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Fahlbusch H, Behrendt P, Becker A, Arras C, Gablac H, Frings J, Hoffmann M, Krause M, Frosch KH. Lateral epicondyle osteotomy results in improved radiologic and functional outcomes in severe lateral tibial plateau fractures: a retrospective cohort study. J Orthop Surg Res 2025; 20:363. [PMID: 40211388 PMCID: PMC11983902 DOI: 10.1186/s13018-025-05775-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2025] [Accepted: 04/01/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND This study evaluated the clinical and radiological outcomes of lateral tibial plateau fractures involving the central and postero-lateral regions, comparing an extended lateral approach with lateral epicondyle osteotomy (ECO) to a conventional approach without an extention (No-ECO). METHODS A retrospective cohort study was conducted at two centers, examining complex lateral tibial plateau fractures treated with either an extended lateral approach with ECO or without it. Only AO/OTA type B3/C3 fractures involving the antero-latero-central (ALC) and postero-latero-central (PLC) segments were included. Fracture reduction quality was assessed via post-operative CT scans, and clinical outcomes and complications were evaluated over a minimum of 24-month follow-up. RESULTS A total of 110 patients (mean age: 51.3 ± 11.1 years) were included, with an average follow-up of 52.7 ± 16.9 months. The ECO group (n = 56) consisted of more severe injuries, indicated by higher external fixator use (48.2% vs. 22.2%, p = 0.0044) and additional affected segments. Postoperative CT scans revealed that the ECO group had significantly less fracture step-off (0.8 mm vs. 3.0 mm, p = 0.0002) and angulation at the ALC/PLC (8.1° vs. 20.1°, p = 0.0002) segment and PLC/PLL (postero-latero-lateral) (2.2° vs. 7.5°, p = 0.02) segments. Clinically, the ECO group achieved superior IKDC scores (71.7 vs. 63.7, p = 0.0097). A negative correlation was found between postoperative ALC/PLC depression and IKDC scores (r=-0.36, p = 0.0002). CONCLUSION Patients treated with ECO had a significantly better clinical and radiologic postoperative outcomes, with the quality of fracture reduction positively correlating with the clinical IKDC score. This was achieved despite more severe injuries, as indicated by higher external fixator use and number of affected segments. LEVEL OF EVIDENCE III Retrospective Cohort Study. TRIAL REGISTRATION The study was retrospectively registered and conducted according to the guidelines of the Declaration of Helsinki and approved by the local Ethics Committee (PV7319).
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Affiliation(s)
- Hendrik Fahlbusch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - P Behrendt
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
- Department of Anatomy, Christian-Albrechts-University, Kiel, Germany
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, Hamburg, Germany
| | - A Becker
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Arras
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Gablac
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, Hamburg, Germany
| | - J Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Hoffmann
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, Hamburg, Germany
| | - M Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K H Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
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Liu CD, Hu SJ, Chang SM, Du SC, Chu YQ, Qi YM, Li HT, Mao W. Treatment of posterolateral tibial plateau fractures: a narrative review and therapeutic strategy. Int J Surg 2025; 111:1071-1082. [PMID: 39017710 PMCID: PMC11745588 DOI: 10.1097/js9.0000000000001955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/06/2024] [Indexed: 07/18/2024]
Abstract
The posterolateral tibial plateau is crucial for maintaining knee stability during flexion, and fractures in this area often involve ligament and meniscus injuries, necessitating effective management. However, treating posterolateral tibial plateau fractures (PLF) poses significant challenges due to the complex anatomy. Therefore, this review aims to explore contemporary concepts of PLF, from identification to fixation, and proposes a comprehensive treatment strategy. In this article, the authors detail the injury mechanisms, fracture morphology, PLF classification systems, surgical approaches, and techniques for open reduction and internal fixation (ORIF) as well as arthroscopic-assisted internal fixation (ARIF). The findings indicate that PLF is typically caused by flexion-valgus forces, resulting in depression or split-depression patterns. For isolated PLF, the supra-fibular head approach is often preferable, whereas posterior approaches are more suitable for combined fractures. Additionally, innovative plates, particularly the horizontal belt plate, have shown satisfactory outcomes in treating PLF. Currently, the 'bicondylar four-quadrant' concept is widely used for assessing and managing the tibial plateau fractures involving PLF, forming the cornerstone of the comprehensive treatment strategy. Despite challenges in surgical exposure and implant placement, ORIF remains the mainstream treatment for PLF, benefiting significantly from the supra-fibular head approach and the horizontal belt plate. Furthermore, ARIF has proven effective by providing enhanced visualization and surgical precision in managing PLF, emerging as a promising technique.
