FUNCTIONAL OUTCOME OF SCHATZKER TYPE 5 AND 6 TIBIAL PLATEAU FRACTURE TREATED BY PROXIMAL LOCKING PLATE

Aims The aim of this study was to determine the trajectory of recovery following fixation of tibial plateau fractures up to five-year follow-up, including simple (Schatzker I-IV) versus complex (Schatzker V-VI) fractures. Patients and Methods Patients undergoing open reduction and internal fixation (ORIF) for tibial plateau fractures were enrolled into a prospective database. Functional outcome, using the 36-Item Short Form Health Survey Physical Component Summary (SF-36 PCS), was collected at baseline, six months, one year, and five years. The trajectory of recovery for complex fractures (Schatzker V and VI) was compared with simple fractures (Schatzker I to IV). Minimal clinically important difference (MCID) was calculated between timepoints. In all, 182 patients were enrolled: 136 (74.7%) in simple and 46 (25.3%) in complex. There were 103 female patients and 79 male patients with a mean age of 45.8 years (15 to 86). Results Mean SF-36 PCS improved significantly in both groups from six to 12 months (p < 0.001) and one to five years (simple, p = 0.008; complex, p = 0.007). In both groups, the baseline scores were not reached at five years. The SF-36 PCS was significantly higher in the simple group compared with the complex group at both six months (p = 0.007) and 12 months (p = 0.01), but not at five years (p = 0.17). Between each timepoint, approximately 50% or more of the patients in each group achieved an MCID in their score change, indicating a significant clinical change in condition. The complex group had a much larger drop off in the first six months, with comparable proportions achieving MCID at the subsequent time intervals. Conclusion Tibial plateau fracture recovery was characterized overall by an initial decline in functional outcome from baseline, followed by a steep improvement from six to 12 months, and ongoing recovery up to five years. In simple patterns, patients tended to achieve a higher functional score by six months compared with the complex patterns. However, comparable functional scores between the groups achieved only at the five-year point suggest later recovery in the complex group. Function does not improve to baseline by five years in either group. This information is useful in counselling patients about the course of prospective recovery. Cite this article: Bone Joint J 2019;101-B:1009–1014.

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Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture: a comparative finite element study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-015-0325-2 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 11

Author(s):

Xiaowei Huang ◽

Zhongzheng Zhi ◽

Baoqing Yu ◽

Fancheng Chen

Keyword(s):

Finite Element ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Screw Fixation ◽

Medial Tibial Plateau ◽

Finite Element Study ◽

Type Iv ◽

Schatzker Type ◽

Plateau Fracture ◽

Element Study

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Plate-screw and screw-washer stability in a Schatzker type-I lateral tibial plateau fracture: a comparative biomechanical study

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20202546 ◽

2020 ◽

Vol 47 ◽

Author(s):

VINCENZO GIORDANO ◽

WILLIAM DIAS BELANGERO ◽

BRENNO DE ARAÚJO SÁ ◽

DANIELA RIVAS ◽

DANILO SOUTO ◽

...

Keyword(s):

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Dynamic Compression ◽

Type I ◽

Small Fragment ◽

Dynamic Compression Plate ◽

Cortical Screw ◽

Schatzker Type ◽

Compression Plate ◽

Plateau Fracture

ABSTRACT The aim of this study was to evaluate the biomechanical role of both a non-locking two-hole small fragment dynamic compression plate with 3.5-mm screws and a 4.5-mm cortical screw with a washer applied to a Schatzker type-I tibial plateau fracture. Sixteen right synthetic tibiae were used to create an anterolateral shear tibial plateau fracture (Schatzker type-I fracture). Eight models were fixed with a small fragment non-locked straight dynamic compression plate with one 3.5-mm bicortical screw (plate-screw construction) and eight models were fixed with a 4.5-mm cortical screw and a washer (screw-washer construction), both inserted at 1.0 mm distal to the apex of the fracture. Specimens were tested up to the onset of yielding at a constant strain rate of 5.0-mm/min. Stiffness ranged from 311.83 N/mm to 199.54 N/mm, with a mean + SD of 260.32 + 33.8 N/mm in the plate-screw construction, and from 290.34 N/mm to 99.16 N/mm, with a mean + SD of 220.46 + 63.12 N/mm in screw-washer construction. There was no significant difference (p=0.172). Use of a two-hole small-fragment non-locked plate with one 3.5-mm cortical screw or a 4.5-mm cortical screw with a washer applied at 1.0 mm distal to the apex of the fracture as buttressing present similar stiffness in terms of preventing axial displacement in synthetic tibiae models tested up to the onset of yielding.

