scholarly journals Aspect Regarding Plastic Deformations in Tibial Plateau Fractures

2018 ◽  
Vol 55 (4) ◽  
pp. 571-574
Author(s):  
Marcel Mihai Berceanu Vaduva ◽  
Horatiu Petrescu ◽  
Rami Musallam ◽  
Abdoul Fattah Boustani ◽  
Milan Velimirovici ◽  
...  
Keyword(s):  
High Performance ◽  
Tibial Plateau ◽  
Late Complications ◽  
Tibial Plateau Fractures ◽  
Bone Lesions ◽  
Type I ◽  
Mechanism Of Injury ◽  
Road Accidents ◽  
Schatzker Type ◽  
Therapeutic Measures

Our purpose was to study tibial plateau fractures considering the rise of their incidence, their potential immediate seriousness or late complications and their complexity. We realized a clinical-statistical study concerning the incidence of tibial plateau fractures taking in account critaeria like age, sex, mechanism of injury, fracture type and correlations between these. The study involves 126 patients, 98 (77.77%) being treated surgically and 28 (22.22%) conservatory between 2008-2016 in the I-st Clinic of Orthopaedics and Traumatology Timisoara. Approximately 2/3 of cases are of Schatzker type I, II and III. Type VI Schatzker occured in 5.78% of all, the mechanism of injury being split almost equal between road accidents and falls from height. Road accidents prevale as a causing circumstance of tibial plateau fractures. 2/3 of the tibial plateau fractures associate with other significant regional lesions. Bone lesions are not rarely underestimated by plain radiographs. Therefore evacuation of haemarthrosis (showing lipohaemarthrosis) and high performance imaging (CT, MRI) are often needed. In comparison to other fracture sites, imperfect reduction of tibial plateau fractures results more frequently in long term sequellae. Being frequently complex, comminuted fractures with associated regional lesions tibial plateau fractures raise the complexity of the medical act from establishing a complete diagnosis to the final therapeutic measures. For a correct and complete preoperatory diagnosis frequently high performance imaging is needed. Tibial plateau fractures significantly affect patients, the healthcare and social-economic system, the healing and rehabilitation.

scholarly journals Arthroscopic Assisted Reduction and Internal Fixation of Tibial Plateau Fractures

2019 ◽  
Vol 7 (7) ◽  
pp. 1133-1137 ◽  
Author(s):  
Sherif Hamdy Mohamed Zawam ◽  
Ahmed Mahmoud Gad
Keyword(s):  
Internal Fixation ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Knee Injuries ◽  
Tibial Plateau Fractures ◽  
Type I ◽  
Type Ii ◽  
University Hospitals ◽  
Type Iii ◽  
Schatzker Type

BACKGROUND: Tibial plateau fractures present an important entity in orthopaedic fractures. Arthroscopic-assisted reduction and internal fixation is a good alternative to ORIF as it has the advantage of direct visualisation of the articular surface of the plateau, direct assessment of the reduction of the articular surface, and managing any associated intra-articular pathology. AIM: Our study aim is to determine the results of arthroscopic assisted reduction and internal fixation of tibial plateau fractures. METHODS: This study involved 25 patients with tibial plateau fractures presenting to the emergency department of Cairo University Hospitals between the periods of November 2016 and May 2017. The patients were followed up for an average of 14 months (11-18 months). According to Schatzker’s classification, five patients had type I, eleven had type II, and nine patients had type III fractures. RESULTS: The average time to full union in Schatzker type I was 9.1 weeks, in type II was 10.2 weeks, and in type III it was 9.4. The mean clinical Rasmussen score among the 25 patients was 26 (range, 24-30). A group of 19 patients (76%) had excellent results, (4 type I, 8 types II, and 7 types III) 6 patients (24 %) had good results (1 type I, 3 types II, 2 types III). Radiologic results were excellent in (14 cases) 56.0% and good results (11 cases) 44%. CONCLUSION: Arthroscopic assisted reduction and fixation of tibial plateau fractures have the advantages of checking the adequacy of reduction, avoiding the need for detachment of the meniscus, and allowing for accurate diagnosis and management of associated knee injuries. Therefore, we recommend that arthroscopic assisted reduction and fixation of tibial plateau fractures should be used more often.