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Affiliation(s)
| | - Sun-Jun Hu
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, Republic of China
| | - Shi-Min Chang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, Republic of China
| | | | | | | | | | - Wei Mao
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, Republic of China
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Behrendt P, Fahlbusch H, Galavics C, Berninger MT, Gablac H, Klepsch L, Frings J, Hoffmann M, Krause M, Frosch KH. Clinical and radiological outcome of extended lateral approach via epicondyle osteotomy in complex lateral tibia plateau fractures involving the central and postero-lateral segments. Injury 2024; 55:111876. [PMID: 39423668 DOI: 10.1016/j.injury.2024.111876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 09/07/2024] [Accepted: 09/10/2024] [Indexed: 10/21/2024]
Abstract
INTRODUCTION The purpose of this study was to evaluate the clinical and radiological results of complex lateral tibial plateau fractures involving the central segments of the lateral tibial plateau. It was hypothesized that an extended lateral approach by using the lateral epicondyle osteotomy improves the rate of malreduction and yields to good and excellent clinical results at a mid-term follow-up. METHODS This retrospective case series conducted at two centers evaluated complex lateral tibial plateau fractures treated with an extended lateral approach by lateral epicondyle osteotomy. Fractures were classified according to the AO/OTA and 10-segment classification, with only B/C type fractures involving the antero-latero-central (ALC) and postero-latero-central (PLC)/postero-latero-lateral (PLL) segments. Postoperative computer tomography scans were used to assess the quality of reduction. Clinical outcomes and postoperative complications were evaluated with a minimum follow-up of 2 years. RESULTS Sixty-five patients (mean age: 47.7 ± 11.5 years) were included, with an average follow-up of 51.9 ± 3.6 months. Radiological outcomes revealed a postoperative fracture step at the ALC/PLC crossing of 0.8 ± 1.1 mm, at the PLC/PLL crossing of 0.4 ± 1.1 mm, and a fracture gap of 1.8 ± 4.0 mm, yielding a Rasmussen Score of 15.1 ± 3.2. No significant differences among type B and C fractures were identified. No case of nonunion of the lateral epicondyle osteotomy was recorded. The mean Knee injury and Osteoarthritis Outcome Score was 80.4 ± 16.2 (type B 85.6 ± 11.9 vs. type C 76.1 ± 18.4, p < 0.05), Lysholm score was 83.4 ± 17.1 (B 89 ± 11.3 vs. C 78.7 ± 20.1, p < 0.05) and International Knee Documentation Committee score was 69.9 ± 18.8 (type B 76.5 ± 15.7 vs. type C 64.3 ± 20.1, p < 0.05). Early complication rate requiring surgical revision due to malreduction or infection were 7 %. None of the patients reported about subjective lateral knee instability at the time of clinical follow-up. CONCLUSION The extended lateral approach with lateral epicondyle osteotomy demonstrated excellent radiological alignment and favorable mid-term clinical outcomes. An overall low complication rate was recorded. Notably, long-term revisions due to lateral instability were absent, indicating the safety and efficacy of lateral epicondyle osteotomy as an operative technique.
