scholarly journals Arthroscopic management of proximal tibial fractures: technical note and case series presentation

2015 ◽  
Vol 88 (2) ◽  
pp. 233-236 ◽  
Author(s):  
Horea Benea ◽  
Gheorghe Tomoaia ◽  
Artur Martin ◽  
Ciprian Bardas
Keyword(s):  
Internal Fixation ◽  
Tibial Plateau ◽  
Case Series ◽  
Tibial Plateau Fractures ◽  
Tibial Fractures ◽  
Type I ◽  
Arthroscopic Reduction ◽  
Schatzker Type ◽  
Associated Lesions ◽  
Proximal Tibial Fractures

Background and aims. The purpose of this article is to describe a new surgical method of arthroscopy assisted treatment of intraarticular proximal tibial fractures (ARIF – arthroscopic reduction and internal fixation), analyzing its efficiency and safety on a series of patients. Tibial plateau fractures affect the proximal tibial metaphyseal and articular surface, representing 1.2% of all fractures and up to 8% of all fractures in elderly. Patients and method. Our case series consists of 6 patients with Schatzker types I-III tibial plateau fractures, treated in the Orthopedic and Traumatology Clinic of Cluj-Napoca from July 2012 to August 2014. Patients included in the study presented Schatzker type I-III tibial plateau fracture.Results. The results obtained with the arthroscopic method were excellent in 5 cases (mean Rasmussen score 27.60 points) and good in 1 case (mean score 23.75). The radiological consolidation appeared after a mean of 12 weeks. No major complication was noted.Conclusions. Diagnosis and treatment of associated lesions, shortening of hospitalization length and postoperative rehabilitation, but also the lower rate of complications, can make arthroscopic reduction and internal fixation the method of choice for the operative treatment of selected Schatzker I-III types of proximal tibial fractures.

scholarly journals Arthroscopic Assisted Reduction and Internal Fixation of Tibial Plateau Fractures

2019 ◽  
Vol 7 (7) ◽  
pp. 1133-1137 ◽  
Author(s):  
Sherif Hamdy Mohamed Zawam ◽  
Ahmed Mahmoud Gad
Keyword(s):  
Internal Fixation ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Knee Injuries ◽  
Tibial Plateau Fractures ◽  
Type I ◽  
Type Ii ◽  
University Hospitals ◽  
Type Iii ◽  
Schatzker Type

BACKGROUND: Tibial plateau fractures present an important entity in orthopaedic fractures. Arthroscopic-assisted reduction and internal fixation is a good alternative to ORIF as it has the advantage of direct visualisation of the articular surface of the plateau, direct assessment of the reduction of the articular surface, and managing any associated intra-articular pathology. AIM: Our study aim is to determine the results of arthroscopic assisted reduction and internal fixation of tibial plateau fractures. METHODS: This study involved 25 patients with tibial plateau fractures presenting to the emergency department of Cairo University Hospitals between the periods of November 2016 and May 2017. The patients were followed up for an average of 14 months (11-18 months). According to Schatzker’s classification, five patients had type I, eleven had type II, and nine patients had type III fractures. RESULTS: The average time to full union in Schatzker type I was 9.1 weeks, in type II was 10.2 weeks, and in type III it was 9.4. The mean clinical Rasmussen score among the 25 patients was 26 (range, 24-30). A group of 19 patients (76%) had excellent results, (4 type I, 8 types II, and 7 types III) 6 patients (24 %) had good results (1 type I, 3 types II, 2 types III). Radiologic results were excellent in (14 cases) 56.0% and good results (11 cases) 44%. CONCLUSION: Arthroscopic assisted reduction and fixation of tibial plateau fractures have the advantages of checking the adequacy of reduction, avoiding the need for detachment of the meniscus, and allowing for accurate diagnosis and management of associated knee injuries. Therefore, we recommend that arthroscopic assisted reduction and fixation of tibial plateau fractures should be used more often.

scholarly journals Early Results of the Medial Approach for Arthroscopic-Assisted Fixation of Lateral Tibial Plateau Fractures

