scholarly journals Treatment of Posterolateral Tibial Plateau Fractures With a Rotational Support Plate and Special Pressurizer: a Technical Note and 12 Cases 

2021 ◽  
Author(s):  
Yu-Feng Chen ◽  
Dong Ren ◽  
Lin-Dan Geng ◽  
Shuang-Quan Yao ◽  
Zhao-Hui Song ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Surgical Approaches ◽  
Bony Union ◽  
Anterolateral Approach ◽  
X Rays ◽  
Postoperative Rehabilitation ◽  
Support Plate

Abstract Background: Posterolateral tibial plateau fractures are uncommon fractures and challenging to treat. Although there are many surgical approaches and fixation methods for the treatment of these fractures, all of these methods have limitations. We designed a new rotational support plate (RSP) and a special pressurizer that can fix the fracture directly via the anterolateral approach. This method is advantageous because it leads to little trauma, involves a simple operation and has a reliable fixation effect. This study details the technique of treating these fractures with the RSP and special pressurizer and provides the outcomes.Methods: From May 2016 to January 2019, the data of 12 patients with posterolateral tibial plateau fractures treated with the RSP and special pressurizer in our hospital were retrospectively analysed. Postoperative rehabilitation was advised, knee X-rays were taken at follow-ups, and fracture healing, complications, and knee range of motion were assessed. The Hospital for Special Surgery (HSS) knee score was used to evaluate knee function at the last follow-up.Results: The average follow-up time of all patients was 16.5 months (range, 12-25 months). The average bony union time was 3.2 months (range, 3-4.5 months). At the last follow-up, the average knee range of motion was 138° (range, 107°-145°). The average HSS score was 91 (range, 64-98). Skin necrosis, incision infections, and fixation failure did not occur during the follow-up period.Conclusions: With our newly designed RSP and special pressurizer, posterolateral tibial plateau fractures can be easily and effectively reduced and fixed through the anterolateral approach, which serves as a novel treatment for posterolateral tibial plateau fractures.

scholarly journals Treatment of posterolateral tibial plateau fractures with a rotational support plate and special pressurizer: technical note and retrospective case series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu-Feng Chen ◽  
Dong Ren ◽  
Lin-Dan Geng ◽  
Shuang-Quan Yao ◽  
Zhao-Hui Song ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tibial Plateau ◽  
Case Series ◽  
Tibial Plateau Fractures ◽  
Surgical Approaches ◽  
Bony Union ◽  
Anterolateral Approach ◽  
X Rays ◽  
Support Plate

Abstract Background In tibial plateau fractures, the posterolateral segment of the tibia plateau is frequently affected and challenging to treat. Although there are many surgical approaches and fixation methods for the treatment of these fractures, all of these methods have limitations. We designed a new rotational support plate (RSP) and a special pressurizer that can fix the fracture directly via the anterolateral approach. This method is advantageous because it leads to little trauma, involves a simple operation, and has a reliable fixation effect. This study details the technique of treating these fractures with the RSP and special pressurizer and provides the outcomes. Methods From May 2016 to January 2019, the data of 12 patients with posterolateral tibial plateau fractures treated with the RSP and special pressurizer in our hospital were retrospectively analyzed. Postoperative rehabilitation was advised, knee X-rays were taken at follow-ups, and fracture healing, complications, and knee range of motion were assessed. The Hospital for Special Surgery (HSS) knee score and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to evaluate knee function at the last follow-up. Results The average follow-up time of all patients was 16.5 months (range, 12–25 months). The average bony union time was 3.2 months (range, 3–4.5 months). At the last follow-up, the average knee range of motion was 138° (range, 107–145°). The average HSS score was 91 (range, 64–98). The average KOOS Symptoms score was 90 (range, 75–96). The average KOOS Pain score was 91 (range, 72–97). The average KOOS ADL score was 91 (range, 74–97). The average KOOS sport/recreation score was 83 (range, 70–90). The average KOOS QOL score was 88 (range, 69–93). Skin necrosis, incision infections, and fixation failure did not occur during the follow-up period. Conclusions With our newly designed RSP and special pressurizer, posterolateral tibial plateau fractures can be easily and effectively reduced and fixed through the anterolateral approach, which serves as a novel treatment for posterolateral tibial plateau fractures.

