scholarly journals Functional outcome of Schatzker type V and VI tibial plateau fractures managed with open reduction internal fixation using dual plates

2017 ◽  
Vol 3 (5) ◽  
pp. 961
Author(s):  
Saranjeet Singh Jagdev ◽  
Subodh Kumar Pathak ◽  
Abhijeet Salunke ◽  
Pritam Maheshwari ◽  
Prahlad Ughareja ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Tibial Plateau ◽  
Oxford Knee Score ◽  
Tibial Plateau Fractures ◽  
Schatzker Type ◽  
The Mean ◽  
Type V

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Complex tibial plateau fractures remain a challenge to even the most experienced surgeons. These injuries usually affect the young population in their productive years thereby causing socioeconomic impact. We performed a retrospective study to evaluate the functional outcome of of Schatzker type V and VI managed through open reduction and internal fixation.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">26 patients with Schatzker type V and type VI tibial plateau fractures treated with open reduction and internal fixation using plates were included in the study. Three patients were lost to follow up, 23 patients were evaluated in the final analysis. The preoperative, intraoperative data was noted from the indoor files.The final evaluation was done using Oxford knee score and VAS score</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">There were nine Schatzker type V fractures and 14 patients with Schatzker type VI fractures. The mean duration of follow-up was 68.32 months ranging from 41 months to 126 months. The mean Oxford knee score was 39.78. Patients with Schatzker type VI had mean OKS of 37.7.The mean MPTA and mean PPTA were 88.75 degrees and 7.35 degrees respectively. Average VAS Score was 2.8 ranging from 1 to 3.9. All patients returned to their pre-injury level of activity and employment. There were no patients of deep infection. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">We conclude that open reduction and internal fixation of high-energy tibial plateau fractures gives excellent to good functional outcome with minimal soft tissue complications. The complications can be minimized with proper patient selection and soft tissue dissection.</span></p>

scholarly journals Functional Evaluation in High Energy (Schatzker Type V and Type VI) Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Kavin Khatri ◽  
Devendra Lakhotia ◽  
Vijay Sharma ◽  
G. N. Kiran Kumar ◽  
Gaurav Sharma ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Wound Infection ◽  
Open Reduction ◽  
Tibial Plateau ◽  
Oxford Knee Score ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Functional Evaluation ◽  
Schatzker Type ◽  
Type V

Objective. To review functional outcome in high energy tibial plateau fractures treated by plating. Design. Retrospective analysis. Material and Methods. Sixty-five patients with Schatzker type V and type VI tibial plateau fractures treated with open reduction and internal fixation using plates were included in the study. The functional evaluation of the patients was carried out with Oxford knee scoring. Results. Fifty-four cases (83%) had Oxford knee score between 40 and 48. Seven (10.7%) had score between 30 and 39, three (4.6%) had score between 20 and 29, and one patient (1.5%) had a score of 18. Delayed union was seen in two cases and nonunion was seen in one case. The superficial wound infection was noticed in (9.2%) patients which was resolved with regular dressings and oral antibiotics. Three (4.6%) patients had developed deep wound infection and one among them had developed osteomyelitis. Conclusion. Open reduction and internal fixation in high energy tibial plateau fractures can provide good functional results in appropriately selected cases.

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 Clinical Analysis of Classification for Tibial Plateau Fractures and Popliteal Artery Injury

2020 ◽  
Author(s):  
Yilun Yao ◽  
Xiaoshu Wu ◽  
Lei Wu ◽  
Lei Yang ◽  
Chunzhi Jiang ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Clinical Analysis ◽  
Tibial Plateau Fractures ◽  
Artery Injury ◽  
Type Iv ◽  
Schatzker Type ◽  
Schatzker Classification ◽  
Tibial Head ◽  
Type V

Abstract Background To explore the association between the classification for tibial plateau fractures (TPF) and the popliteal artery injury (PAI).Methods 22 TPF patients accompanied by PAI who were treated from May 2012 to July 2019 were retrospectively analyzed. There were 19 males and 3 females with an average age of 49.43 years. The Schatzker classification and three-column classification were performed for TPF. The severity of extremity injury was evaluated using the mangled extremity severity score (MESS). Except 3 patients treated with amputation, the remaining patients underwent surgical repair of popliteal artery and fracture external fixation. The outcome was evaluated using the Rasmussen score for tibial head fractures.Results There were 10 cases of Schatzker type IV fractures, 1 case of type V fractures and 11 cases of type VI fractures. Based on the three-column classification, the posterior column was involved in 22 cases, 2 columns in 15 cases and 3 columns in 6 cases. The MESS was 6-10 points, with an average of 7.59 points. Except 1 case directly receiving amputation, 3 cases of segment P1 injury was observed via preoperative DSA + intraoperative exploration, while segment P2 in 6 cases and segment P3 in 12 cases. Popliteal artery was found completely ruptured in 11 cases, partially ruptured in 1 case, and severely contused with thrombosis in 10 cases. The Rasmussen score was given to 19 patients at the last follow-up, except for the cases undergoing amputation. The outcome was satisfied in 14 cases, unsatisfied in 5 cases.Conclusion: In patients with complex TPF, the risk of PAI becomes higher with the increase of Schatzker classification level. Knee CT scan is helpful in determining the severity of fractures and evaluating PAI. Based on the three-column classification, PAI should be suspected when the fractures involve the medial and posterior column.PAI is mainly in the segment P3, and artery rupture or severe contusion with extensive thrombosis may occur.