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Tunay Erden ◽  
Suat Batar ◽  
Gökçer Uzer ◽  
Demet Pepele Kurdal ◽  
Nurzat Elmalı
Keyword(s):  
Tibial Plateau ◽  
Soft Tissues ◽  
Lateral Meniscus ◽  
Case Series ◽  
Tibial Plateau Fractures ◽  
Meniscus Tear ◽  
Type I ◽  
Lateral Tibial Plateau ◽  
Schatzker Type ◽  
Diagnostic Arthroscopy

The use of arthroscopy in the management of tibial plateau fractures is not a particularly new concept. It has been used successfully for Schatzker types I–III fractures. In addition to evaluating the fracture itself, it is easier to evaluate the other intraarticular structures. Coventionally, reduction for lateral tibial plateau fractures have been performed through a laterally based metaphyseal window, which is not without limitations, including difficulty with reduction of the fracture, as well as bone grafting though the resultant short subchondral tunnel. Also, there is a risk of lateral vascular supply distrubtion because of same side fracture. A medially based metaphyseal window to approach lateral tibial plateau fractures allows for minimal insult to the soft tissues, with advantageous ease of reduction and grafting through a longer tunnel for subchondral support. We aimed to present our initial experiences in twelwe cases approaching lateral tibial plateau fractures through a medial metaphyseal window. Material-Methods: Our series involves 12 patients with 7 Schatzker type II, 3 Schatzker type I, and 2 Schatzker type III fractures. There were 8 males and 4 females. The average age at the time of surgery was 37 (25-57) years. All of the patients underwent plain radiography and BT in each knee Time from injury to surgery was 6.2 days. Follow up was 18 months (9-22 months).Firstly diagnostic arthroscopy was performed. Concomittant pathology was adreessed as needed. There was 3 lateral meniscus tear that treated with partial meniscectomy. An ACL guide pin was placed percutaneously anteromedial tibia approximately 9 cm distal to the joint line. Once stisfactory positioning a cortical window 1x2 cm. made around the guide pin. Reduction was accomplished with a bone tamp that fits easily into the tunnel. Screws were used as rafters to support the articular surface and subchondral bone. We used in 7 patients lateral plate and screws and in 5 patients only screws. Care was taken to keep pump pressure at approximately 40 millimeters of mercury for alleviate the risk of compartment syndrome. Results: No complications related to the procedure were observed. No secondary loss of reduction was observed in radiological controls. Functional assessment according to HSS of the patients were excellent in 5 cases, good in 5 cases and fair 2 cases. Discussion: Because depressed fragments are elevated from distal cortical windows, the importance of an intact, or easily restored, “cortical envelope” is paramount. This case series showed satisfactory early clinical results. [Figure: see text][Figure: see text]

scholarly journals Application of Percutaneous Screw Fixation and Closed Reduction for Tibial Plateau Fractures in Karachi, Pakistan

2021 ◽  
pp. 25-30
Author(s):  
Muhammad Azeem Akhund ◽  
Muhammad Latif ◽  
Rahat Zahoor Moton ◽  
Zohaib Khan ◽  
Zohaib Nawaz ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Tibial Plateau ◽  
Screw Fixation ◽  
Case Series ◽  
Early Mobilization ◽  
Tibial Plateau Fractures ◽  
Type I ◽  
Percutaneous Screw Fixation ◽  
Schatzker Classification ◽  
Average Patient

Objective: Objective of this study is to assess the application of percutaneous screw fixation and closed reduction for tibial plateau fractures in Karachi, Pakistan. Methods: The study design of this study is case series with sample size of 58 patients calculated by WHO calculator with functional outcome of 80-100%. The duration of the study was about 6 months.Non-probability sequential technique was adopted for data collection. Results: The average patient age was 35.35±6.84 years however male patient were high in numbers (83.8%). Types of fractures (type I, II and IV) and functional outcomes (un-satisfactory and satisfactory) showed 17(29.3%), 33(56.8%) and 12(20.6%) and 4(6.45%) and 58(93.5%). The mean Rasmussen Score was 24.6(4.9%) however significant relationship between age and functional group were observed (p<0.05). The Rasmussen Functional Scoring System and Schatzker classification were also evaluated w.r.t ache, capability of walking normally, extension lag, stability as well as range of motion. Scores ranging from 28 up till 36 stipulate excellent, from 20 to 27 good, considering score of 10 to 20 fair and 6 to 10 poor. Conclusion: The application of Percutaneous screw fixation and closed reduction for tibial plateau fractures in Karachi, Pakistanis less invasive, decrease hospital stays and charges, escalation of early mobilization along with satisfactory outcomes.