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Affiliation(s)
- P Behrendt
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Anatomy, Christian-Albrechts-University, Kiel, Germany
| | - H Fahlbusch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Galavics
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, Hamburg, Germany
| | - M T Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Gablac
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, Hamburg, Germany
| | - L Klepsch
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, Hamburg, Germany
| | - J Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Hoffmann
- Department of Trauma Surgery, Orthopedics and Sportsorthopedics, Asklepios St. Georg, Hamburg, Germany
| | - M Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K H Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.
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Hörmandinger C, Bitschi D, Berthold DP, Neidlein C, Schroeder L, Watrinet J, Pätzold R, Böcker W, Holzapfel BM, Fürmetz J, Bormann M. Lack of standardisation in the management of complex tibial plateau fractures: a multicentre experience. Eur J Trauma Emerg Surg 2024; 50:2937-2945. [PMID: 39095621 PMCID: PMC11666675 DOI: 10.1007/s00068-024-02616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE In recent years, the trauma mechanisms and fracture types in tibial plateau fractures (TPF) have changed. At the same time, treatment strategies have expanded with the establishment of new classification systems, extension of diagnostics and surgical strategies. Evidence-based recommendations for treatment strategies are rare. The aim of this study is to assess the extent of standardization in the treatment of complex TPF. MATERIAL AND METHODS For the study, specialists in trauma surgery/orthopaedics were presented thin-slice CT data sets of three complex TPFs including 3D reconstructions. A standardized questionnaire on fracture morphology and planned treatment strategy was then completed. RESULTS A total of 23 surgeons from 7 hospitals (Trauma center levels I-III) were included. All three fractures were most frequently classified as Schatzker type V (fracture I: 52.2%, II: 56.5%, III: 60%). Averaged over all three fractures, 55% of the respondents chose the same patient positioning. The combination of a posteromedial and anterolateral approach was the most frequently chosen approach at 42.7%. Double plating was favored for the surgical treatment of all fractures (70.7%). Preoperative MRI, extended approaches and intraoperative fraturoscopy were significantly more common in level I trauma centres. CONCLUSION There are major differences in the management of complex TPF. 360° treatment is carried out in all departments regardless of the level of care, but without further standardization in terms of preoperative imaging, classification, initial treatment, approach, fixation and intraoperative imaging. There are major differences within the departments with different level of care.
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Affiliation(s)
- Christina Hörmandinger
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - David Bitschi
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Claas Neidlein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Lennart Schroeder
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Julius Watrinet
- Department of Trauma Surgery, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Robert Pätzold
- Department of Trauma Surgery, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Julian Fürmetz
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- Department of Trauma Surgery, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Markus Bormann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
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Migliorini F, Schäfer L, Bell A, Weber CD, Vecchio G, Maffulli N. Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5485-5495. [PMID: 37812251 PMCID: PMC10719156 DOI: 10.1007/s00167-023-07600-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Meniscal tears are common and may impair knee function and biomechanics. This meta-analysis compared meniscal repair versus resection in patients with symptomatic meniscal tears in terms of patient-reported outcomes measures (PROMs), joint width, surgical failure, and rate of progression to osteoarthritis (OA) at conventional radiography. METHODS This study was conducted according to the 2020 PRISMA statement. In August 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. Two reviewers independently performed the analysis and a methodological quality assessment of the included studies. All the clinical investigations which compared repair versus resection of meniscal tears were accessed. RESULTS Data from 20 studies (31,783 patients) were collected. The mean BMI was 28.28 ± 3.2 kg/m2, and the mean age was 37.6 ± 14.0 years. The mean time elapsed from injury to surgery was 12.1 ± 10.2 months and the mean medial joint width was 4.9 ± 0.8 mm. Between studies comparability at baseline was found in age, women, BMI, time from injury to surgery and length of the follow-up, PROMs, medial joint width, and stage of OA. The resection group demonstrated a greater Lysholm score (P = 0.02). No difference was found in the International Knee Documentation Committee (P = 0.2). Nine studies reported data on the rate of failures at a mean of 63.00 ± 24.7 months. No difference was found between the two groups in terms of persistent meniscal symptoms (P = 0.8). Six studies reported data on the rate of progression to total knee arthroplasty at a mean of 48.0 ± 14.7 months follow-up. The repair group evidenced a lower rate of progression to knee arthroplasty (P = 0.0001). Six studies reported data on the rate of advanced knee OA at a mean of 48.0 ± 14.7 months of follow-up. The repair group evidenced a lower rate of advanced knee OA (P = 0.0001). No difference was found in the mean joint space width (P = 0.09). CONCLUSION Meniscal repair is associated with a lower progression to knee osteoarthritis at approximately six years of follow-up compared to partial meniscectomy. No difference in PROMs, medial joint width, and failures were evidenced. LEVEL OF EVIDENCE Level III, meta-analysis.