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

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.

Treatment of Tibial Avulsion Fracture of Posterior Cruciate Ligament by Open Reduction and Internal Fixation

2020 ◽  
Vol 9 (1) ◽  
pp. 17-21
Author(s):  
Ranjib Kumar Jha ◽  
Santosh Thapa
Keyword(s):  
Clinical Outcome ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Posterior Cruciate Ligament ◽  
Open Reduction ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Avulsion Injury ◽  
The Mean

Background: An avulsion fracture of posterior cruciate ligament from tibial attachment is more common in younger age group. It should be fixed otherwise it may lead to secondary changes in knee. Various techniques and approaches are available to fix posterior cruciate ligament avulsion. Different biomechanical studies have shown that, results both open and arthroscopic methods of fixation of posterior cruciate ligament avulsion by screws are comparable. The purpose of study is to evaluate functional and clinical outcome of open reduction and fixation of posterior cruciate ligament avulsion injury through posteromedial approach. Materials and Methods: The study enrolled 19 cases of isolated posterior cruciate ligament avulsion injury with mean age of 33.21±9.07 year. All cases were treated by open reduction and internal fixation through modified posterior approach. The patients having duration of injury more than 12 weeks were excluded. The minimum follow up duration was 12 months. Results were assessed clinically and radiologically. Final functional outcome was assessed using the Lysholm scoring for knee. Results: The mean duration of follow up was 14±1.85 months. All patients achieved union at 3months. At final follow up the mean range of motion was 125.42±6.37 degree (range 110 to 135 degree) without any extensor lag. The functional outcome assessed by Lysholm scoring system was excellent in 15 cases and good in 4 cases. Conclusion: Open reduction and internal fixation with early range of motion exercises provides good clinical outcome and stable knee.

scholarly journals PROXIMAL HUMERUS FRACTURES;

2017 ◽  
Vol 24 (12) ◽  
pp. 1788-1793
Author(s):  
Faisal Abdul Jabbar ◽  
Rehana Ali Shah
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Avascular Necrosis ◽  
Open Reduction ◽  
Proximal Humerus ◽  
Case Series ◽  
Proximal Humerus Fractures ◽  
Humerus Fractures ◽  
The Mean

Objectives: The aim of our study is to study the radiological and functionaloutcome of proximal humerus fractures treated via open reduction and internal fixation usingthe proximal humerus internal locking system or PHILOS. Study Design: Case series study.Period 05 years duration from January 2011 to December 2015. Setting: Large tertiary carecentre in Karachi, Pakistan. Materials and methods: The study population consisted of n=50patients all of whom underwent open reduction and internal fixation utilizing the proximalhumeral internal locking system or PHILOS for fractures of the proximal humerus. The inclusioncriterion was all the patients with closed fractures of the proximal humerus and were belongingto 2,3 and 4 part of the Neer system of classification. Physiotherapy was started as soon aspossible for the patients. Serial radiographic imaging in two views was done at 6, 12, 24 and52 weeks postoperatively. For the functional outcome of the procedure Constant and Murleyscoring system was used. Data was analyzed using IBM SPSS version 21. Results: The studypopulation consisted of n= 50 patients of which n= 35 were males and n= 15 were femaleshaving a mean age of 38.50 years. The mean duration of follow up was 24 months. All thepatients in the study had union of fracture both radiographically and clinically, the mean timeduration for the radiographically evident union of the humerus bone was 12 weeks with a rangeof 8 to 20 weeks, the mean Constant Murley score for the functional outcome of the shoulderjoint was 79 at the final follow up with a range of 50 to 100. Complications were found in n= 9patients and varus malunion was the most common complication. In our case series we did notobserve complications such as avascular necrosis, non union or implant failure. Conclusion:According to the results of our study the proximal humerus internal locking system or PHILOSis a good method for open reduction and internal fixation of the proximal humerus fractures andprovides a stable fixation, and has lower incidence of complications such as avascular necrosis.

scholarly journals Timing of Open Reduction and Internal Fixation of Ankle Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Direk Tantigate ◽  
J. Turner Vosseller ◽  
Justin Greisberg ◽  
Benjamin Ascherman ◽  
Christina Freibott ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Demographic Variables ◽  
Ankle Fractures ◽  
Significant Difference ◽  
The Mean