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

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

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">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</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">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 &amp; VI included in study. Criteria for acceptable reduction 1) &lt;5 mm of articular step; 2) &lt;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</span>.</p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">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</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">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</span><span lang="EN-IN">.</span></p>

scholarly journals To analyze the functional outcome of proximal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis technique

2017 ◽  
Vol 3 (6) ◽  
pp. 1205
Author(s):  
Sivakumar Arumugam ◽  
Venkateshwara Arumugam ◽  
V. Raviraman
Keyword(s):  
Minimally Invasive ◽  
Functional Outcome ◽  
Tibial Plateau ◽  
Plate Osteosynthesis ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Tibial Fractures ◽  
Soft Tissue Dissection ◽  
Proximal Tibial Fractures ◽  
Walking Capacity

<p class="abstract"><strong>Background:</strong> Tibial plateau fractures constitute about 1% of all fractures and complex bicondylar fractures constitute 30% of all Tibial plateau fractures. Minimally Invasive Percutaneous Plate Osteosynthesis [MIPPO] is a method of biological fixation in which a plate is percutaneously inserted and fixed at a distance proximally and distally from the fracture site. By minimal exposure, this helps in the preservation of the essential fracture hematoma, minimal soft tissue dissection, avoidance of periosteal stripping and providing an adequate fixation. The objective of the study was to analyze the functional outcome of proximal Tibial fractures treated with MIPPO technique. The method of fixation shall be evaluated for the time period required for the patients to return to active work following surgery.</p><p class="abstract"><strong>Methods:</strong> In our study, all 18 patients with proximal Tibial fractures underwent definitive fixation by MIPPO technique. All our cases underwent initial stabilization as per the ATLS guidelines. Patients with closed Tibial plateau fractures associated with a tense haemarthrosis underwent aspiration of the joint under aseptic precautions. The limb was immobilized either in an above knee slab or through skeletal traction using a distal Tibial or calcaneal pin traction on a Bohler Braun splint until definitive fixation was carried out. In cases complicated with excessive swelling and blistering, definitive fixation was delayed until the swelling/ blistering subsided.<strong></strong></p><p class="abstract"><strong>Results:</strong> The post-operative results were designated as excellent, good, fair and poor according to pain, walking capacity, the range of motion and stability of the knee using Rasmussen’s grading system. In our study, the average functional knee score was 22.89. Rasmussen’s score does not consider articular congruity while assessing the functional outcome of the knee.</p><p class="abstract"><strong>Conclusions:</strong> MIPPO technique gives good to excellent results even in high energy Tibial condyle fractures [72.22% cases in our study]. Our patients were able to achieve a good functional range of movement, averaging 120 degrees. [Krettek et al – 124 degrees]. Those who were treated with early fixation and early mobilization were found to have a better functional outcome irrespective of the fracture type. No secondary bone grafting was required. </p>

scholarly journals Functional and Radiological evaluation of management of tibial plateau fractures: A prospective study

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 1365-1371
Author(s):  
Priyank Bhatt ◽  
Sunil Nikose
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
High Speed ◽  
Tibial Plateau ◽  
Road Traffic ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Fracture Pattern ◽  
Tibial Plateau Fractures ◽  
Type I

The knee is a crucial joint, as it performs various functions such as standing, walking, running, sitting etc. Tibial plateau fractures constitute 1% of overall fractures and 8% of fractures occurring in the geriatric age group. Knee injuries must be properly and adequately treated to keep the knee in a good functional state. The transition to a fast-paced lifestyle on account of rapid industrialization, urbanization and mechanization has led to a significant increase in the traumatic incidences - especially polytrauma, comminuted Fractures and soft tissue injury.  High-speed injury acquired in vehicular accidents and a rise in road traffic injuries together creates a forever increasing issue. The static lower extremity can be encountered by an object in motion, frequent in roadside injury, resulting in the infamous "Bumper Fracture". Open Reduction with Internal Fixation (ORIF) is currently recommended. Hence, a study has been conducted to learn the mode of injury, fracture pattern, outcome of open reduction and internal fixation, complications encountered and associated injuries. 50  Patients were studied prospectively and pre and post-operative evaluation were done using modified Rasmussen clinical and radiological criteria and Womac knee score. Open reduction and internal fixation provide reasonable outcome with regards to functional and radiological outcome in younger patients and type I and II fractures.