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>

scholarly journals Early Results of the Medial Approach for Arthroscopic-Assisted Fixation of Lateral Tibial Plateau Fractures

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Tunay Erden ◽  
Suat Batar ◽  
Gökçer Uzer ◽  
Demet Pepele Kurdal ◽  
Nurzat Elmalı
Keyword(s):  
Tibial Plateau ◽  
Soft Tissues ◽  
Lateral Meniscus ◽  
Case Series ◽  
Tibial Plateau Fractures ◽  
Meniscus Tear ◽  
Type I ◽  
Lateral Tibial Plateau ◽  
Schatzker Type ◽  
Diagnostic Arthroscopy

The use of arthroscopy in the management of tibial plateau fractures is not a particularly new concept. It has been used successfully for Schatzker types I–III fractures. In addition to evaluating the fracture itself, it is easier to evaluate the other intraarticular structures. Coventionally, reduction for lateral tibial plateau fractures have been performed through a laterally based metaphyseal window, which is not without limitations, including difficulty with reduction of the fracture, as well as bone grafting though the resultant short subchondral tunnel. Also, there is a risk of lateral vascular supply distrubtion because of same side fracture. A medially based metaphyseal window to approach lateral tibial plateau fractures allows for minimal insult to the soft tissues, with advantageous ease of reduction and grafting through a longer tunnel for subchondral support. We aimed to present our initial experiences in twelwe cases approaching lateral tibial plateau fractures through a medial metaphyseal window. Material-Methods: Our series involves 12 patients with 7 Schatzker type II, 3 Schatzker type I, and 2 Schatzker type III fractures. There were 8 males and 4 females. The average age at the time of surgery was 37 (25-57) years. All of the patients underwent plain radiography and BT in each knee Time from injury to surgery was 6.2 days. Follow up was 18 months (9-22 months).Firstly diagnostic arthroscopy was performed. Concomittant pathology was adreessed as needed. There was 3 lateral meniscus tear that treated with partial meniscectomy. An ACL guide pin was placed percutaneously anteromedial tibia approximately 9 cm distal to the joint line. Once stisfactory positioning a cortical window 1x2 cm. made around the guide pin. Reduction was accomplished with a bone tamp that fits easily into the tunnel. Screws were used as rafters to support the articular surface and subchondral bone. We used in 7 patients lateral plate and screws and in 5 patients only screws. Care was taken to keep pump pressure at approximately 40 millimeters of mercury for alleviate the risk of compartment syndrome. Results: No complications related to the procedure were observed. No secondary loss of reduction was observed in radiological controls. Functional assessment according to HSS of the patients were excellent in 5 cases, good in 5 cases and fair 2 cases. Discussion: Because depressed fragments are elevated from distal cortical windows, the importance of an intact, or easily restored, “cortical envelope” is paramount. This case series showed satisfactory early clinical results. [Figure: see text][Figure: see text]

scholarly journals Arthroscopically assisted treatment for Schatzker type I-V tibial plateau fractures

2008 ◽  
Vol 11 (5) ◽  
pp. 288-292 ◽  
Author(s):  
Xiao-jun DUAN ◽  
Liu YANG ◽  
Lin GUO ◽  
Guang-xing CHEN ◽  
Gang DAI
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Type I ◽  
Schatzker Type ◽  
Arthroscopically Assisted

scholarly journals Arthroscopic management of proximal tibial fractures: technical note and case series presentation

