scholarly journals Assessment of Functional Outcome of Bicolumnar Dual Plating for Bicondylar Fractures of Tibial Plateau

2022 ◽  
Vol 19 (1) ◽  
pp. 101-105
Author(s):  
Dinesh Kumar Shrestha ◽  
Dipendra KC ◽  
Prateek Karki ◽  
Sabin Shrestha ◽  
Sushil Yogi
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Tibial Plateau ◽  
College Teaching ◽  
Common Peroneal Nerve ◽  
Schatzker Type ◽  
Dual Plating ◽  
Duration Of Surgery ◽  
Bicondylar Fractures

Introduction: Operative treatment of bicondylar fractures of tibial plateau is challenging and controversial. Aims: The aim of this study is to reveal the functional outcome of it by using bicolumnar dual plates and screws. Methods: This is a prospective hospital based interventional study carried out in the department of Orthopaedics of Nepalgunj Medical College Teaching Hospital. Thirty two Schatzker type V or AO (Association of Osteosynthesis) type 41 C1 & C2 fractures were treated between January 2016 and December 2019 with bicolumnar dual plating. The functional clinical outcomes were analyzed and evaluated using modified Rasmussen score. Results: Thirty two patients were included in the study. Out of which twenty four were male and eight were female. Average age was 32.21 years, eighteen were right sided and fourteen were left sided. Duration of surgery was 106 mins (range 90-120 mins) and the average duration of hospitalization was 7.81 days (range 4-14 days). Five patients of impending compartment syndrome and three patients with common peroneal nerve palsy were managed conservatively and also were included in the study. Two patients with superficial wound infection needed minimal debridement. One patient had varus angulation of 100 at third follow up after he fell from bed but surgical intervention were not needed. All fractures united. The average time for fracture healing was 21.5 weeks (range 16-32 weeks). At the Eighteen months follow up, the average knee range of motion was 1310(range 1100-1400). The functional outcome were evaluated using modified Rasmussen scoring system, which was 27.34 (range 22-30). Conclusion: Bicolumnar dual plating for bicondylar fractures of tibial plateau can provide excellent and stable fixation allowing early range of motion and gives excellent to good functional outcome.

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 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 Primary intra-articular osteotomy for varus malunion of the medial condyle of the tibial plateau

2020 ◽  
Vol 6 (2) ◽  
pp. 360
Author(s):  
Jeremy Bliss ◽  
Dan Barnabas Inja ◽  
Manasseh Nithyananth ◽  
Vinoo Mathew Cherian
Keyword(s):  
Functional Outcome ◽  
Tibial Plateau ◽  
Statistical Significance ◽  
P Value ◽  
Medial Condyle ◽  
Medial Condyle Fracture ◽  
Excellent Functional Outcome ◽  
Male Patients ◽  
Condyle Fracture

<p class="abstract"><strong>Background:</strong> Reconstructive operative procedures for post-traumatic deformities of the tibial plateau have been described in literature, though rarely. We report short term follow-up of eleven such cases of primary intra-articular osteotomy.</p><p class="abstract"><strong>Methods:</strong> From 2005 through 2011, a primary intra-articular osteotomy for varus malunion of the medial condyle of the tibial plateau was performed in eleven consecutive cases. The patients were assessed clinically and radiologically at a minimum of 28 months post-operatively. The functional outcome was assessed using Rasmussen score.  Paired ‘t’ test was used to determine the statistical significance.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were eleven male patients. Average follow up was 59 months (range 28 to 159). Articular congruity was restored to acceptable in all patients and varus malalignment was corrected from a mean of 1.5 degrees varus to 5.7 degrees of valgus (statistically significant, two-tailed P value of 0.0056) to an extent comparable to the normal side (mean 5.8 degrees). There were no infections. All patients had good to excellent functional outcome.</p><p class="abstract"><strong>Conclusions:</strong> A primary intra-articular osteotomy and osteosynthesis for malunited medial condyle fracture of the tibial plateau would help to restore mechanical alignment and improve functional outcome.</p>

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 Functional outcome after open reduction and internal fixation for traumatic diastasis of the pubic symphysis a one year follow-up study

2016 ◽  
Vol 2 (4) ◽  
pp. 256
Author(s):  
B. L. S. Kumar Babu ◽  
Biju Ravindran
Keyword(s):  
Internal Fixation ◽  
Functional Outcome ◽  
Open Reduction ◽  
High Energy ◽  
Walking Distance ◽  
Early Weight Bearing ◽  
Dual Plating ◽  
Pubic Diastasis ◽  
One Year

<p class="abstract"><strong>Background:</strong> Pubic diastasis often results in anteroposterior compression (APC) injuries based on Young and Burgess classification. It is caused due to high-energy trauma and of much clinical importance is given when coexists with urogenital and neurological complications with hemodynamic instability. Open reduction and internal fixation with plating facilitates early mobilisation with better results and is the preferable mode of stabilisation. We evaluated the clinical and functional outcome of such patients in a one-year follow-up period.</p><p class="abstract"><strong>Methods:</strong> In our study, we included 20 patients with APC II injuries who underwent an open reduction by single or dual plating technique by the Pfannenstiel approach, were followed for one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> Among 20 patients, 14 patients (70%) were operated with single superior plating, six patients (30%) were performed with dual plating, i.e., both superior and anterior plating. Among 20 patients, two patients (10%) were operated for primary arthrodesis with double plating. Only one among 20 (5%) had implant failure due to early weight bearing and were re-operated with primary arthrodesis with plating. Results were analysed based on a scoring system which includes five criteria such as anterior pelvic pain, dyspareunia and sexual dysfunction, ability to sit, gait abnormalities and walking distance. Among 20 patients ten patients (50%) had excellent results, six patients (30%) had good results, two patients (10%) had fair results, two patients (10%) had poor results.</p><p><strong>Conclusions:</strong> Open reduction and internal fixation of traumatic pubic diastasis in type II APC injuries with single or dual plating had given better results and early functional recovery.</p>