scholarly journals The Mid-Term Radiological and Functional Outcomes of Bicondylar Tibial Plateau Fractures Managed with Open Reduction and Internal Fixation Using Dual Plates

2021 ◽  
Author(s):  
Angelo V. Vasiliadis ◽  
Frideriki Poutoglidou ◽  
Dimitrios Metaxiotis ◽  
Anastasios Mpeletsiotis
Keyword(s):  
Internal Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Radiological Outcome ◽  
Schatzker Type ◽  
Dual Plating ◽  
Type V ◽  
Bicondylar Tibial Plateau

Objective: This study was designed to evaluate the mid-term radiological and functional outcome of tibial plateau fractures treated by plating. Methods: Patients with Schatzker type V and type VI tibial plateau fractures who were managed with open reduction and internal fixation using dual plates were included in this retrospective study. The functional evaluation of the patients was carried out with the visual analogue scale (VAS), the health-related quality of life status was measured using the Short Form-36 (SF-36) and the dimensions of pain, stiffness and function were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). For the radiological outcome evaluation, the modified Rasmussen criteria were used. Results: 57 patients (30 male and 27 female) were included in the study with a mean follow-up of 50.88 months. There were 23 Schatzker type V and 34 Schatzker type VI fractures. The majority of patients (86%) had a good to excellent radiological outcome. The mean VAS score was 1.65 for all the patients. The functional outcome was excellent in the majority of the patients. Among them, 5.3% (n = 3) suffered wound infection and all of the wounds healed after different treatments. All patients returned to their pre-injury activities of daily living and employment status, while 53% of the patients returned to sporting activities. Conclusion: Our findings support previous literature, which has demonstrated that bicondylar tibial plateau fractures can provide good to excellent radiological and functional outcomes if they were treated with open reduction and internal fixation with dual plating. Keywords: tibial plateau fracture; bicondylar fracture; Schatzker classification; dual plating

scholarly journals Aspect Regarding Plastic Deformations in Tibial Plateau Fractures

2018 ◽  
Vol 55 (4) ◽  
pp. 571-574
Author(s):  
Marcel Mihai Berceanu Vaduva ◽  
Horatiu Petrescu ◽  
Rami Musallam ◽  
Abdoul Fattah Boustani ◽  
Milan Velimirovici ◽  
...  
Keyword(s):  
High Performance ◽  
Tibial Plateau ◽  
Late Complications ◽  
Tibial Plateau Fractures ◽  
Bone Lesions ◽  
Type I ◽  
Mechanism Of Injury ◽  
Road Accidents ◽  
Schatzker Type ◽  
Therapeutic Measures

Our purpose was to study tibial plateau fractures considering the rise of their incidence, their potential immediate seriousness or late complications and their complexity. We realized a clinical-statistical study concerning the incidence of tibial plateau fractures taking in account critaeria like age, sex, mechanism of injury, fracture type and correlations between these. The study involves 126 patients, 98 (77.77%) being treated surgically and 28 (22.22%) conservatory between 2008-2016 in the I-st Clinic of Orthopaedics and Traumatology Timisoara. Approximately 2/3 of cases are of Schatzker type I, II and III. Type VI Schatzker occured in 5.78% of all, the mechanism of injury being split almost equal between road accidents and falls from height. Road accidents prevale as a causing circumstance of tibial plateau fractures. 2/3 of the tibial plateau fractures associate with other significant regional lesions. Bone lesions are not rarely underestimated by plain radiographs. Therefore evacuation of haemarthrosis (showing lipohaemarthrosis) and high performance imaging (CT, MRI) are often needed. In comparison to other fracture sites, imperfect reduction of tibial plateau fractures results more frequently in long term sequellae. Being frequently complex, comminuted fractures with associated regional lesions tibial plateau fractures raise the complexity of the medical act from establishing a complete diagnosis to the final therapeutic measures. For a correct and complete preoperatory diagnosis frequently high performance imaging is needed. Tibial plateau fractures significantly affect patients, the healthcare and social-economic system, the healing and rehabilitation.

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