(s):  
L. J. Gonzalez ◽  
K. Hildebrandt ◽  
K. Carlock ◽  
S. R. Konda ◽  
K. A. Egol
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Tibial Plateau Fractures ◽  
Term Outcome ◽  
Patient Reported ◽  
Schatzker Classification ◽  
Plateau Fracture ◽  
One Year

Aims Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. Methods In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired t-test. Results Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA). Conclusion Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: Bone Joint J 2020;102-B(5):632–637.

scholarly journals Open posterior dislocation of the knee with rupture of the patellar tendon and a tibial plateau fracture

2010 ◽  
Vol 2 (1) ◽  
pp. 7 ◽  
Author(s):  
Mohammed Fahd Amar ◽  
Badr Chbani ◽  
Oussama Ammoumri ◽  
Amine Marzouki ◽  
Fawzi Boutayeb
Keyword(s):  
Patellar Tendon ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Tissue Injury ◽  
Full Range ◽  
Soft Tissue Injury ◽  
Knee Dislocation ◽  
High Energy ◽  
Plateau Fracture ◽  
Posterior Knee

Knee dislocations are rare injuries. They represent a severe soft tissue injury following high-energy blunt trauma. We report a case of open posterior knee dislocation with rupture of the patellar tendon and a fracture of the tibial plateau. The treatment was surgical and consisted of reduction of the knee dislocation, fixation of the tibial plateau fracture by lag screws, and transosseous sutures for the patellar tendon protected by a patellotibial cerclage. The result was successful with full range of motion.

scholarly journals Tibial Plateau Fracture Following Low Energy Fall in the Rocky Mountains

2019 ◽  
Vol 12 (3) ◽  
pp. 91-93
Author(s):  
Alexandra V. Arvanitakis ◽  
Kerry C. Mian ◽  
Raymond Kreienkamp ◽  
Charles E. Rhoades
Keyword(s):  
Rocky Mountains ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Weight Bearing ◽  
High Energy ◽  
Classification Systems ◽  
Tibial Plateau Fractures ◽  
Mechanism Of Injury ◽  
Direct Trauma ◽  
Plateau Fracture

Tibial plateau fractures are debilitating injuries. They can occurin younger individuals who sustain a high energy trauma or, withincreasing age, lesser degrees of trauma and underlying bone pathology such as osteoporosis, metabolic bone disease, and malignancy.1Outside these cases, tibial plateau fractures are relatively uncommon.However, these fractures can occur in healthy patients who have sustained direct trauma to the knee.Fractures of the tibial plateau often are classified according to theSchatzker or AO classification systems.2,3 These systems evaluate theinvolvement of both the medial and lateral plateaus, degree of comminution, extension into the joint, and displacement (both articularsurfaces and the relationship of the diaphysis to the metaphysis).Most tibial plateau fractures occur in the lateral aspect of the tibialplateau.1 The increased frequency of lateral fractures is due to themedial tibial plateau being able to resist higher weight-bearing loaddue to the presence of more cancellous bone. More importantly, thelateral plateau has more articular surface exposed during extensioncompared to the medial plateau, which increases likelihood of injury.4The standard of care for most displaced tibial plateau fracturesis surgical management with open reduction and internal fixation(ORIF).5 Conservative management, such as leg bracing, is an optionfor fractures that are nondisplaced or in patients too fragile for surgical intervention. In the senior population, a total knee arthroplasty(TKA) is a less common option. Tibial plateau fractures, particularlymedial tibial plateau fractures, caused by direct trauma in the elderly,non-osteoporotic population are uncommon.We present the case of an active male without overt risk for severefracture (10-year fracture risk of 10% via FRAX score) who wasworking to repair a trail in the Rocky Mountains. While other injurieswere more likely given the mechanism of injury and patient risk, thiscase highlighted the importance of considering tibial plateau fracture,even in atypical settings without significant risk. Improved awarenessof this mechanism of injury will lead to more accurate diagnosis andgreater post-injury management.

scholarly journals Hold Relax dan Passive Stretching Efektif Dalam Meningkatkan Kemampuan Fungsional Pada Pasien Post-Gips Fracture Tibial Plateau Dextra

2020 ◽  
Vol 3 (2) ◽  
pp. 16-23
Author(s):  
Nizatul Mumtazah ◽  
Faizah Abdullah
Keyword(s):  
Functional Ability ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Single Case ◽  
Axial Loading ◽  
High Energy ◽  
Passive Stretching ◽  
Plateau Fracture ◽  
Muscle Groups

Background:  Tibial plateau fracture  is one type of fracture  that usually occur in legs.  Tibial Plateau fracture usually occur because of high energy trauma that produced by the force of varus and valgus and also because of axial loading or because of the pedestrian that crashed by the car with high energy which can also called as fracture bumber. The purpose of this case study is to examine  the effectiveness of hold relax and passive stretching in tibial plateau fracture. Method: A single case study, providing physiotherapy interventions for a 44 year old woman with a diagnosis of a tibial plateau post-cast fracture. Hold-relax stretching  is a technique in which shortened antagonistic muscle groups are isometrically contracted against the optimal resistance given by the physiotherapist. Passive stretching is a method for extending the contractile or non-contractile components of the musculotendinoeus unit where force is exerted externally and given manually. Hold relax and passive stretching are given for 2 weeks with 5 evaluations. ROM assessment was measured by a goniometer and spasm by palpation. Result: There is an increase in LGS knee flexion  90ᴼ to 110ᴼ and decrease in spasm which  associated with an improvement  LEFS score from 17 to 44, indicates that there is an increase in the functional ability of lower extremity. Conclusion: This study shows that the method of therapeutic exercise with hold relax and passive stretching can improve functional ability in tibial plateau fracture which is measured using LEFS parameters.

Unusual injury mechanism of a tibial plateau fracture in relation with a knee brace in handball – A case study

2016 ◽  
Vol 32 (2) ◽  
pp. 165-168 ◽  
Author(s):  
Felix Hoffmann ◽  
Christian Nührenbörger ◽  
Alexander Hoffmann ◽  
Dietrich Pape ◽  
Romain Seil
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Injury Mechanism ◽  
Knee Brace ◽  
Plateau Fracture ◽  
Unusual Injury
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