scholarly journals "MORIEF Technique" for Schatzker Type II–III Tibial Plateau Fractures with Tension Blisters: A Retrospective Study of Seven Patients

2021 ◽  
Author(s):  
Xin Qi ◽  
Yong-Qing Xu ◽  
Hong-Bo Tan ◽  
Shen Xia ◽  
Xiao-Yan Xu ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Weight Bearing ◽  
Clinical Score ◽  
Tibial Plateau Fractures ◽  
Functional Score ◽  
Type Ii ◽  
Joint Function ◽  
Schatzker Type ◽  
Needle Tract

Abstract Background: When tibial plateau fractures are combined with tension blisters, internal fixation surgery must be delayed. However, a prolonged delay may cause complications during fracture treatment. To combat this challenge, we innovatively proposed a minimally open reduction and Ilizarov external fixation (MORIEF) technology. Therefore, the present study aimed to explore the treatment, safety, and efficacy of the MORIEF technique in Schatzker type II–III tibial plateau fractures with tension blisters.Methods: We retrospectively analyzed data of seven patients with Schatzker type II–III tibial plateau fractures with tension blisters treated at our hospital from September 2013 to March 2017. All patients (five males, two females; mean age: 38.1±8.2 [range: 28–50] years) underwent the MORIEF technique. The Knee Society Score (KSS) and assessment of bone status according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system were used to evaluate the knee joint function and bone healing condition.Results: The operative time was 108.6±14.6 (range: 90–135) min, blood loss was 104.3±50.4 (range: 50–200) ml, time from operation to discharge was 2.6±0.7 (range: 2–4) days, and the follow-up period was 20.6±1.8 (range: 18–22) weeks. The fractures healed in all patients at 11.9±1.1 (range: 10–14) weeks. Except for one case of needle tract infection, no other complications occurred. At the last follow-up, the KSS presented a clinical score of 80–95 (mean: 86.4±4.4) points and a functional score of 85–95 (mean: 87.9±3.6) points. According to ASAMI, four cases were classified as excellent, two as good, one as fair, and none as poor.Conclusions: The use of the MORIEF technology for the treatment of Schatzker type II–III tibial plateau fractures with tension blisters showed that the resulting incidence of infection is low, weight-bearing and walking can be resumed immediately, hospitalization time is shortened, economic burden of patients is reduced, and fracture healing and joint function recovery are not affected postoperatively. Therefore, this technique was shown to be a relatively safe and effective treatment method for the condition.

scholarly journals Functional Outcome of Revision Osteosynthesis after failed surgical treatment of patellar fractures

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Elena Müller ◽  
Karl-Heinz Frosch
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Revision Surgery ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Fracture Dislocation ◽  
Secondary Fracture ◽  
Patellar Fractures ◽  
Tegner Score

Aims and Objectives: Patellar fractures account for approximately 1% of all skeletal fractures. They are rare, but due to the crucial function of the patella in the extensor mechanism of the knee they can lead to a serious impairment. New data are revealing functional impairment remains common even with improved surgical techniques. The aim of this study is to asses the functional outcome of patients after revision surgery in case of secondary fracture dislocation or remaining articular incongruity. Materials and Methods: The study was designed as a retrospective observatory study. We included all patients who underwent a revision surgery because of a remaining articular incongruity or a secondary fracture dislocation or re-fracture from January 2010 until december 2016. Results: Sixteen patients of mean age 51,8 years were included in the study with a mean follow-up period of 28,8 months. Fifteen patients had AO type C fractures, within ten a C3 fracture. Thirteen were initially treated with tension band wiring via k-wires or cannulated screws. The reason for a revision surgery were 5 times a remaining articular incongruity, 11 times a secondary fracture dislocation or re-fracture. We analysed pain, satisfaction, range of motion, Böstman-Score, Tegner-Score and KOOS and could extract follow-up data from 15 of the patients. All fractures healed, no articular incongruity remained. Mean pain measured with the visual analogue scale (0-10) was at rest 0,57 (range 0-3,5), on exertion 2,79 (range 0-8). The measurement of the range of motion compared with the opposite knee showed a complete extension. Mean Flexion was 120°, in the opposite knee 136° (p = 0,05). Mean postoperative Böstman-Score and Tegner-Score were 25,11 (good, max. 30) and 78,67 (moderate, max. 100). KOOS: symptoms 66,8 points, pain 77,55 points, ADL 75,67 points and qualitiy of life 56,25 points. Conclusion: Early revision surgery in case of secondary fracture dislocation, re-fracture or remaining articular incongruity leads to statisfactory functional outcomes. Furthermore in case of complexe fractures the tension band wiring technique shouldn’t be the first choice, alternatives like the plate osteosynthesis should be considered.

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