Category: Ankle, Trauma Introduction/Purpose: Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) for stabilization in an effort to ultimately prevent post-traumatic arthritis. It is not uncommon for operative treatment to be performed as an outpatient in the ambulatory surgery setting several days to a couple weeks after the injury to facilitate things from a scheduling perspective. It is unclear what effect this delay has on functional outcome. The purpose of this study is to assess the impact of delayed operative treatment by comparing the functional outcomes for groups of patients based on the amount of time between the injury and surgery. Methods: A retrospective chart review of 122 ankle fracture patients who were surgically treated by ORIF over a three year period was performed. All ankle fracture patients older than 18 years with a minimum of 24 months of follow-up were included. A total of 61 patients were included for this study. Three patients were excluded; 2 patients had an open injury and 1 patient presented with a delayed union. Demographic data, comorbidities, injury characteristics, duration from injury to surgery, operative time, length of postoperative stay, complications and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow-up visit. Comparison of demographic variables and the subcategory of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) was performed between patient underwent ORIF less than 14 days after injury and 14 days or greater. Results: A total of 58 patients were included in this study. Thirty-six patients (62.1%) were female. The mean age of patients was 48.14 ± 16.84 years (19-84 years). The mean follow-up time was 41.48 ± 12.25 months (24-76 months). The duration between injury and operative fixation in the two groups was 7 ± 3 days (<14 days) and 18 ± 3 days (>14 days), respectively. There was no statistically significant difference in demographic variables, comorbidities, injury characteristics, or length of operation. Each subcategory of FAOS demonstrated no statistically significant difference between these two groups. (Table 1) Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS. Conclusion: Open reduction and internal fixation of ankle fracture more than 14 days does not significantly diminish functional outcome according to FAOS. Delay of ORIF for ankle fractures does not play a significant role in the long-term functional outcome.

scholarly journals Paratricepital approach for open reduction and internal fixation of delayed presentation of pediatric supracondylar humerus fracture

2019 ◽  
Vol 6 (1) ◽  
pp. 107
Author(s):  
Ramachandra Subbasetty ◽  
Dayanand Manjunath ◽  
Deepak Shivanna ◽  
Narasimha Murthy
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Perioperative Complications ◽  
Humerus Fracture ◽  
Delayed Presentation ◽  
Supracondylar Humerus Fracture ◽  
Fractures In Children ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Delayed presentation of pediatric displaced supracondylar humerus fracture is relatively common. Management of such cases have higher incidence of perioperative complications and usually require open reduction and pinning. Open reduction can be done by various approaches, each having its own advantage and disadvantages.</p><p class="abstract"><strong>Methods:</strong> A prospective study was done comprising 20 children with displaced Supracondylar fracture presented 2-14 days of injury, Mean patient age was 6 years. 15 were boys and 5 were girls. Children in whom closed reduction and percutaneous pinning was achieved, vascular injury and more than 2 weeks old fracture cases were excluded. Paratricepital approach was used for Open reduction and pinning for all the cases. The functional outcome was assessed using Flynn criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> In all cases the fracture had united at complete follow-up and the mean follow-up period was 16 months. The outcome was excellent in 15 (75%), good in 3 (15%), fair in 1 (5%), and poor in 1 (5%) patients. The mean Baumann angle was 76º in the affected elbow and 73º in the normal elbow. Average time for complete union in the current study was 7 weeks. Pin tract infection was seen in 2, stiffness in 2 patients, cubitus varus in 1 patient. No case of compartment syndrome or iatrogenic nerve injury was seen was recorded.</p><p class="abstract"><strong>Conclusions:</strong> Finally, we concluded that triceps sparing paratricepital approach is an easy, simple and safe approach for exposure and internal fixation of supracondylar humeral fractures in children with excellent functional outcome.</p>

scholarly journals Treatment of choice for bicondylar tibial plateau fractures between open reduction with internal fixation versus hybrid circular external fixator: a systematic review

2020 ◽  
Vol 9 (1) ◽  
pp. 262
Author(s):  
I. Made Arya Susila ◽  
Sherly Desnita Savio ◽  
Cokorda Gde Oka Dharmayuda
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
Tibial Plateau ◽  
Operation Time ◽  
Tibial Plateau Fractures ◽  
Similar Operation ◽  
Bicondylar Tibial Plateau

The high complication rate is closely related to the incidence of bicondylar tibial plateau fractures (BTPF) due to the involvement of the articular surface. The aim of this study is to compare open reduction with internal fixation (ORIF) and hybrid circular external fixation (HCEF) as the choice of surgical procedure for BTPF because these two procedures is still controversial until now. A systematic review using Cochrane library, PubMed, and Google Scholar was conducted based on PRISMA guideline. Inclusion criteria were studies comparing HCEF and ORIF of BTPF. Studies of only one surgical technique modality, schatzker types I-IV tibial plateau fractures, and case reports were excluded, resulting in six included studies. There is no significant difference in radiographs, functional and anatomical outcomes in both group (ORIF vs HCEF). Complications that measured are higher infection rate found in the ORIF group. Blood loss was higher in the ORIF group, while both procedures have similar operation time and functional outcome. The mean of hospital length of stay (LoS) seems to be higher 6.83 days (95%CI 0.96-12.70; P<0.00001) on ORIF group from the random effect of forest plot evaluation. According to this study, HCEF is more beneficial in terms of blood loss and hospital LoS. But overall ORIF and HCEF carry similar operation time, functional outcome, union rate, and complication.

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