MANAGEMENT OF HIGH VELOCITY TIBIAL PLATEAU FRACTURES BY LIGAMENTOTAXIS USING ILIZAROV EXTERNAL FIXATOR

2021 ◽  
pp. 33-35
Author(s):  
Mayank Poddar ◽  
Abhinav Sinha ◽  
Amit Narang
Keyword(s):  
Soft Tissue ◽  
High Velocity ◽  
Bone Grafting ◽  
Tibial Plateau ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Type Iv ◽  
Schatzker Type ◽  
Duration Of Surgery ◽  
The Mean

Background: Tibial plateau fractures resulting from high energy trauma, typically Schatzker type IV, V and VI pattern fractures are difcult to deal with due to poor overlying soft tissue cover. Ligamentotaxis with ilizarov ring xator can be a suitable denitive treatment option for such injuries with fewer associated complications as compared to internal xation. Patients and Methods: 30 patients within the age group of 18-80 years with Schatzker type IV, V and VI pattern injuries were included in the study. A four ring ilizarov assembly was used with knee spanning with a proximal femoral ring. The patients were followed for 12 months and evaluation was analyzed as per Rasmussen clinical and radiological criteria. Results: The mean age of patients in our study was 39.76 years. Twenty cases were Schatzker type VI, 7 cases were Schatzker type IV (with extensive soft tissue swelling following high velocity trauma) and only 3 cases were type V. The mean duration of surgery was 47±12 mins without bone grafting and 72±14 mins with bone grafting. The mean interval from injury to surgery was 2.36 days (range 1-5 days). Rasmussen total anatomical outcome was excellent in 14 patients(46.66%) and good in 16 patients(53.33%). Rasmussen total functional outcome was excellent in 21 patients(70%) and good in 9 patients(30%). Final Outcome was excellent in 22 patients(73.33%) and good in 8 patient(26.66%). Discussion: High velocity tibial plateau fractures, when treated with internal xation and plating, carry a higher risk of associated complications ranging from deep infections to even compartment syndrome. The rate of re-operation following internal xation in such injuries has been high with most of the re-surgeries being required within one year of primary xation which adds to the morbidity of the patient. Ligamentotaxis with ilizarov ring xation as denitive treatment in such cases can be a fruitful operation with lesser complications and early return to previous level of activity.

scholarly journals Combined lateral peripatellar and posteromedial approaches for Schatzker type IV tibial plateau fractures involving posteromedial plane: A prospective study.

2020 ◽  
Author(s):  
Jun Zhang ◽  
Bo Yin ◽  
Jianmin Zhao ◽  
Yihan Li ◽  
Peng Yin ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Operation Time ◽  
Knee Extension ◽  
Tibial Plateau Fractures ◽  
Lower Limbs ◽  
Type Iv ◽  
Schatzker Type ◽  
Study Results ◽  
The Mean ◽  
A Prospective Study

Abstract Objective The objective of this study to evaluate prospectively the effectiveness of Schatzker type IV tibial plateau fractures involving posteromedial plane managed by combined lateral peripatellar and posteromedial approaches Materials and methods We analyzed 18 patients with Schatzker type IV tibial plateau fractures involving posteromedial plane. There were 12 males and 6 females with an average of 38.5 years (range, 25-60 years). The mechanism of injury included traffic accident in 15 patients and falling in 3 patients. The injured lower limbs were right in 11 patients and left in 7 patients. The mean time from injury to surgery was 6.78 days (range, 5-9 days). There were 8 patients with meniscus injuries in our study. Results The mean operation time was 3.41 hours (range, 3-4 hours). The mean blood loss was 352.78 ml (range, 300-410 ml). All the injured meniscuses were repaired. All patients were followed up, and the average time of follow up was 16.61 months (range, 14-22 months). Bone union was achieved at a mean of 12 weeks (range, 10-14 weeks). The mean degree of knee extension was 1.11° (range, 0-5°), and the mean degree of knee flexion was 120.56°(range, 110-130°). The mean points of KSS were 83 (range, 74-89 points). According to the criteria of KSS, 14 patients had clinical outcomes rated as excellent and 4 patients were rated as good. Conclusion Our results suggested that Combined lateral peripatellar and posteromedial approaches in the treatment of Schatzker type IV tibial plateau fractures involving posteromedial plane acquired satisfying outcomes. It was good for repairing the injured meniscus through our approaches.

