scholarly journals Complex Tibial Plateau Fractures Treated with a Hybrid External Fixator – Long Term Results

2021 ◽  
Vol 48 (3) ◽  
pp. 26-29
Author(s):  
Y. Andonov
Keyword(s):  
Internal Fixation ◽  
External Fixator ◽  
Tibial Plateau ◽  
Soft Tissues ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Long Term Results ◽  
Joint Degeneration

Abstract Introduction: High energy tibial plateau fractures represent a challenge because of the combined bone and soft tissue injury. The iatrogenic impact can further increase the likelihood for crippling complications. Less invasive treatment protocols have been developed to improve the results. Objective: We present the long-term results of limited internal fixation combined with a small wire external fixator. Patients and Methods: Fourteen patients were followed for at least 10 years. Initial and final functional results, complications and presence of joint degeneration were registered according to validated rating scores. Results: Of all patients included in the study, thirteen showed an excellent initial rating and one had an average result at baseline. 10 years later, eight patients still showed excellent grading results, four – good ones, one – average and one – poor results. Ten knees (71%) had osteoarthritis. Postphlebitic syndrome was diagnosed in two cases. Three knees showed medio-lateral instability, one showed a varus and one – a valgus deformity. Knee arthroplasty was performed in one case. Conclusion: The limited internal fixation combined with a hybrid ex fix can be considered as an alternative to the ORIF, especially when the soft tissues are severely compromised. Despite the inevitable joint degeneration, the associated overall morbidity is low and the long term function is quite satisfactory.

scholarly journals Treatment of high energy tibial plateau fractures with hybrid external fixator: intermediate term outcome

2017 ◽  
Vol 5 (10) ◽  
pp. 4582
Author(s):  
Alamgir Jahan ◽  
Muhammad Haseeb ◽  
Fahad Wazir
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixator ◽  
Tibial Plateau ◽  
High Energy ◽  
Deep Infection ◽  
Tibial Plateau Fractures ◽  
Open Fractures ◽  
Hybrid External Fixator ◽  
Primary Management

Background: High energy tibial plateau fractures pose a management challenge because of the complexity of bone and soft tissue trauma. Because of the frequency and magnitude of soft tissue of soft tissue injury in these fractures, early internal fixation becomes difficult. Wound breakdown and deep infection are common complications in plating of these difficult fractures. Primary management with hybrid external fixator can be a useful alternative to internal fixation in such cases.Methods: The study was a prospective case series done in the orhtopaedic department of a teaching hospital. 20 patients were studied. There were 13 Schatzker VI, 5 Schatzker V and 2 Schatzker IV fractures included. 4 patients had open fractures and 1 had compartment syndrome. Open fractures were operated in emergency department. Those with severe swelling and blisters were allowed few days to settle. Primary fixation using a hybrid external fixator was done. Mobilisation was started early. Patients were followed up to 1 year.Results: Union was obtained in all patients within 18 weeks. There was only deep infection. 95% patients had range of motion of 90 degrees or more. No patient had an extensor lag.Conclusions: Primary management of high energy tibial plateau fractures using hybrid external fixator is a reasonable option for cases that are not immediately amenable to internal fixation. It provides adequate stabilization to allow early motion and hastens patient rehabilitation. We have a good experience with this technique and recommend it for judicious use.

Tibial plateau fracture: anatomy, diagnosis and management

2020 ◽  
Vol 81 (10) ◽  
pp. 1-9
Author(s):  
Branavan Rudran ◽  
Christopher Little ◽  
Anatole Wiik ◽  
Kartik Logishetty
Keyword(s):  
Surgical Management ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Lateral Condyle ◽  
Mechanism Of Injury ◽  
Schatzker Classification ◽  
Plateau Fracture

Tibial plateau fractures are peri-articular knee fractures of the proximal tibia. The presentation is dependent on the mechanism of injury. The tibial plateau is the bony platform of the distal half of the knee joint, and is made up of a medial and lateral condyle separated by the intercondylar eminence. The presentation of tibial plateau fractures can vary greatly as a result of the bimodal mechanism of injury and patient characteristics. The patient should be assessed for life- and limb-threatening injuries in accordance with British Orthopaedic Association Standards of Trauma guidelines. Imaging is undertaken to understand configuration of the fracture, which is classified by the Schatzker classification. Definitive management of the fracture depends on the severity, ranging from conservative to surgical management. Surgery is required for more severe tibial plateau fractures to restore articular congruity, mechanical alignment, ligamentous stability and to permit early mobilisation. Medium-term functional outcome after tibial plateau fractures is generally excellent when anatomy and stability is restored. At least half of patients return to their original level of physical activity. Surgical management of tibial plateau fractures is not without complication. Risk factors include postoperative arthritis, bicondylar and comminuted fractures, meniscal removal, instability, malalignment and articular incongruity. Tibial plateau fractures account for 1% of all fractures, and typically occur either as a fragility fracture or secondary to a high-energy impact. These latter injuries are associated with extensive soft tissue injury, life- and limb-threatening complications and long-term sequelae. While outcomes are generally good, severe injuries are at higher risk of infection and post-traumatic arthritis requiring knee arthroplasty. This article considers the anatomy, diagnosis and evidence-based management strategies for tibial plateau fracture.

