scholarly journals Does Time to Theatre Affect the Ability to Achieve Fracture Reduction in Tibial Plateau Fractures?

2021 ◽  
Vol 11 (1) ◽  
pp. 138
Author(s):  
David Stuart Kitchen ◽  
Jack Richards ◽  
Peter J. Smitham ◽  
Gerald J. Atkins ◽  
Lucian B. Solomon

Surgical management of displaced tibial plateau fracture (TPF) is often delayed due to accompanying soft tissue injuries sustained at the time of injury. The primary aim of this study was to assess the effect of time to surgery on fracture reduction in cases of TPF. The secondary aim was to assess the effect of preoperative demographics and residual articular step on Lysholm Scores and Knee Injury and Osteoarthritis Outcome Scores (KOOS) following fixation. Patients between 2006 and 2017, managed by a single surgeon, were prospectively enrolled in the study. Reduction of articular step, defined as <2 mm, was assessed by a single blinded examiner. A total of 117 patients were enrolled, 52 with Schatzker II, 4 with Schatzker IV, and 61 with Schatzker VI fractures. Patients were followed up to a mean of 3.9 years. Analysis showed that the ability to achieve fracture reduction was negatively influenced by time to theatre, with the odds of achieving reduction decreasing 17% with each subsequent day post injury (p = 0.002). Furthermore, an increased time to theatre was associated with a reduced Lysholm score at one year (p = 0.01). The ability to achieve fracture reduction did not influence PROMs within the study period. We conclude that delay in surgical fixation negatively affects fracture reduction in TPF and may delay recovery. However, residual articular step does not necessarily influence PROMs over the mid-term.

2021 ◽  
Author(s):  
David S. Kitchen ◽  
Jack Richards ◽  
Peter J. Smitham ◽  
Gerald J. Atkins ◽  
Lucian B. Solomon

AimsThe primary aim of this study was to assess the effect of time to surgery on fracture reduction, assessed as residual articular step, in cases of tibial plateau fracture (TPF). The secondary aim was to assess the effect of pre-operative demographics and residual articular step on patient reported outcomes (PROMs) following TPF.MethodBetween 2006 and 2017 all surgically treated TPF patients managed by a single surgeon at our institution were prospectively consented for the study of fracture outcomes. Timing to surgical intervention, reduction of articular step, age, gender, medical background, fracture classification, mechanism of injury and PROMs (Lysholm Scores and Knee Injury and Osteoarthritis Outcome Scores (KOOS)) were recorded and analysed. Reduction of articular step, defined as <2mm, was assessed by a single blinded examiner using measurements on plain radiographs on PACS.ResultsOne hundred seventeen patients were enrolled, 52 with Schatzker II, four with Schatzker IV and 61 with Schatzker VI fractures. Patients were followed-up to a mean time of 3.9 years. The ability to achieve fracture reduction was negatively influenced by time to theatre with the odds of achieving reduction decreasing 17% each day post-injury (p = 0.002). An increased time to theatre was associated with reduced Lysholm scores at the one-year mark (p = 0.01). The ability to achieve fracture reduction did not influence PROMs within the study period.ConclusionDelay in surgical fixation negatively affects fracture reduction in TPF and may delay recovery. However, residual articular step did not influence the investigated PROMs in the cohort investigated over the mid-term (mean of 3.9 years).


2012 ◽  
Vol 21 (3) ◽  
pp. 564-570 ◽  
Author(s):  
Alexander S. Spiro ◽  
Marc Regier ◽  
Alexander Novo de Oliveira ◽  
Eik Vettorazzi ◽  
Michael Hoffmann ◽  
...  

Author(s):  
Sorawut Thamyongkit ◽  
Laura M. Fayad ◽  
Lynne C. Jones ◽  
Erik A. Hasenboehler ◽  
Norachart Sirisreetreerux ◽  
...  

2021 ◽  
pp. 33-35
Author(s):  
Manoj Kumar ◽  
Bharat Bhushan ◽  
Arun Vaishy ◽  
Rajendra Fageria ◽  
Ramakishan Ramakishan

INTRODUCTION: In the modern world,due to advent of high speed motor vehicles , high energy trauma commonly involves the knee joint and results in complex tibial plateau fractures and associated ligament and meniscal injuries . Proper diagnosis and management of these injuries reduced the chances of degenerative changes around knee joint later on. MATERIAL AND METHOD: A prospective study was conducted in the Department of Orthopaedics in a tertiary health care center of western rajasthan from January 2018 to December 2020 . A total of eighty patients( 62 males: 18 females) with tibial plateau fractures and associated soft tissue injuries were included .Patients were assessed both clinically and radiologically and “ SCHATZKER'S classication was used to classify the tibial plateau fractures. Pre-operatively in every case CT-scan was used to study fracture pattern and MRI was done to see fracture morphology and associated soft tissue injuries. RESULT: A total 80 patient was included in our study,out of which 73 (91.25%) having ligaments( Cruciate and Collaterals) and meniscal injury . Injury to the lateral meniscus was found most frequently in Schatzker II fracture (p<0.0006) and medial meniscus in schatzker IV (p< 0.011). Variable association was shown by ACL and PCL injuries with tibial plateu fracture morphology ,but as the grade of designation increases within schatzker classication as does the frequency of cruciate ligament tear. Overall incidence of LCL rupture occurred least frequently in Schatzker II fractures (7 of 34; 20.5%), which was statistically signicant (P < 0.01). Complete MCL tear occurred in 27( 33.7%) of all fractures and in 41% of Schatzker II fractures. PLC tear had shown signicant association with medial tibial plateu fracture (schatzker IV). CONCLUSION: The likelihood of the cruciate , collateral ligament and PLC injury increases as the grade of designation within schatzker classication (schatzker I-VI). PLC injury had a signicant association with medial tibial plateu fracture (schatzker IV) and MCL had a signicant association with lateral tibial plateau fracture .


2007 ◽  
Vol 12 (4) ◽  
pp. 195-207 ◽  
Author(s):  
A. Khoury ◽  
J. H. Siewerdsen ◽  
C. M. Whyne ◽  
M. J. Daly ◽  
H. J. Kreder ◽  
...  

2007 ◽  
Vol 12 (4) ◽  
pp. 195-207 ◽  
Author(s):  
A. Khoury ◽  
J. H. Siewerdsen ◽  
C. M. Whyne ◽  
M. J. Daly ◽  
H. J. Kreder ◽  
...  

2018 ◽  
Vol 32 (3) ◽  
pp. 141-147 ◽  
Author(s):  
Stephen J. Warner ◽  
Matthew R. Garner ◽  
Patrick C. Schottel ◽  
Peter D. Fabricant ◽  
Ryan R. Thacher ◽  
...  

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