scholarly journals Three-column Subdivision for Isolated Posterolateral Tibial Plateau Fractures and Perspective Surgical Approachs

2021 ◽  
Author(s):  
Jae Ang Sim ◽  
Ji Hyeon Park ◽  
Young Gon Na ◽  
Byung Hoon Lee
Keyword(s):  
Range Of Motion ◽  
Surgical Approach ◽  
Postoperative Period ◽  
Supine Position ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Surgical Approaches ◽  
Anterolateral Approach ◽  
Plateau Fracture

Abstract BackgroundManagement of the tibial plateau fracture involving posterolateral compartment is technically challenging. This study aimed to introduce a computed tomography-based classification of the posterolateral compartment of tibial plateaus based on the fibula and to propose the individualized surgical approaches for each zone; and 2) to determine the surgical approach based on the classification, would achieve a safe and effective reduction and can improve postoperative clinical outcomes.MethodsEighteen cases of tibia plateau fracture involved the isolated posterolateral compartment in a single institution were retrospectively analyzed. The posterolateral compartment of tibial plateau was segmented into three zones based on the fibular position and individualized surgical approach was proposed for each zone. In anterior Zone I, surgical treatment was performed using an extended anterolateral approach and patient was placed in the supine position; In middle Zone II, using the transfibular approach in the supine position; In posterior Zone III, using the posteromedial approach in prone. Articular reduction (intra-articular step off in CT images) and mechanical medial proximal tibial angle (mMPTA) in simple radiographs taken in the immediate postoperative period and clinical outcomes of the Lysholm knee scoring scale and range of motion were evaluated at postoperative 1-year follow-up,ResultsIn all cases, anatomical articular reduction (intra-articular step off < 2 mm) was achieved, maintained for the follow-up period. The average mMPTA was increased from 87.6º before surgery to 88.2º in immediate postoperative period (p = 0.060), and maintained for the follow-up period (mean 89.9º at one-year follow-up). At the 1-year follow-up, the knee range of motion averaged 140 degrees and the Lysholm knee function scored 95.0 points.ConclusionAn individualized surgical approach and fixation according to three-zone subdivision for isolated posterolateral tibial plateau fractures provided an effective and safe method to treat posterolateral tibial plateau fractures.Level of evidence: Therapeutic study, IV

scholarly journals Three-column Subdivision for Isolated Posterolateral Tibial Plateau Fractures and Perspective Surgical Approachs

2020 ◽  
Author(s):  
Jae Ang Sim ◽  
Ji Hyeon Park ◽  
Young Gon Na ◽  
Byung Hoon Lee
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Surgical Approach ◽  
Postoperative Period ◽  
Supine Position ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Anterolateral Approach ◽  
Plateau Fracture

Abstract Background: Management of the tibial plateau fracture involving posterolateral compartment is technically challenging. This study aimed to introduce a computed tomography-based classification of the posterolateral compartment of tibial plateaus based on the fibula and to propose the individualized surgical approaches for each zone; and 2) to determine the surgical approach based on the classification, would achieve a safe and effective reduction and can improve postoperative clinical outcomes.Methods: Eighteen cases of tibia plateau fracture involved the isolated posterolateral compartment in a single institution were retrospectively analyzed. The posterolateral compartment of tibial plateau was segmented into three zones based on the fibular position and individualized surgical approach was proposed for each zone. In anterior Zone I, surgical treatment was performed using an extended anterolateral approach and patient was placed in the supine position; In middle Zone II, using the transfibular approach in the supine position; In posterior Zone III, using the posteromedial approach in prone. Articular reduction (intra-articular step off in CT images) and mechanical medial proximal tibial angle (mMPTA) in simple radiographs taken in the immediate postoperative period and clinical outcomes of the Lysholm knee scoring scale and range of motion were evaluated at postoperative 1-year follow-up,Results: In all cases, anatomical articular reduction (intra-articular step off < 2mm) was achieved, maintained for the follow-up period. The average mMPTA was increased from 87.6º before surgery to 88.2º in immediate postoperative period (p = 0.060), and maintained for the follow-up period (mean 89.9º at one-year follow-up). At the 1-year follow-up, the knee range of motion averaged 140 degrees and the Lysholm knee function scored 95.0 points.Conclusion: An individualized surgical approach and fixation according to three-zone subdivision for isolated posterolateral tibial plateau fractures provided an effective and safe method to treat posterolateral tibial plateau fractures. Level of evidence: Therapeutic study, IV