scholarly journals Functional outcome of hybrid external fixator in proximal tibial fractures Schatzker type V and VI with Gustillo grade-II

2021 ◽  
Vol 8 (1) ◽  
pp. 43
Author(s):  
Johney Juneja ◽  
Mohzin Asiger ◽  
Dinesh Kumar ◽  
Mahendra P. Jain ◽  
Gaurav Garg ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixator ◽  
Tibial Plateau ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Bony Union ◽  
Fracture Stabilization ◽  
Hybrid External Fixator ◽  
Schatzker Type ◽  
Type V

<h2>Background: Management of high energy tibial plateau fractures along with extensive soft tissue damage is still challenging to many orthopaedic surgeons. This study evaluates the purpose of hybrid external fixator intreating high energy tibial plateau fractures with minimal invasion and accurate reduction.</h2><h2>Methods: Twenty patients with high energy Schatzker type V and VI tibial plateau fractures with severe soft tissue injury were enrolled into the study in RNT medical college, Udaipur.</h2><h2>Results: The results- bony union, range of movements and associated complications were assessed. All fractures united in an average time period of 20 weeks. Ten patients developed knee stiffness, five patients developed delayed union andthreenon-union.15 patients required split skin graft. Final outcome showed excellent score in 53 patients.</h2><h2>Conclusions: Hybrid external fixation is a safe option for managing complex high energy tibial plateau fractures by simultaneously providing adequate fracture stabilization and necessary protection to soft tissue healing to achieve bony union.</h2>

scholarly journals Combined lateral peripatellar and posteromedial approaches for Schatzker type IV tibial plateau fractures involving posteromedial plane: A prospective study.

2020 ◽  
Author(s):  
Jun Zhang ◽  
Bo Yin ◽  
Jianmin Zhao ◽  
Yihan Li ◽  
Peng Yin ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Operation Time ◽  
Knee Extension ◽  
Tibial Plateau Fractures ◽  
Lower Limbs ◽  
Type Iv ◽  
Schatzker Type ◽  
The Mean ◽  
A Prospective Study

Abstract Background: The objective of this study to evaluate prospectively the effectiveness of Schatzker type IV tibial plateau fractures involving posteromedial plane managed by combined lateral peripatellar and posteromedial approaches.Methods: We analyzed 18 patients with Schatzker type IV tibial plateau fractures involving posteromedial plane. There were 12 males and 6 females with an average of 38.5 years (range, 25-60 years). The mechanism of injury included traffic accident in 15 patients and falling in 3 patients. The injured lower limbs were right in 11 patients and left in 7 patients. The mean time from injury to surgery was 6.78 days (range, 5-9 days). There were 8 patients with meniscus injuries in our study.Results: The mean operation time was 3.41 hours (range, 3-4 hours). The mean blood loss was 352.78 ml (range, 300-410 ml). All the injured meniscuses were repaired. All patients were followed up, and the average time of follow up was 16.61 months (range, 14-22 months). Bone union was achieved at a mean of 12 weeks (range, 10-14 weeks). The mean degree of knee extension was 1.11° (range, 0-5°), and the mean degree of knee flexion was 120.56° (range, 110-130°). The mean points of KSS were 83 (range, 74-89 points). According to the criteria of KSS, 14 patients had clinical outcomes rated as excellent and 4 patients were rated as good.Conclusion: Our results suggested that Combined lateral peripatellar and posteromedial approaches in the treatment of Schatzker type IV tibial plateau fractures involving posteromedial plane acquired satisfying outcomes. It was good for repairing the injured meniscus through our approaches.

scholarly journals Combined lateral peripatellar and posteromedial approaches for Schatzker type IV tibial plateau fractures involving posteromedial plane: A prospective study.