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FIXATION OF POSTERIOR TIBIAL PLATEAU FRACTURE AND ITS OUTCOME: A COMPARATIVE STUDY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.904 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Hrishikesh Saodekar ◽

Kamal Agrawal

Keyword(s):

Functional Outcome ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Plate Fixation ◽

Tibial Plateau Fractures ◽

Fracture Union ◽

Posterior Tibial ◽

Plateau Fracture ◽

Group A ◽

Group B

Introduction: Tibial plateau fractures are complex injuries of proximal tibia which are produced by high- or low-energy trauma and principally affect young adult population. These fractures usually have associated soft-tissue lesions affecting the treatment. Posterior tibial plateau fractures (PTPF), may be medial or lateral, are common and they occur in about 28.8% patients as a part of bicondylar tibial plateau fractures. These fractures are difficult to reduce, therefore articular incongruity was not found to be detrimental factor in final functional outcomes. Studies have supported the fact that residual articular incongruence is well tolerated by proximal tibial plateau fracture in the form of minimal functional limitation or onset of arthrosis. Anterolateral and anteromedial surgical approaches do not show adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is advised to reduce and fix the fracture through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement. Material and Methods: This comparative prospective cohort study on done on 50 adult patients. Two groups were formed: Group A – double-plate fixation with both posterior and anterolateral having 25 participants and Group B – single anterolateral plate fixation having 25 participants in PTPFs were followed up to 1 year. For Group A, the reduction was done under direct vision and assisted with fluoroscopy in two planes. The reduction was assessed with submeniscal approach. In Group B posterior fragment was reduced by screws through the anterolateral plate followed by CT scan. Patients were evaluated by radiographs every 6 weeks till fracture union is evident. Fracture union was assessed by cortical continuity and progressive loss of fracture line on X-rays. Functional status at 1-year postoperative CT scanogram was done at final follow up to record articular subsidence, nonunion, coronal, or sagittal deformities. Knee functions were assessed by the International Knee Documentation Committee 2000 subjective knee evaluation form and objective functional Knee Society Score (KSS). Results: There were 22 male and 3 female in Group A while in Group B there were 20 male and 5 female. Right tibial fracture was observed in 15 cases and left in 10 cases in group A while in Group B right fracture was seen in 17 cases and in 8 cases left sided fracture. 23 cases each in group A and B were associated with RTA. Operative time (minutes) in group A and group B was 124 ± 26.7 and 79.52± 16.22 respectively. Total mean hospitalization days were 9.4±2.6 in group A and 8.2±1.5 in group B. Union time in group A was 14.6±3.4 weeks while in group B was 15.4±3.2. Statistically significant correlation was observed in group A and B with respect to KSS clinical outcome and KSS functional outcome. Flexion deformity was observed in 3 (12%) cases in group A and in 6 (24%) cases in group B. Conclusion: PTPF can achieve an early and satisfactory functional outcome. Rehabilitation and fracture healing are better in PTPF. Keywords: Tibial plateau fractures, PTPF, Open reduction and internal fixation (ORIF)

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To study outcomes in patients with schatzker type V and VI tibial plateau fracture treated with single 4.5mm lateral locking compression plate

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2019.v5.i4d.1675 ◽

2019 ◽

Vol 5 (4) ◽

pp. 204-208

Author(s):

Dr. Pulkit P Maniar ◽

Dr. Pratik Patel ◽

Dr. Tejash patel

Keyword(s):

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Locking Compression Plate ◽

Schatzker Type ◽

Compression Plate ◽

Plateau Fracture ◽

Type V

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A study of minimally invasive percutaneous plate osteosynthesis for tibial plateau fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175656 ◽

2017 ◽

Vol 4 (1) ◽

pp. 92

Author(s):

Ujwal S. Ramteke ◽

Vidyadhar Telang ◽

Nadir Shah ◽

Ayush Singh ◽

Hitesh Mangukiya ◽

...

Keyword(s):

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Weight Bearing ◽

Full Range ◽

Tibial Plateau Fractures ◽

Type I ◽

X Rays ◽

Age Group ◽

Schatzker Type ◽

Plateau Fracture

Background: Fractures of proximal tibia involve a major weight-bearing joint and are serious injuries, which, if not treated well, result in functional impairment. To preserve normal knee function one must strive to maintain joint congruity, preserve the normal mechanical axis, ensure joint stability and restore a full range of motion. This is a formidable task to accomplish, especially in the face of associated medical conditions of the patients.Methods: In our study, 30 cases were selected. Selection of cases were done on the basis of X-rays. Schatzker type I, II, III, IV, V & VI included in study. Criteria for acceptable reduction 1) <5 mm of articular step; 2) <5 mm of articular depression. Each case is referred to one set of tibial plateau fracture, showing distribution of tibia plateau fractures that we treated with MIPPO. Clinical follow-up examination was performed at 4, 6, 10, 12 weeks and 3, 6 months. Clinico-radiological assessment was done at 3 month and grading was done. Patients were evaluated according to grading minimum 3 months after injury.Results: Our study of 30 tibial plateau fractures confirms that the MIPPO technique is an excellent treatment modality in case of tibial plateau fractures. We observed these fractures mainly in age group of 30-40 years, which were involved in road traffic accident. Tibial plateau fractures seen in elder age group were mainly due to abnormal loading patterns on the leg. We have found oblique views very much informative especially for posterolateral or posteromedial displacement, articular depression which helps to plan the position and direction of screws to be used for fixation. Conclusions: In view of the excellent results obtained with this technique, we advocate MIPPO over conventional open reduction and internal fixation technique for tibial plateau fracture fixation.

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