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany
| | - Christian David Weber
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gianluca Vecchio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Italy
| | - Nicola Maffulli
- Faculty of Medicine and Psychology, University Hospital Sant' Andrea, University La Sapienza, 00185, Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, ST4 7QB, UK
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London, E1 4DG, UK
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Rosteius T, Rausch V, Jettkant B, Lotzien S, Schildhauer TA, Königshausen M, Geßmann J. Influence of articular step-off on contact mechanics in fractures of the posterolateral-central tibial plateau - a biomechanical study. Knee 2023; 41:283-291. [PMID: 36780843 DOI: 10.1016/j.knee.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 09/19/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The posterior quadrants of the tibial plateau are frequently involved in OTA type C tibial plateau fractures. The biomechanical influence of a residual articular step-off of the posterolateral-central (PLC) segment, which is difficult to visualize intraoperatively, remains unclear. Therefore, aim of this study was to investigate the contact area and stress of the tibial plateau in cases of different articular step-offs of the PLC segment. METHODS Seven human cadaveric knees were used to simulate articular impressions of the PLC segment with step-offs of 1 mm, 3 mm, and 5 mm. The knees were axially loaded up to 150 N during a total of 25 dynamic cycles of knee flexion up to 90°. Pressure mapping sensors were inserted into the medial and lateral joint compartments beneath the menisci to measure articular contact area and stress. RESULTS Between 60° and 90° of knee flexion, increasing PLC segment impressions of the tibial plateau led to increasing contact stress and a significantly reduced contact area. The largest decrease in the contact area was 30 %, with an articular step-off of 5 mm (0.003). An increase in contact stress, especially from a 3-mm step-off, was measured, with a doubling of the mean contact stress at 3-mm and 5-mm step-offs and 90° knee flexion (p = 0.06/0.05). CONCLUSION From a biomechanical point of view, posterior impressions of the PLC segment greater than a 1-mm step-off should be addressed as anatomically as possible, especially in active patients with the need for higher knee flexion angles.
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Affiliation(s)
- Thomas Rosteius
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany.
| | - Valentin Rausch
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Birger Jettkant
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Matthias Königshausen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
| | - Jan Geßmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle- de- la- Camp Platz 1, 44789 Bochum, Germany
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Behrendt P, Berninger MT, Thürig G, Dehoust J, Christensen JH, Frosch KH, Krause M, Hartel MJ. Anterolateral versus modified posterolateral approach for tibial plateau fractures with involvement of the posterior column: a cadaveric study. Eur J Trauma Emerg Surg 2023; 49:201-207. [PMID: 36171336 PMCID: PMC9925589 DOI: 10.1007/s00068-022-02113-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to compare the reduction quality of the anterolateral (AL) and modified posterolateral approach (PL) in lateral tibial plateau fractures involving the posterior column and central segments. METHODS Matched pairs of pre-fractured cadaveric tibial plateau fractures were treated by either AL approach (supine position) or PL approach (prone position). Reduction was controlled by fluoroscopy and evaluated as satisfying or unacceptable. Afterwards, the reduction was examined by 3D scan. RESULTS 10 specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were evaluated. PL approach achieved significantly (p 0.00472) better fracture reduction results (0.4 ± 0.7 mm) of the posterior column compared to the AL group (2.1 ± 1.4 mm). Fracture steps involving the central area of the lateral plateau were insufficiently reduced after fluoroscopy using both approaches. CONCLUSION Optimal reduction of displaced tibial plateau fractures involving the posterolateral column necessitates a posterior approach, which can be conducted in prone or lateral positioning. The anterolateral approach is indicated in fractures with minor displacement of the posterolateral rim but fracture extension in the latero-central segments. In these cases, an additional video-assisted reduction or extended approaches are helpful.
