Functional outcome of internal fixation for tibial plateau fracture

Abstract Purpose Surgical treatment of tibial plateau fracture (TPF) is common. Surgical site infections (SSI) are among the most serious complications of TPF. This multicentre study aimed to evaluate the effect of fracturoscopy on the incidence of surgical site infections in patients with TPF. Methods We performed a retrospective multicentre study. All patients with an AO/OTA 41 B and C TPF from January 2005 to December 2014 were included. Patients were divided into three groups: those who underwent arthroscopic reduction and internal fixation (ARIF), and those who underwent open reduction and internal fixation (ORIF) with fracturoscopy, and those treated with ORIF without fracturoscopy. The groups were compared to assess the effect of fracturoscopy. We characterised our cohort and the subgroups using descriptive statistics. Furthermore, we fitted a logistic regression model which was reduced and simplified by a selection procedure (both directions) using the Akaike information criterion (AIC). From the final model, odds ratios and inclusive 95% confidence intervals were calculated. Results Overall, 52 patients who underwent fracturoscopy, 48 patients who underwent ARIF, and 2000 patients treated with ORIF were identified. The rate of SSI was 0% (0/48) in the ARIF group and 1.9% (1/52) in the fracturoscopy group compared to 4.7% (93/2000) in the ORIF group (OR = 0.40, p = 0.37). Regression analyses indicated a potential positive effect of fracturoscopy (OR, 0.65; 95% CI, 0.07–5.68; p = 0.69). Conclusion Our study shows that fracturoscopy is associated with reduced rates of SSI. Further studies with larger cohorts are needed to investigate this. Level of evidence Level III.

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Mapping recovery in simple and complex tibial plateau fracture fixation

The Bone & Joint Journal ◽

10.1302/0301-620x.101b8.bjj-2018-1288.r1 ◽

2019 ◽

Vol 101-B (8) ◽

pp. 1009-1014 ◽

Cited By ~ 2

Author(s):

D. N. Ramoutar ◽

K. Lefaivre ◽

H. Broekhuyse ◽

P. Guy ◽

P. O’Brien

Keyword(s):

Functional Outcome ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Short Form ◽

Tibial Plateau Fractures ◽

Functional Score ◽

Complex Group ◽

Sf 36 ◽

Functional Scores ◽

Plateau Fracture

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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Total knee arthroplasty following internal fixation of a tibial plateau fracture

Injury Extra ◽

10.1016/j.injury.2004.12.065 ◽

2005 ◽

Vol 36 (8) ◽

pp. 352-354 ◽

Cited By ~ 1

Author(s):

M. Rowsell ◽

D. Gale

Keyword(s):

Total Knee Arthroplasty ◽

Internal Fixation ◽

Knee Arthroplasty ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Plateau Fracture ◽

Total Knee

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A Serious Vascular Complication of Internal Fixation of a Tibial Plateau Fracture

The Journal of Trauma: Injury, Infection, and Critical Care ◽

10.1097/00005373-199602000-00032 ◽

1996 ◽

Vol 40 (2) ◽

pp. 323-325 ◽

Cited By ~ 6

Author(s):

M.L. Rawes ◽

W.H. Harper ◽

O.O.A. Oni

Keyword(s):

Internal Fixation ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Vascular Complication ◽

Plateau Fracture

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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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Arthroscopy-Assisted Reduction Percutaneous Internal Fixation Versus Open Reduction Internal Fixation for Tibial Plateau Fracture: A Systematic Review and Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211027838 ◽

2021 ◽

Vol 9 (12) ◽

pp. 232596712110278

Author(s):

Liangjun Jiang ◽

Erman Chen ◽

Lu Huang ◽

Cong Wang

Keyword(s):

Systematic Review ◽

Internal Fixation ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Open Reduction Internal Fixation ◽

Radiological Evaluation ◽

Plateau Fracture ◽

Mean Differences ◽

Percutaneous Internal Fixation

Background: Arthroscopy-assisted reduction percutaneous internal fixation (ARIF) has emerged recently as an alternative treatment method in treating lower-energy tibial plateau fractures. To date, the comparison of clinical efficacy between ARIF and open reduction internal fixation (ORIF) is limited, with divergent conclusions. Purpose: To review studies on the clinical efficacy of ARIF and ORIF in the treatment of tibial plateau fracture. Study Design: Systematic review; Level of evidence, 3. Methods: A search was conducted using the PubMed, Web of Science, Cochrane Library, and EMBASE databases between inception and August 20, 2020, for retrospective and prospective studies evaluating ARIF versus ORIF in the treatment of tibial plateau fracture. We identified 6 clinical studies that met the inclusion criteria, with 231 patients treated with ARIF and 386 patients treated with ORIF. The risk of bias and the quality of evidence of the included studies were assessed. The 2 treatment types were compared in terms of clinical results and complications by using odds ratios (ORs), mean differences (MDs), or standardized mean differences (SMDs), with 95% confidence intervals (CIs). Heterogeneity among studies was quantified using the I 2 statistic. Results: The quality of the studies was high. Compared with ORIF, treatment with ARIF led to better clinical function (SMD = 0.31; 95% CI, 0.14 to 0.48; I 2 = 15%; P = .0005), shorter hospital stay (MD = –2.37; 95% CI, –2.92 to –1.81; I 2 = 0%; P < .001), and more intra-articular lesions found intraoperatively (OR = 3.76; 95% CI, 1.49 to 9.49; I 2 = 66%; P = .005). There were no complications or significant differences between the techniques in the radiological evaluation of reduction. Conclusion: Compared with ORIF, the ARIF technique for tibial plateau fractures led to faster postoperative recovery and better clinical function and the ability to find and treat more intra-articular lesions during the operation. However, the radiological evaluation of reduction and complications were not significantly different between the 2 groups.

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