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.

scholarly journals Participation in Recreational Athletics After Operative Fixation of Tibial Plateau Fractures: Predictors and Functional Outcomes of Those Getting Back in the Game

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774391 ◽  
Author(s):  
David N. Kugelman ◽  
Abdullah M. Qatu ◽  
Jack M. Haglin ◽  
Sanjit R. Konda ◽  
Kenneth A. Egol
Keyword(s):  
Postoperative Complications ◽  
Alcohol Consumption ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Severe Injuries ◽  
White Race ◽  
Operative Fixation

Background: Tibial plateau fractures can be devastating traumatic injuries to the knee, particularly in active athletes. Purpose/Hypothesis: The purpose of this study was to report on the return to participation in recreational athletics after operatively managed tibial plateau fractures. In addition, this study assessed factors associated with the ability to return to participation in recreational athletics after tibial plateau fractures treated with open reduction internal fixation and compared final outcomes between patients who were able to return to recreational athletics and those who could not. The hypothesis was that returning to participation in recreational athletics would be dependent on the time from surgery after operative fixation of tibial plateau fractures. Less severe injuries would be associated with a quicker return to athletics. Study Design: Case-control study; Level of evidence, 3. Methods: All tibial plateau fractures treated by 1 of 3 surgeons at a single academic institution over an 11-year period were prospectively followed. Final outcomes were evaluated using the Short Musculoskeletal Function Assessment at latest follow-up. All complications were recorded at each follow-up. Differences between the groups were compared using Student t tests for continuous variables. Chi-square analysis was used to determine whether differences between categorical variables existed. Logistic regression was performed to assess independent variables associated with returning to participation in recreational athletics. Results: A total of 169 patients who underwent operative management of their tibial plateau fracture reported participation in recreational athletics before their injury. By the 6-month time point, 48 patients (31.6%) had returned to participation in recreational athletics, and at final follow-up (mean, 15 months), 89 patients (52.4%) had returned to participation in recreational athletics. Predictors of returning to recreational athletics included white race, female sex, social alcohol consumption, younger age, increased range of motion (ROM), low-energy Schatzker patterns (I-III), injuries not inclusive of orthopaedic polytrauma or open fractures, and no postoperative complications. White race, social alcohol consumption, and increased ROM were associated with returning to athletics at both 6-month and final follow-up. Lack of a venous thromboembolism was associated with returning to athletics at final follow-up. Patients who returned to recreational athletics had associations with better functional outcomes and emotional status than those who did not. Conclusion: The number of patients who returned to participation in recreational athletics gradually increased over time after operative fixation of tibial plateau fractures. Less severe injuries and a lack of postoperative complications were associated with a quicker return to athletics. Predictors of returning to participation in recreational athletics after operatively managed tibial plateau fractures can be used to target patients at risk of not returning to play to provide interventions aimed at improving their recovery, such as early knee range of motion, muscle strengthening, and participation in low-impact activities.

A Novel Method of the Treatment for Posterolateral Tibial Plateau Fractures

2019 ◽  
Vol 33 (10) ◽  
pp. 1010-1019
Author(s):  
Dong Ren ◽  
Yueju Liu ◽  
Yanxi Chen ◽  
Jian Lu ◽  
Zhaohui Song ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Vertical Displacement ◽  
Knee Extension ◽  
Tibial Plateau Fractures ◽  
Posterolateral Approach ◽  
Anterolateral Approach ◽  
Plateau Fracture