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Affiliation(s)
- Peter Behrendt
- Department of Trauma Surgery, Orthopedics and Sports Orthopedics, Asklepios St. Georg, Hamburg, Germany.
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Anatomy, Christian-Albrechts-University, Kiel, Germany.
| | - Markus T Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Grégoire Thürig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Orthopedics and Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Julius Dehoust
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Jan H Christensen
- Department of Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian J Hartel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
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Zhu F, Jiao J, Huang Y, Xiao F, Zuo W, Chen M, Wang X, Wang J. A preliminary study of the surgical approach for posterior tibial plateau fractures: Based on posterior fragment segment classification. Injury 2022; 53:3820-3827. [PMID: 36116959 DOI: 10.1016/j.injury.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The optimal surgical approach for the posterior tibial plateau fractures (PTPFs) remains controversial. This study aims to establish a method for posterior fragment segment classification to guide the choice of surgical approach and to reveal the outcome of their early reduction and health status. METHODS The medical records of 42 PTPFs patients treated with the strategy were collected retrospectively from December 2017 to December 2021. The posterior cortex of the tibial plateau was classified into postero-medial (PM), postero-central (PC), and postero-lateral (PL) segments. A posteromedial inverted L-shaped approach was adopted when the fractures involved the PM segment in the presence or absence of PC. The Frosch approach was performed when the PL segment was concerned. Fractures containing both PM and PL segments were treated by combined approaches. Four factors were measured to evaluate the reduction effect, including medial proximal tibial angle (MPTA), lateral posterior slope angle (LPSA), medial posterior slope angle (MPSA), and articular step-off. The Short Form 36 (SF-36) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were completed at the last follow-up to assess health status and the degree of osteoarthritis. RESULTS A posteromedial inverted L-shaped approach was adopted in 16 PTPFs patients, a Frosch approach was adopted in 14 PTPFs patients, and a combined approach was adopted in 12 PTPFs patients. Immediate radiographic results indicated a promising fixation performance with this treatment strategy. The results of SF-36 and WOMAC scores reported good health status in all patients with a mean follow-up time of 34.50 (23-50) months. Two patients developed superficial wound infections, and one patient had liquefaction necrosis in adipose tissue. Although skin numbness occurred in 4 patients, they recovered within 6 months. CONCLUSION PTPFs patients treated under the guidance of posterior fragment segment classification achieved encouraging levels of immediate fixation and health status.
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Affiliation(s)
- Fukang Zhu
- Department of Orthopedics, Third People's Hospital of Hubei Province, Wuhan 430000, China
| | - Jing Jiao
- Department of Orthopedic Trauma, Wuhan Fourth Hospital, Wuhan 430000, China
| | - Yucheng Huang
- Department of Orthopedic Trauma, Wuhan Fourth Hospital, Wuhan 430000, China
| | - Fei Xiao
- Department of Orthopedic Trauma, Wuhan Fourth Hospital, Wuhan 430000, China
| | - Wei Zuo
- Department of Orthopedic Trauma, Wuhan Fourth Hospital, Wuhan 430000, China
| | - Ming Chen
- Department of Orthopedic Trauma, Wuhan Fourth Hospital, Wuhan 430000, China
| | - Xianxun Wang
- Department of Orthopedics, Third People's Hospital of Hubei Province, Wuhan 430000, China
| | - Junwen Wang
- Department of Orthopedic Trauma, Wuhan Fourth Hospital, Wuhan 430000, China.
