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 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>

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 High-energy tibial plateau fractures treated with Ilizarov fixator

2019 ◽  
Vol 147 (7-8) ◽  
pp. 427-431
Author(s):  
Slavko Tomic ◽  
Andreja Baljozovic ◽  
Danilo Jeremic
Keyword(s):  
Soft Tissue ◽  
Knee Society Score ◽  
Tibial Plateau ◽  
Articular Surface ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Anatomical Reconstruction ◽  
Significant Group ◽  
Ilizarov Fixator

Introduction/Objective. Tibial plateau fractures constitute a significant group of injuries to a major weight-bearing joint. High-energy fractures are difficult to treat, as they entail articular depression, condylar displacement, dissociation of comminuted metaphysis, and closed degloving injuries. The principles of the treatment are anatomical reconstruction of the articular surface, restoration of the anatomical axis, fixation spanning the metaphyseal comminution, and further minimization of soft tissue injury. The aim of this study is to evaluate the clinical outcome of using Ilizarov external fixator in the treatment of high-energy Schatzker IV, V, and VI tibial plateau fractures. Methods. This retrospective study was conducted from 2013?2016 on 35 patients (36 fractures) with high-energy tibial plateau fractures classified as Schatzker type IV, V, and VI. The mechanisms of injury were road traffic accident, fall from a height and direct trauma. The fractures were closed in 26 cases and open in 10 cases. All patients were treated with ligamentotaxis and percutaneous fixation using Ilizarov fixator. Functional outcome was determined using the Knee Society Score. Results. The mean follow-up period was 20 months. All fractures healed in an average time of 14 weeks. The range of knee flexion after one-year follow-up averaged at 100?. Average Knee Society Score in our study was 77. Conclusion. Ilizarov external fixation is a safe and efficient treatment modality for high-energy tibial plateau fractures. It allows reconstruction of the articular surface, stable fixation, early rehabilitation, and care of soft tissue injuries.

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 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 "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 Tibial plateau fractures in a limited-resource setting: A prospective study of surgical techniques and outcome over three years

2022 ◽  
pp. 31
Author(s):  
Keyword(s):  
External Fixation ◽  
Tibial Plateau ◽  
Wide Spectrum ◽  
Surgical Techniques ◽  
Tibial Plateau Fractures ◽  
Resource Setting ◽  
Schatzker Type ◽  
Satisfactory Outcome ◽  
Pathologic Fractures ◽  
Post Traumatic

Introduction: Tibial plateau fractures form a wide spectrum of injuries accounting for 1.2% of all fractures and a prevalence of 10 cases per 100,000 inhabitants. Methodology: A prospective consecutive multicentre study from May 2018 to May 2021 was carried out in Yaounde. All consenting cases of tibial plateau fracture underwent surgical treatment while patients with pathologic fractures, previous knee osteoarthritis, medically unfit for surgery, and discharging against medical advice were excluded. Data was analysed with SPSS 26.0 and the level of significance set at p<0.05. Results:Eighty-four (84) cases of tibial plateau fractures were sampled and 68 consented to surgery. The mean age was 42 ±13.6 years and sex ratio 2.4. Estimated prevalence was 2.2 cases per 100,000 inhabitants. Schatzker type II fractures were most represented (33.3%). The left leg was affected in 57.1%. Motorbike accidents were the main cause of injury (66.7%). Of the 68 operated, 63.3% by plating osteosynthesis, 32.4% by external fixation, and 4.4% by screws fixation. Tricortical iliac bone graft was realised in 4 cases. The minimum follow-up was 6 months, with a median of 18 months (5 to 37 months). Plating osteosynthesis (p<0.001), operative time between 60 to 120 minutes (p<0.02) and a good radiologic fracture healing (p<0.04) were associated with a satisfactory outcome. Poor prognosis was seen with open fractures (p<0.001), bridging external fixation (p<0.001), and Schatzker VI fractures (p<0.02). Complications included post-traumatic osteoarthritis (64.7%), post-traumatic osteomyelitis (29.4%), knee ankylosis (5.9%), and limb malalignment (30.9%). Conclusion:The prevalence of tibial plateau fractures remains lower than reported in literature but it is projected to rise. Plating remains a viable treatment option. A larger scale study will establish the burden of this entity in our context.

Combination of Fine Wire Fixation and Limited Internal Fixation for High-Energy Tibial Plateau Fractures: Functional Results at Minimum 5-Year Follow-up

2009 ◽  
Vol 23 (7) ◽  
pp. 493-501 ◽  
Author(s):  
Dimitris Katsenis ◽  
George Dendrinos ◽  
Antonis Kouris ◽  
Nikos Savas ◽  
Nikos Schoinochoritis ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Tibial Plateau ◽  
Functional Results ◽  
High Energy ◽  
Tibial Plateau Fractures ◽  
Fine Wire ◽  
Wire Fixation

scholarly journals Treatment of high energy tibial plateau fractures with hybrid external fixator: intermediate term outcome

2017 ◽  
Vol 5 (10) ◽  
pp. 4582
Author(s):  
Alamgir Jahan ◽  
Muhammad Haseeb ◽  
Fahad Wazir
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
External Fixator ◽  
Tibial Plateau ◽  
High Energy ◽  
Deep Infection ◽  
Tibial Plateau Fractures ◽  
Open Fractures ◽  
Hybrid External Fixator ◽  
Primary Management

Background: High energy tibial plateau fractures pose a management challenge because of the complexity of bone and soft tissue trauma. Because of the frequency and magnitude of soft tissue of soft tissue injury in these fractures, early internal fixation becomes difficult. Wound breakdown and deep infection are common complications in plating of these difficult fractures. Primary management with hybrid external fixator can be a useful alternative to internal fixation in such cases.Methods: The study was a prospective case series done in the orhtopaedic department of a teaching hospital. 20 patients were studied. There were 13 Schatzker VI, 5 Schatzker V and 2 Schatzker IV fractures included. 4 patients had open fractures and 1 had compartment syndrome. Open fractures were operated in emergency department. Those with severe swelling and blisters were allowed few days to settle. Primary fixation using a hybrid external fixator was done. Mobilisation was started early. Patients were followed up to 1 year.Results: Union was obtained in all patients within 18 weeks. There was only deep infection. 95% patients had range of motion of 90 degrees or more. No patient had an extensor lag.Conclusions: Primary management of high energy tibial plateau fractures using hybrid external fixator is a reasonable option for cases that are not immediately amenable to internal fixation. It provides adequate stabilization to allow early motion and hastens patient rehabilitation. We have a good experience with this technique and recommend it for judicious use.

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