Subchondral Rafting Plate for the Treatment of Fragmented Articular Central Depression Tibial Plateau Fracture Patterns: Case Series and Technical Illustration

The posterolateral tibial plateau fracture was not easy to be exposed and fixed with usual techniques. The aim of this study was to investigate the biomechanical stability and clinical outcome of the isolated posterolateral tibial plateau fracture fixed with a single horizontal belt plate through the anterolateral supra-fibular-head approach. Fracture models were created by 18 synthetic tibias and fixed with three different fixation modes. Each group was fixed and tested on the loading machine, and final vertical displacement of the fragment was detected and calculated. Clinically, a retrospective analysis of 12 cases of posterolateral tibial plateau fracture from January 2013 to December 2017 was performed. There were 8 males and 4 females, aged 33-72 years, with an average age of 49.6 years. Isolated posterolateral tibial plateau fractures were identified according to preoperative X-ray and computed tomography scan. Through the modified anterolateral supra-fibular-head approach, the fracture was reduced and fixed by a prebending T-shaped distal radius plate and rafting screws, with bone substitute grafting or autogenous iliac bone implantation. Patients were followed up to a minimum one year of time period, and the outcome was evaluated clinically and radiologically. The biomechanical study shows that horizontal belt plate fixation for the isolated PL tibial plateau fracture can provide sufficient stability, allowing early knee functional exercise and partial weight bearing. For clinical case series, the average operation time in this group was 73.3 ± 10.2 mins (range: 55-90), and the average duration of hospitalization was 9.1 ± 3.3 days (range: 5-16). Patients were followed up for 12-24 months with an average of 16.5 months, and all patients achieved radiological fracture union after an average of 13.7 weeks. At one year after operation, the average knee score of the Hospital for Special Surgery (HSS) scale was 93.2 ± 4.2 points(range: 90-98), the average score of SMFA was 21.1 ± 5.6 points (range: 14-31), and the average knee range of motion (ROM) was 121.48 ° ± 8.88 ° (range: 105°-135°). There were 8 cases that were very satisfied and 3 cases that were satisfied with the operation. For an isolated posterolateral tibial plateau fracture, the supra-fibular-head approach can fully expose the fracture site; the horizontal belt plate fixation of the fracture is stable and reliable to allow for early-stage knee rehabilitation, and the outcome of medium-term clinical follow-up was satisfactory.

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Applying autogenous iliac bone combined with allogeneic cortical bone for reconstructing collapse of the tibial plateau fracture

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2011.00694 ◽

2011 ◽

Vol 31 (6) ◽

pp. 694-695

Author(s):

Wen-yue WANG ◽

Shen-sheng NIAN ◽

Lie-hu CAO ◽

Yong-fa WU ◽

Gen BA ◽

...

Keyword(s):

Cortical Bone ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Iliac Bone ◽

Plateau Fracture

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Comparison of tibial plateau fracture surgical outcomes between young and elderly patients: are outcomes really poorer in the elderly?

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03855-7 ◽

2021 ◽

Author(s):

Joon-Kuk Kim ◽

Kyu-Tae Hwang ◽

Hyun-Soo Soh ◽

Oog-Jin Shon ◽

Ki-Chul Park

Keyword(s):

Elderly Patients ◽

Surgical Outcomes ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

The Elderly ◽

Plateau Fracture

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Late-onset isolated cerebral fat embolism syndrome after a simple tibial plateau fracture: a rare case report

Journal of International Medical Research ◽

10.1177/03000605211028415 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110284

Author(s):

Ta-Li Hsu ◽

Tien-Chi Li ◽

Fei-Pi Lai ◽

Ming Ouhyoung ◽

Chih-Hung Chang ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rare Case ◽

Tibial Plateau ◽

Tibial Plateau Fracture ◽

Fat Embolism ◽

Resonance Imaging ◽

Fat Embolism Syndrome ◽

Embolism Syndrome ◽

Plateau Fracture

Fat embolism syndrome (FES) is a complication of long bone fractures that often occurs within 72 hours of injury. Early-onset isolated cerebral fat embolism is catastrophic and rarely reported. We herein present a rare case of delayed-onset isolated cerebral FES that developed 10 days after definite fixation of a left tibial plateau fracture. A 70-year-old woman was injured in a traffic accident and diagnosed with a left tibial plateau fracture. However, she developed sudden loss of consciousness (E4V1M1) and quadriplegia 10 days after fracture fixation. Her vital signs showed no respiratory distress. Diagnosis of isolated cerebral FES was made based on magnetic resonance imaging of the brain, the findings of which were compatible with the clinical neurological findings. After supportive care and rehabilitation, her consciousness became clear on the second day of admission, and her consciousness changed to E4V5M6. She gradually regained strength in her right limbs but had residual left limb paraplegia. Isolated cerebral FES should always be considered for patients who develop a change in consciousness, even beyond 72 hours after injury. Imaging may not initially show definitive abnormalities. Repeated magnetic resonance imaging should be considered if the initial clinical presentation does not fully meet Gurd’s criteria.

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Gastrocnemius muscle flap with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone graft for the phase I treatment of localized osteomyelitis after tibial plateau fracture surgery

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02496-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Weiwei Ruan ◽

Menglu Li ◽

Qiaofeng Guo ◽

Bingyuan Lin

Keyword(s):

Phase I ◽

Calcium Sulfate ◽

Tibial Plateau ◽

Gastrocnemius Muscle ◽

Tibial Plateau Fracture ◽

Muscle Flap ◽

Iliac Bone ◽

Type Iii ◽

Plateau Fracture ◽

Fracture Surgery

Abstract Purpose To investigate the clinical effect of gastrocnemius muscle flaps combined with vancomycin/gentamicin-calcium sulfate combined and autologous iliac bone graft in the phase I treatment of traumatic focal osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. Methods From July 2009 to January 2018, 35 patients with localized osteomyelitis (Cierny-Mader type III) who met the inclusion criteria were followed up and treated. All patients were infected after undergoing internal fracture fixation surgery. Among them, 18 cases were plate-exposed, 14 cases were due to sinus tracts, two were due to skin necrosis, and one was bone-exposed. We treated patients with several measures. All cases were then followed up. The follow-up indicators included Hospital for Special Surgery knee scores (HSS), the time of laying drainage pipe, bone healing time, infection control rate, and the incidence of nonunion and other complications. Results All patients were followed up for 24–60 months. None of them underwent amputation. For repairing soft tissue defects, 17 cases were covered with a muscle flap using the medial head of gastrocnemius alone, 15 cases were treated with the lateral head of gastrocnemius muscle, and three cases were covered with the combination of the two heads. Compared to the preoperative score, we found that the average HSS improved at the 1-year and 2-year follow-up (54 vs. 86 vs. 87). Conclusion Using a gastrocnemius muscle flap combined with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone was an effective method for the phase I treatment of osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. In the primary treatment of focal traumatic osteomyelitis, it can decrease the treatment time, number of surgeries, pain of patients, time of bone healing, postoperative exudation, and infection recurrence rate and increase the healing bone’s strength.

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