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Clinical Efficacy of Endoscopic Infratentorial Supracerebellar Approach for Pineal Region Tumors: A Retrospective Case-Control Study. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5702309. [PMID: 36017015 PMCID: PMC9385296 DOI: 10.1155/2022/5702309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
Tumors in the pineal region are deep, with complex surrounding anatomy, adjacent to important blood vessels and nerve structures, and surgical resection is difficult and risky. In this paper, we reviewed the literature to understand the epidemiology and clinical manifestations of pineal region tumors in the country and study the clinical indications, related problems, and successful experiences of patients with pineal region tumors treated by the transtentorial-superior approach. The clinical data of 80 patients with pineal region tumors were selected as the retrospective research objects and divided into the control group and the treatment group, with 40 cases in each group, according to the random number table method. The control group was treated using the endoscopic transtentorial approach (Poppen approach), while the treatment group was treated with the endoscopic supratentorial approach (Krause approach). The inflammatory factors, inflammatory stress response, postoperative neurological dysfunction, clinical efficacy, and poor prognosis were observed and compared between the two groups. Tumor resection and recurrence were used to compare the clinical outcomes of tumors in the pineal region. The extent of surgical resection was 100% higher in both groups, and the treatment group was comparable to the control group. The prognosis of patients after the operation was poor. Nausea and vomiting, visual disturbance, upper vision paralysis, and ataxia in the treatment group were significantly lower than those in the control group, with no statistical significance (P > 0.05). At the same time, the bone window can be reduced to reduce trauma and provide a certain reference for patients to choose a safe and complete resection method.
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Affiliation(s)
- Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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Krause M, Alm L, Berninger M, Domnick C, Fehske K, Frosch KH, Herbst E, Korthaus A, Raschke M, Hoffmann R. Bone metabolism is a key factor for clinical outcome of tibial plateau fractures. Eur J Trauma Emerg Surg 2020; 46:1227-1237. [PMID: 33151357 PMCID: PMC7691299 DOI: 10.1007/s00068-020-01537-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022]
Abstract
Purpose Given that tibial plateau fractures (TPF) are rare, they may pose a challenge to the treating surgeon due to their variety of complex fracture patterns. Numerous studies have identified potential fracture-specific, surgery-related, and patient-related risk factors for impaired patient outcomes. However, reports on the influence of bone metabolism on functional outcomes are missing. Methods In a retrospective multicenter cohort study, 122 TPF of 121 patients were analyzed with respect to radiological and clinical outcomes (Rasmussen) with a mean follow-up of 35.7 ± 24.9 months. The risk factor assessment included bone metabolism-affecting comorbidities and medication.
Results The findings showed that 95.9% of the patients reported a good-to-excellent clinical outcome, and 97.4% reported a good-to-excellent radiological outcome. Logistic regression revealed that potentially impaired bone metabolism (IBM) was an independent risk factor for the clinical (p = 0.016) but not the radiological outcome (Table 4). Patients with 41-type B fractures and a potential IBM had a seven times higher risk to present a fair-to-poor clinical outcome [OR 7.45, 95 CI (4.30, 12.92)]. The most common objective impairment was a limited range of motion in 16.4% of the patients, especially in 41-type C fractures (p = 0.06). The individual failure analysis additionally identified surgery-related options for improvement. Conclusion This study demonstrated that potential IBM was an independent risk factor for a poor-to-fair clinical outcome.
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Affiliation(s)
- Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany.
| | - Lena Alm
- BG Trauma Hospital Hamburg, Hamburg, Germany
| | - Markus Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany
| | - Christoph Domnick
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Kai Fehske
- Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Alexander Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246, Hamburg, Germany
| | - Michael Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt am Main, Germany
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