2015 ◽  
Vol 88 (2) ◽  
pp. 233-236 ◽  
Author(s):  
Horea Benea ◽  
Gheorghe Tomoaia ◽  
Artur Martin ◽  
Ciprian Bardas
Keyword(s):  
Internal Fixation ◽  
Tibial Plateau ◽  
Case Series ◽  
Tibial Plateau Fractures ◽  
Tibial Fractures ◽  
Type I ◽  
Arthroscopic Reduction ◽  
Schatzker Type ◽  
Associated Lesions ◽  
Proximal Tibial Fractures

Background and aims. The purpose of this article is to describe a new surgical method of arthroscopy assisted treatment of intraarticular proximal tibial fractures (ARIF – arthroscopic reduction and internal fixation), analyzing its efficiency and safety on a series of patients. Tibial plateau fractures affect the proximal tibial metaphyseal and articular surface, representing 1.2% of all fractures and up to 8% of all fractures in elderly. Patients and method. Our case series consists of 6 patients with Schatzker types I-III tibial plateau fractures, treated in the Orthopedic and Traumatology Clinic of Cluj-Napoca from July 2012 to August 2014. Patients included in the study presented Schatzker type I-III tibial plateau fracture.Results. The results obtained with the arthroscopic method were excellent in 5 cases (mean Rasmussen score 27.60 points) and good in 1 case (mean score 23.75). The radiological consolidation appeared after a mean of 12 weeks. No major complication was noted.Conclusions. Diagnosis and treatment of associated lesions, shortening of hospitalization length and postoperative rehabilitation, but also the lower rate of complications, can make arthroscopic reduction and internal fixation the method of choice for the operative treatment of selected Schatzker I-III types of proximal tibial fractures.

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.

Age-Related Variances in Patients with Tibial Plateau Fractures

2019 ◽  
Vol 33 (06) ◽  
pp. 611-615 ◽  
Author(s):  
Lasun O. Oladeji ◽  
John R. Worley ◽  
Brett D. Crist
Keyword(s):  
Elderly Patients ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
The Elderly ◽  
Tibial Plateau Fractures ◽  
Mechanism Of Injury ◽  
Younger Patients ◽  
Age Related ◽  
Comorbidity Burden ◽  
Plateau Fracture

AbstractTibial plateau fractures account for approximately 8% of fractures in the elderly population. Treatment strategies in the elderly are similar to those for younger patients; however, practitioners must account for the elevated comorbidity burden in this population. To date, few studies have analyzed age-based outcomes in patients with tibial plateau fractures. Therefore, the purpose of this study was to determine age-related variances in demographics, fracture characteristics, mechanism of injury, and complications. A 10-year retrospective review was conducted to identify patients who received treatment for a tibial plateau fracture. There were 351 patients (360 tibial plateau fractures) who were identified and subsequently stratified according to their age at the time of injury. Patients were classified as elderly if they were 65 years of age or older at the time of injury; all other patients were included in the control cohort. These two cohorts were analyzed using bivariate analysis to isolate for age-related variations with respect to risk factors, mechanism of injury, and complications. There were 351 patients (360 tibial plateau fractures) with a median follow-up of 1.84 ± 2.44 years who met inclusion criteria. There were a greater proportion of women in the elderly cohort as compared with the younger cohort (60.0 vs. 43.4%, p = 0.06). Elderly patients were significantly more likely to present with diabetes (33.3 vs. 16.1%, p = 0.01) or osteoporosis (14.3 vs. 1.6%, p = 0.001). Younger patients were significantly more likely to require further surgery to address ligament (12.6 vs. 0%, p = 0.008), meniscus (20.9 vs. 7.1%, p = 0.036), or cartilage pathology (13.6 vs. 0%, p = 0.005). There was no difference in the arthroplasty conversion rate (4.8% elderly vs. 7.9% control, p = 0.755). While elderly patients presented with a greater comorbidity burden, they had equivalent or better short-term outcomes when compared with their younger peers when treated with open reduction and internal fixation (ORIF). Despite the recent interest in primary total knee arthroplasty for elderly patients with tibial plateau fractures, the results of this study suggest that elderly patients may respond well when treated with ORIF following a tibial plateau fracture.

