A prospective study of functional outcome of closed schatzker type V and type VI tibial plateau fractures managed by open reduction and internal fixation

Knee joints comprised of the distal femur, proximal tibia & patella. Injuries of the knee must be treated properly to maintain a good knee function. Fractures of the tibia plateau represent 1% of all fractures and approximately 8% of fractures occurring in the elderly. The aim was tostudy the “functional outcome of treatment of closed schatzker type V and type VI tibial plateau fractures using locking compression plate”. In this study, twenty patients with tibia plateau fractures who presented to our casualty were studied. All the patients were victims of road traffic accidents. Once they were thermodynamically stable, were clinically examined and assessed for associated injuries.Out of 11 patients with Type VI fractures, 4(36%) had excellent results, 4(36%) had good results, 2(18%) had fair results and 1(9%) had poor results. The poor result was due to the associated pelvic injury, which interrupted the regular post-op rehabilitation. Out of 9 patients with type V fractures, 2(22%) had excellent results and 7(78%) had good results according to Rasmussen Radiologic Assessment. Hence,early mobilization is absolutely essential for preventing the knee stiffness & for quick articular cartilage regeneration. Weight-bearing should be delayed until solid union to prevent the articular collapse.

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Evaluation of functional outcome of tibial plateau fractures managed by different surgical modalities

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20160709 ◽

2016 ◽

Vol 2 (1) ◽

pp. 5 ◽

Cited By ~ 2

Author(s):

Ravi kant Jain ◽

Rajeev Shukla ◽

Mudit Baxi ◽

Utkarsh Agarwal ◽

Sankalp Yadav

Keyword(s):

Functional Outcome ◽

Fracture Fixation ◽

Traffic Accidents ◽

Tibial Plateau ◽

Road Traffic ◽

Wide Spectrum ◽

Weight Bearing ◽

Age Groups ◽

Fracture Morphology ◽

Tibial Plateau Fractures

Background: Tibial plateau makes up one of the most important weight bearing surface. Its fractures are commonly faced entity encompassing a wide spectrum of injuries of variable fracture morphology. Due to in-crease in incidence of high velocity trauma and higher functional demands of patients, surgery is warranted in most of the cases. Although, there is advancement in fracture fixation methods, apt treatment of tibial plateau fractures still remains controversial.Methods: In our series, we analyzed the functional outcomes of 58 of surgically treated tibial plateau fractures. Fractures were classified with Schatzker’s classification. Various fixation modalities of fixation were employed. Functional outcome was evaluated with modified Rasmussen’s criteria.Results: Most of the patient’s belonged to younger age groups (58.62%) and males (79.31%) were predominately involved. Road traffic accidents were the most common etiological factor (70.69%). Schatzker types I (29.31%) and II (27.59%) were the most common observed fracture type. The majority of the patients had a complication free recovery (81.03%). Infection was reported in only one case (1.72%). Similarly, malunion was noticed in only in one case (1.72%). None of the patients had complications like nonunion or neurovascular damage. The functional outcome assessment according to Modified Rasmussen’s criteria at the end of 12 months showed the excellent functional outcome in 41 (70.68%), good in eight (13.79%), fair in five (10.34%) and poor in four (6.9%) patients.Conclusions: Surgical treatment of tibial plateau fractures is challenging, yet it helps in achieving excellent anatomical restoration and rigid fracture fixation enabling in the restoration of articular congruity and facilitation of early knee motion thus achieving optimal knee function.

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Functional outcome of surgical management in schatzker type V, VI tibial plateau fractures with locking compression plate

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2019.v5.i2h.53 ◽

2019 ◽

Vol 5 (2) ◽

pp. 556-559

Author(s):

Dr. Mahesh Kumar Dindivanam ◽

Dr. Prakashappa TH ◽

Dr. Avinash P ◽

Dr Vamsinath P

Keyword(s):

Functional Outcome ◽

Surgical Management ◽

Tibial Plateau ◽

Locking Compression Plate ◽

Tibial Plateau Fractures ◽

Schatzker Type ◽

Compression Plate ◽

Type V

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173215 ◽

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

Background: 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.Methods: 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.Results: 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. Conclusions: 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.

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Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates

Indian Journal of Orthopaedics ◽

10.4103/0019-5413.108915 ◽

2013 ◽

Vol 47 (2) ◽

pp. 188 ◽

Cited By ~ 28

Author(s):

GThiruvengita Prasad ◽

TSuresh Kumar ◽

RKrishna Kumar ◽

GanapathyK Murthy ◽

Nandkumar Sundaram

Keyword(s):

Functional Outcome ◽

Tibial Plateau ◽

Tibial Plateau Fractures ◽

Schatzker Type ◽

Type V

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

10.21203/rs.3.rs-33674/v2 ◽

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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Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20171891 ◽

2017 ◽

Vol 3 (3) ◽

pp. 497

Author(s):

Vijaysing S. Chandele ◽

Abhishek P. Bhalotia ◽

Milind V. Ingle ◽

Maroti R. Koichade

Keyword(s):

Functional Outcome ◽

Tibial Plateau ◽

Weight Bearing ◽

Oxford Knee Score ◽

Tibial Plateau Fractures ◽

Knee Score ◽

Early Weight Bearing ◽

Non Union ◽

Approach Time

Background: Management of tibial plateau fractures with coronal fractures especially posteromedial fragment is frequent and challenging. This study was conducted to evaluate the functional outcome of patients with tibial plateau fractures having posteromedial fragment treated with open reduction and internal fixation (ORIF) using Lobenhoffer approach.Methods: Thirty two patients with tibial plateau fractures having posteromedial fracture alone or part of bicondylar fracture was operated with ORIF using Lobenhoffer approach. Time to union, maintenance of alignment, rate of complications and functional outcome was assessed using Oxford knee score.Results: The mean time to healing was 16.4 weeks, without any complication in the form of non-union and infection. Malunion with secondary loss of alignment was seen in only one case due to fracture comminution and early weight bearing. Oxford knee score was good to excellent in all the cases. Conclusions: With recent development in understanding these fractures, ORIF gives excellent to good outcome in all patients operated through Lobenhoffer approach. Long term disability can be prevented by maintenance of adequate alignment and reduction through direct visualization of fracture.

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

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175656 ◽

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

Background: 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.Methods: 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 & VI included in study. Criteria for acceptable reduction 1) <5 mm of articular step; 2) <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.Results: 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. Conclusions: 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.

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

10.21203/rs.3.rs-198072/v1 ◽

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.

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