2020 ◽  
Author(s):  
Jun Zhang ◽  
Bo Yin ◽  
Jianmin Zhao ◽  
Yihan Li ◽  
Peng Yin ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Operation Time ◽  
Knee Extension ◽  
Tibial Plateau Fractures ◽  
Lower Limbs ◽  
Type Iv ◽  
Schatzker Type ◽  
The Mean ◽  
A Prospective Study

Abstract Objective The objective of this study to evaluate prospectively the effectiveness of Schatzker type IV tibial plateau fractures involving posteromedial plane managed by combined lateral peripatellar and posteromedial approaches Materials and methods We analyzed 18 patients with Schatzker type IV tibial plateau fractures involving posteromedial plane. There were 12 males and 6 females with an average of 38.5 years (range, 25-60 years). The mechanism of injury included traffic accident in 15 patients and falling in 3 patients. The injured lower limbs were right in 11 patients and left in 7 patients. The mean time from injury to surgery was 6.78 days (range, 5-9 days). There were 8 patients with meniscus injuries in our study. ResultsThe mean operation time was 3.41 hours (range, 3-4 hours). The mean blood loss was 352.78 ml (range, 300-410 ml). All the injured meniscuses were repaired. All patients were followed up, and the average time of follow up was 16.61 months (range, 14-22 months). Bone union was achieved at a mean of 12 weeks (range, 10-14 weeks). The mean degree of knee extension was 1.11° (range, 0-5°), and the mean degree of knee flexion was 120.56°(range, 110-130°). The mean points of KSS were 83 (range, 74-89 points). According to the criteria of KSS, 14 patients had clinical outcomes rated as excellent and 4 patients were rated as good. Conclusion Our results suggested that Combined lateral peripatellar and posteromedial approaches in the treatment of Schatzker type IV tibial plateau fractures involving posteromedial plane acquired satisfying outcomes. It was good for repairing the injured meniscus through our approaches.

scholarly journals Small Wire External Fixation for High-Energy Tibial Plateau Fractures

2007 ◽  
Vol 15 (2) ◽  
pp. 137-143 ◽  
Author(s):  
H Kataria ◽  
N Sharma ◽  
RK Kanojia
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Tibial Plateau ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
High Rate ◽  
Anatomical Reconstruction ◽  
Functional Score ◽  
Soft Tissue Necrosis ◽  
The Mean

Purpose. To assess results of small wire external fixation using a ligamentotaxis technique for high-energy tibial plateau fractures. Methods. Between April 2002 and May 2004, 38 consecutive patients aged 21 to 60 (mean, 32) years underwent small wire external fixation for high-energy tibial plateau fractures. 15 involved the right and 23 the left knee. 34 were closed and 4 were open injuries. Fractures were classified according to Schatzker's staging system. After a minimal of 2 years' follow-up (range, 24–42 months), each affected knee was evaluated using Rasmussen's (1) 30-point clinical grading system and (2) radiological evaluation. Results. There were 22 type-VI and 16 type-V Schatzker tibial plateau fractures. Complications consisted of: 2 superficial infections, 3 pin site infections, and 4 peroneal nerve palsies. No soft tissue necrosis or devitalisation occurred. The mean range of knee movement was 132°. The mean Rasmussen radiological score was 14 (range, 10–18): excellent in 6, good in 26, and fair in 6. The mean Rasmusssen functional score was 26 (range, 17–30): excellent in 19 patients, good in 17, and fair in 2. Clinical results did not parallel the radiological results. Conclusion. Small wire external fixation allows anatomical reconstruction of the articular surface, stable fixation of fracture fragments, early movement of the joint, and care of associated soft tissue injuries, without a high rate of complications.

scholarly journals Arthroscopic Reduction and Percutaneous Osteosynthesis of Tibial Plateau Fractures

2019 ◽  
Vol 7 (5) ◽  
pp. 779-781
Author(s):  
Konstantin Mitev ◽  
Gorgi Zafiroski ◽  
Sasho Mladenovski ◽  
Ljupcho Nikolov
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Surgical Techniques ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Percutaneous Technique ◽  
Case Presentation ◽  
Schatzker Type ◽  
Tissue Damages

BACKGROUND: Tibial plateau fractures are complex lesions capable of causing severe consequences if not appropriately treated. They are often the result of high-energy trauma and, not rarely, are associated with significant soft-tissue and intra-articular injuries. Different therapeutic options can be managed in the treatment of these lesions. Minimally invasive surgery percutaneous technique-offers several advantages compared to other surgical techniques and allows, with less additional soft tissue damages, good reduction and stable fixation of the fracture. CASE PRESENTATION: In this study, we assessed the results of the combined arthroscopic and radioscopic assisted reduction and internal fixation of tibial plateau fractures in 7 patients with Schatzker type II and III. CONCLUSION: According to Hohl’s and Rasmussen’s grading system, all of the patients scored excellent and good results at 1 year follow up. We experienced no complications due to arthroscopy.

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.

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