AbstractReduction and fixation of posterolateral tibial plateau fracture via a posterolateral approach is challenging, and the posterolateral approach itself may injure the posterolateral ligament complex of the knee and can result in knee instability. We developed a new curved support plate (CSP) that can pass, via traditional anterolateral approach, through the superior tibiofibular interval and effectively support the posterolateral fragments. The purpose of our study was to determine the biomechanical reliability of the new plate and report the preliminary efficacy of the CSP for posterolateral tibial plateau fracture. In the biomechanical experiment, 40 synthetic tibias were used to create posterolateral shearing tibial fracture models, which were randomly assigned to groups A to D. Vertical displacement of the posterolateral fragments was measured under axial loads of 500 to 1,500 N. The new plate and 3.5-mm lateral locking plate exhibited similar control over fragment displacement. From June 2016 to August 2017, eight patients with posterolateral tibial plateau fracture underwent treatment with the CSP. Hospital for Special Surgery (HSS) knee score, knee flexion and extension ranges of motion, and complications were recorded to evaluate treatment effects. Eight patients (five men and three women, mean age 44 years [range, 23–66 years]) were enrolled in the study. Mean follow-up time was 13 months (range, 7–19 months). All patients achieved radiographic bone union by 3.3 months (range, 3–4 months) postoperatively. There were no complications of neurovascular injury, deep vein thrombosis, infection, and implant loosening throughout the follow-up period. At final follow-up, mean HSS score was 92.6 (88–96), with a mean knee flexion of 131.25 degrees (120–135 degrees) and a mean knee extension of 1 degree (0–5 degrees). Fixation of posterolateral tibial plateau fracture was easily and successfully achieved using our newly designed CSP, which may provide a new choice for posterolateral tibial plateau fractures.

A Comparative Study of Clinical Outcomes and Functional Status after Knee Fracture and Knee Fracture Dislocation

2021 ◽  
Author(s):  
Mackenzie L Bird ◽  
Kristofer E Chenard ◽  
Leah J Gonzalez ◽  
Sanjit R Konda ◽  
Philipp Leucht ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Arterial Injury ◽  
Tibial Plateau Fractures ◽  
Knee Fracture ◽  
Plateau Fracture

AbstractThe aim of this study was to compare outcomes of tibial plateau fracture dislocations (FD) with tibial plateau fractures alone. This study was an analysis of a series of tibial plateau fractures, in which FD was defined as a fracture of the tibial plateau with an associated loss of congruent joint reduction and stability of the knee, and classified by the Moore system. Patient data collected included demographics, injury information, and functional outcomes (short musculoskeletal function assessment [SMFA] score and Pain by the visual analog scale). Clinical outcomes at follow-up were recorded including knee range of motion, knee stability and development of complications. There were a total of 325 tibial plateau fracture patients treated operatively, of which 22.2% were identified as FD (n = 72). At injury presentation there was no difference with regard to nerve injury or compartment syndrome (both p > 0.05). FD patients had a higher incidence of arterial injury and acute ligament repair (both p < 0.005). At a mean follow-up of 17.5 months, FD patients were similar with regard to pain, total SMFA scores, and return to sports than their non-FD counterparts (p = 0.884, p = 0.531, p = 0.802). FD patients were found to have decreased knee flexion compared with non-FD patients by 5 degrees (mean: 120 and 125 degrees) (p < 0.05). FD patients also had a higher incidence of late knee instability and subsequent surgery for ligament reconstruction (p < 0.005 & p < 0.05). However, there was no difference in neurological function between groups at follow-up (p = 0.102). Despite the higher incidence of ligamentous instability and decreased range of motion, FD patients appear to have similar long-term functional outcomes compared with non-FD of the tibial plateau. While FD patients initially presented with a higher incidence of arterial injury, neurovascular outcomes at final follow-up were similar to those without a dislocation.

scholarly journals Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

2009 ◽  
Vol 1 (1) ◽  
pp. 4 ◽  
Author(s):  
Marcus Jaeger ◽  
Michael Schmidt ◽  
Alexander Wild ◽  
Bernd Bittersohl ◽  
Susanne Courtois ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Mean Value ◽  
Surgical Approaches ◽  
Radiological Outcome ◽  
Scarf Osteotomy ◽  
Post Surgery ◽  
The Mean

Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years) were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years). Surgical indications were: intermetatarsal angle (IMA) of 12-23&deg;; increased proximal articular angle (PAA&gt;8&deg;), and range of motion of the metatarsophalangeal joint in flexion and extension &gt;40&deg;. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM) of the great toe post-surgery was 0.8&plusmn;1.73 points (0: full ROM, 10: total stiffness). The mean subjective cosmetic result was 2.7&plusmn;2.7 points (0: excellent, 10: poor). The overall post-operative patient satisfaction with the result was high (2.1&plusmn;2.5 points (0: excellent, 10: poor). The mean hallux valgus angle improvement was 16.6&deg; (pre-operative mean value: 37.5&deg;) which was statistically significant (p&lt;0.01). The IMA improved by an average of 5.96&deg; from a pre-operative mean value of 15.4&deg; (p&lt;0.01). Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

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.

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