scholarly journals Plate-screw and screw-washer stability in a Schatzker type-I lateral tibial plateau fracture: a comparative biomechanical study

2020 ◽  
Vol 47 ◽  
Author(s):  
VINCENZO GIORDANO ◽  
WILLIAM DIAS BELANGERO ◽  
BRENNO DE ARAÚJO SÁ ◽  
DANIELA RIVAS ◽  
DANILO SOUTO ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Dynamic Compression ◽  
Type I ◽  
Small Fragment ◽  
Dynamic Compression Plate ◽  
Cortical Screw ◽  
Schatzker Type ◽  
Compression Plate ◽  
Plateau Fracture

ABSTRACT The aim of this study was to evaluate the biomechanical role of both a non-locking two-hole small fragment dynamic compression plate with 3.5-mm screws and a 4.5-mm cortical screw with a washer applied to a Schatzker type-I tibial plateau fracture. Sixteen right synthetic tibiae were used to create an anterolateral shear tibial plateau fracture (Schatzker type-I fracture). Eight models were fixed with a small fragment non-locked straight dynamic compression plate with one 3.5-mm bicortical screw (plate-screw construction) and eight models were fixed with a 4.5-mm cortical screw and a washer (screw-washer construction), both inserted at 1.0 mm distal to the apex of the fracture. Specimens were tested up to the onset of yielding at a constant strain rate of 5.0-mm/min. Stiffness ranged from 311.83 N/mm to 199.54 N/mm, with a mean + SD of 260.32 + 33.8 N/mm in the plate-screw construction, and from 290.34 N/mm to 99.16 N/mm, with a mean + SD of 220.46 + 63.12 N/mm in screw-washer construction. There was no significant difference (p=0.172). Use of a two-hole small-fragment non-locked plate with one 3.5-mm cortical screw or a 4.5-mm cortical screw with a washer applied at 1.0 mm distal to the apex of the fracture as buttressing present similar stiffness in terms of preventing axial displacement in synthetic tibiae models tested up to the onset of yielding.

scholarly journals Application of Percutaneous Screw Fixation and Closed Reduction for Tibial Plateau Fractures in Karachi, Pakistan

2021 ◽  
pp. 25-30
Author(s):  
Muhammad Azeem Akhund ◽  
Muhammad Latif ◽  
Rahat Zahoor Moton ◽  
Zohaib Khan ◽  
Zohaib Nawaz ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Tibial Plateau ◽  
Screw Fixation ◽  
Case Series ◽  
Early Mobilization ◽  
Tibial Plateau Fractures ◽  
Type I ◽  
Percutaneous Screw Fixation ◽  
Schatzker Classification ◽  
Average Patient

Objective: Objective of this study is to assess the application of percutaneous screw fixation and closed reduction for tibial plateau fractures in Karachi, Pakistan. Methods: The study design of this study is case series with sample size of 58 patients calculated by WHO calculator with functional outcome of 80-100%. The duration of the study was about 6 months.Non-probability sequential technique was adopted for data collection. Results: The average patient age was 35.35±6.84 years however male patient were high in numbers (83.8%). Types of fractures (type I, II and IV) and functional outcomes (un-satisfactory and satisfactory) showed 17(29.3%), 33(56.8%) and 12(20.6%) and 4(6.45%) and 58(93.5%). The mean Rasmussen Score was 24.6(4.9%) however significant relationship between age and functional group were observed (p<0.05). The Rasmussen Functional Scoring System and Schatzker classification were also evaluated w.r.t ache, capability of walking normally, extension lag, stability as well as range of motion. Scores ranging from 28 up till 36 stipulate excellent, from 20 to 27 good, considering score of 10 to 20 fair and 6 to 10 poor. Conclusion: The application of Percutaneous screw fixation and closed reduction for tibial plateau fractures in Karachi, Pakistanis less invasive, decrease hospital stays and charges, escalation of early mobilization along with satisfactory outcomes.

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