scholarly journals Saving of Foot Support Ability in Post-traumatic Defects Using Microsurgical Tissue Autotransplantation

2020 ◽  
Vol 9 (3) ◽  
pp. 434-441
Author(s):  
A. P. Vlasov ◽  
E. Y. Shibayev ◽  
A. M. Fayn ◽  
P. A. Ivanov ◽  
D. A. Kisel ◽  
...  
Keyword(s):  
Soft Tissues ◽  
High Energy ◽  
Infectious Complications ◽  
Long Term Results ◽  
Foot And Ankle ◽  
Automobile Accidents ◽  
Post Traumatic ◽  
Open Injuries ◽  
Ability Measure

Background. Severe open injuries of the lower extremities in most cases are the result of high-energy trauma, because the foot and ankle are damaged as a result of automobile accidents almost in every fourth victim. According to the literature, the percentage of infectious complications after surgical debridement of open injuries of the foot is 43–67.9% and shows no tendency to decrease.Material and methods. We performed 32 operations with the use of free revascularized grafts in patients aged from 16 to 70 years with extensive posttraumatic defects of the foot between 2010 and 2018.Results. As a result, 30 (93.7%) out of 32 grafts provided foot support ability provided during the post-operative period. When replacing large defects (more than 80 cm2) of soft tissues supporting surface of the foot we used free musculocutaneous flap of the latissimus dorsi, fasciocutaneous flaps were used for defects of the dorsum of the foot (less than 80 cm2). Long-term results were assessed using the Foot and ankle ability Measure (FAAM) questionnaire.Conclusion. Primary early replacement of tissue defects on the foot with free revascularized autografts is the method of choice for solving this problem, as it allows you to maintain the supporting function of the foot and is often alternative method to amputation.

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 TIBIAL PLATEAU FRACTURES

2018 ◽  
Vol 25 (06) ◽  
pp. 810-814
Author(s):  
Saeed Ahmad ◽  
Tariq Mahmood ◽  
Muhammad Imran Haider
Keyword(s):  
External Fixator ◽  
Tibial Plateau ◽  
Case Series ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Tibial Fractures ◽  
Female Ratio ◽  
Non Union ◽  
Hybrid External Fixator ◽  
Pin Track

Background: Tibial fractures is most common type of long bone fractures. Highspeed lifestyles with vehicles motorcycles as well as growing waves of violence, contributingincrease occurrence of tibial fractures. Tibial plateau fractures continues to be a challenge fororthopedic surgeon. Treatment of these fractures have been plagued by complications. Recentimprovements in the techniques and development of hybrid external fixator have revolutionizedthe treatment of such fractures. Objective: To evaluate the clinical outcomes of hybrid externalfixator in high energy Schatzkar V and VI tibial plateau fractures. Study Design: Descriptive,Case series. Period: 27 June 2013 to 26 June 2016. Setting: Nishtar Hospital, Multan. Materialand methods: A total of 125 patients with open and close tibial plateau fractures, 20 to 50 yearsof age of both genders were included in the study. Patients having history of pervious surgeryor intervention tibial plateau fractures, and h/o malignancy were excluded. All the patients wereoperated by a consultant orthopedic surgeon. Outcome was assessed at 16 weeks by serialradiological x-ray by formation of callus and noting any grade of pin track infection. Results; Ourstudy comprised of 125 patients having Schatzker V and Schatzker VI tibial plateau fractureswho met our inclusion criteria. Mean age of 38.925 ± 7.09 years. Majority of the patients 47(37.60%) were between 41 to 50 years of age. Mean duration since injury in our study was 13.18± 4.79 hours. Out of 125 patients, 102 (81.60%) were males and 23(18.40%) were females withmale to female ratio of 1.2:5.4. Fifty three (42.4%) patients presented with Schatzker V and 72(57.6%) had Schatzker VI type of tibial plateau fractures. In our study, non-union was seen in10cases (8.0%) and pin track infection was noted to be present in 19 (15.20%) patients. So, theacceptable outcome (achievement of union without non-union or pin track infection during 16weeks) was seen in 96(76.8%) patients. Conclusion: This study concluded that there is highrate of acceptable outcome (achievement of union without any non-union or pin track infectionduring 16 weeks) after hybrid external fixator of the open and closed fractures of tibial plateauamong the patients having schatzker-V and VI.

Management of high-energy tibial plateau fractures by Ilizarov external fixator

2013 ◽  
Vol 5 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Kamal El-Gafary ◽  
Wael El-adly ◽  
Osama Farouk ◽  
Mohamed Khaled ◽  
Marwa Mahmoud Abdelaziz
Keyword(s):  
External Fixator ◽  
Tibial Plateau ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Ilizarov External Fixator
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