scholarly journals A New Approach to Surgical Management of Tibial Plateau Fractures

2020 ◽  
Vol 9 (3) ◽  
pp. 626 ◽  
Author(s):  
Stuart A. Callary ◽  
Claire F. Jones ◽  
Karim Kantar ◽  
Heleen Du Toit ◽  
Markus P. Baker ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Weight Bearing ◽  
Surgical Site Infections ◽  
Tibial Plateau Fractures ◽  
Fracture Reduction ◽  
Management Approach ◽  
Anterolateral Approach ◽  
Complication Rates ◽  
Management Protocol ◽  
Patient Reported

Tibial plateau fractures (TPFs) are challenging, requiring complex open reduction and internal fixation (ORIF) and are often associated with complications including surgical site infections (SSIs). In 2007, we introduced a novel management protocol to treat TPFs which consisted of an angiosome- or perforator-sparing (APS) anterolateral approach followed by unrestricted weight bearing and range of motion. The primary aim of this retrospective study was to investigate complication rates and patient outcomes associated with our new management protocol. In total, 79 TPFs treated between 2004 and 2007 through a classic anterolateral surgical approach formed the “Classic Group”; while 66 TPFS treated between 2007 and 2013 formed the “APS Group”. Fracture reduction, maintenance of reduction and patient-reported outcomes were assessed. There was a clinically important improvement in the infection incidence with the APS (1.5%) versus the Classic technique (7.6%) (1/66 versus 2/79 for superficial infections; 0/66 versus 4/79 for deep infections). Despite a more aggressive rehabilitation, there was no difference in the fracture reduction over time or the functional outcomes between both groups (p > 0.05). The APS anterolateral approach improved the rate of SSIs after TPFs without compromising fracture reduction and stabilisation. We continue to use this new management approach and early unrestricted weight bearing when treating amenable TPFs.

Postoperative weight bearing and patient reported outcomes at one year following tibial plateau fractures

Injury ◽  
2017 ◽  
Vol 48 (7) ◽  
pp. 1650-1656 ◽  
Author(s):  
Dominic Thewlis ◽  
Francois Fraysse ◽  
Stuart A. Callary ◽  
Viju Daniel Verghese ◽  
Claire F. Jones ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Tibial Plateau ◽  
Weight Bearing ◽  
Tibial Plateau Fractures ◽  
Patient Reported ◽  
One Year

scholarly journals The Medial Approach for Arthroscopic-Assisted Fixation of Lateral Tibial Plateau Fractures

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0021
Author(s):  
Nurzat Elmali ◽  
Özgür Baysal ◽  
Mustafa Karakaplan ◽  
Deniz Gülabi ◽  
Fevzi Sağlam
Keyword(s):  
Tibial Plateau ◽  
Weight Bearing ◽  
Vascular Supply ◽  
Tibial Plateau Fractures ◽  
Fracture Reduction ◽  
Meniscus Tear ◽  
Type Ii ◽  
Lateral Tibial Plateau ◽  
Medial Approach ◽  
Schatzker Type

Objectives: Tibial plateau fractures are complex injuries involving the weight bearing surface of the tibia. Open reduction and internal fixation with plates and screws is an established method of treatment for complex fractures (Schatzker types V–VI). Arthroscopically assisted techniques have been used successfully for simple fractures (Schatzker types I–III). Historically, arthroscopic-assisted reduction for lateral tibial plateau fractures have been performed through a laterally based metaphyseal window. We found this technique to have several limitations, including bone grafting through a short subchondral tunnel. Also, there was a risk of lateral vascular supply distrubtion. We proposed that medial window approach technique would provide a longer tunnel for subchondral support and aid in fracture reduction. We aimed to present our initial experiences in first seven cases approaching lateral tibial plateau fractures through a medial metaphyseal window. Methods: Our series involves 7 patients with 5 Schatzker type II and 2 Schatzker type III lateral tibial plateau fractures treated by a single surgeon, using a medial approach for the arthroscopic assisted fixation. There were 5 males and 2 females. The average age at the time of surgery was 34.2 years, (29-52). All of the patients underwent plain radiography and CT scanning in each knee Time from injury to surgery was 7.2 days (4-12 days). Length of follow up was 9 months (6-22 months). There was 2 lateral meniscus tear that treated with partial meniscectomy and 1 MCL injury that treated conservativeely. Surgery was performed in four steps. First step was diagnostic arthroscopy of the injured knee, , second step was reduction of the fracture using a sylindiric tube with fluoroscopic guidance, third step was the arthroscopic verification of the fracture reduction, and finally percutaneous osteosynthesis of the fracture.Care is taken to keep the flow to gravity or, if using a pressure controlled pump, to set the pressure at approximately 40 millimeters of mercury. This will help alleviate the risk of compartment syndrome. Compartment firmness should be continuously monitored throughout the procedure. Results: No complications related to the procedure were observed. All patients reported a relevant reduction in pain, were able to mobilize with full weight bearing in the average 12 weeks (9–15 weeks). No secondary loss of reduction was observed in radiological controls; No revision surgery was required. Functional assessment according to HSS (hospital for special surgery) of the patients were excellent in 5 cases, good in 2 cases. Conclusion: Because depressed fragments are elevated from distal cortical windows, the importance of an intact, or easily restored, “cortical envelope” is paramount. In most Schatzker Type II and III fractures, the cortical envelope is either intact or can easily be restored with a clamp. The main advantage of medial approach for these fracture patterns is the creation of a long tunnel for subchondral support, the ease of fracture reduction and saving the lateral vascular supply.

An intact fibula may contribute to allow early weight bearing in surgically treated tibial plateau fractures

2017 ◽  
Vol 26 (3) ◽  
pp. 756-761 ◽  
Author(s):  
Ion Carrera ◽  
Pablo Eduardo Gelber ◽  
Gaetan Chary ◽  
Mireia Gomez Masdeu ◽  
Miguel A. González Ballester ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Weight Bearing ◽  
Tibial Plateau Fractures ◽  
Early Weight Bearing

Extended Anterolateral Approach for Complex Lateral Tibial Plateau Fractures

2017 ◽  
Vol 30 (03) ◽  
pp. 204-211 ◽  
Author(s):  
Joseph Schatzker ◽  
Marcello Castiglia ◽  
Vincenzo Giordano ◽  
Fabricio Fogagnolo ◽  
James Stannard ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Anterolateral Approach ◽  
Lateral Tibial Plateau

scholarly journals Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

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

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">Management of tibial plateau fractures with coronal fractures especially posteromedial fragment is frequent and challenging. This study was conducted to </span><span lang="EN-IN">evaluate the</span><span lang="EN-GB"> functional outcome of patients with tibial plateau fractures having posteromedial fragment treated with open reduction and internal fixation (ORIF) using Lobenhoffer approach</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">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</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">The mean </span><span lang="EN-IN">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. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">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</span><span lang="EN-IN">.</span></p>

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

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

<p class="abstract"><strong>Background:</strong> <span lang="EN-GB">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</span><span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">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 &amp; VI included in study. Criteria for acceptable reduction 1) &lt;5 mm of articular step; 2) &lt;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</span>.</p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">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</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">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</span><span lang="EN-IN">.</span></p>

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