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Berto L, Palma GHDB, Silva ACD, Rodrigues MRGB, Amorim R, Cardoso GS. Treatment of Tibial Plateau Fractures with a Circular External Fixator: A Comparative Analysis of Two Assembly Methods. Rev Bras Ortop 2024; 59:e206-e212. [PMID: 38606135 PMCID: PMC11006512 DOI: 10.1055/s-0044-1785203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/06/2023] [Indexed: 04/13/2024] Open
Abstract
Objective To compare the functional outcomes of two circular external fixation techniques to treat complex fractures of the proximal end of the tibia. Materials and Methods The present is a retrospective cohort study with 51 patients who underwent surgical treatment for complex fractures of the tibial plateau with a circular external fixator. There were two groups of patients: 12 subjects underwent treatment with the classic assembly technique, and 39 subjects underwent treatment with the simplified technique. The variables analyzed included age, sex, injury mechanism, trauma energy, associated injuries, fixator type, time of fixator use, and clinical-radiographic outcomes. The classic technique mainly uses transfixing Kirschner wires, while the simplified one replaces the Kirschner wires with Schanz pins in the distal block of the circular external fixator. Result There were no statistically significant differences ( p > 0.05) between the two groups concerning the clinical-radiographic outcomes, including fracture consolidation, quality of joint fracture reduction, range of motion, lower limbs residual discrepancy, and postoperative pain. Conclusion We suggest that the simplified technique, using Schanz pins instead of Kirschner wires, can be a viable and effective alternative to treat complex fractures of the proximal end of the tibia with a circular external fixator. This simplified approach can offer benefits, such as a lower infection rate and greater patient comfort, without compromising clinical and radiographic outcomes, thus justifying its use.
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Affiliation(s)
- Leonardo Berto
- Serviço de Ortopedia e Traumatologia, Hospital Governador Celso Ramos, Florianópolis, SC, Brasil
| | | | - André Crippa da Silva
- Serviço de Ortopedia e Traumatologia, Hospital Governador Celso Ramos, Florianópolis, SC, Brasil
| | | | - Renato Amorim
- Serviço de Ortopedia e Traumatologia, Hospital Governador Celso Ramos, Florianópolis, SC, Brasil
| | - Gracielle Silva Cardoso
- Serviço de Ortopedia e Traumatologia, Hospital Governador Celso Ramos, Florianópolis, SC, Brasil
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Martínez Ros J, Escudero Martínez A, Martínez Ros M, Molina González J, Carrillo García M, García Paños JP, Puertas García-Sandoval JP, Salcedo Cánovas C. Treatment of Schatzker Type VI Tibia Fractures Using Circular External Fixation: State of the Art, Surgical Technique and Results. J Clin Med 2024; 13:1249. [PMID: 38592108 PMCID: PMC10931701 DOI: 10.3390/jcm13051249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Schatzker type VI tibia fractures are usually associated with infection and surgical wound-related problems. Circular external fixation (CEF) has been shown to minimize such complications. METHODS We pose a retrospective study of patients with Schatzker type VI fractures treated with CEF. RESULTS Twenty-two (22) patients were included (11M/11F) with a mean age of 60.1 ± 14.9 years. According to the AO/OTA classification, two fractures (9.1%) were A2, three (13.6%) were A3, and seventeen (77.3%) were C3. Three (13.6%) of them were open. The tissue damage observed in the nineteen (86.4%) closed fractures was classified according to Tscherne (four grade I, twelve grade II, and three grade III). The mean ex-fix time was 24.1 ± 5.1 weeks. None of the patients experienced deep infections, nonunion, or malunion. The mean ROM was 111.4 ± 17.8 degrees. Although stability was achieved in all cases, 50% of them suffered osteoarthritic degeneration. Four knees required TKR at a mean of 8.77 ± 5.58 years from trauma. The mean HHS knee score was 84.2 ± 10.3 points (excellent in fifteen (68.2%) cases, good in four (18.2%), and acceptable in three (13.6%)). The mean Rasmussen radiological score was 13.3 ± 3.5 (excellent in three (13.6%) cases, good in fifteen (68.2%), and acceptable in four (18.2%)). The mean SF-12 score was 35.1 ± 10.4 points on the physical scale and 53.0 ± 10.6 points on the mental scale. CONCLUSIONS CEF has shown itself to be a valid treatment for patients with Schatzker type VI fractures, particularly for those where the fracture is comminuted, severely displaced, open, or associated with severe soft tissue damage.
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Affiliation(s)
- Javier Martínez Ros
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Patología Séptica Osteoarticular, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.M.G.); (C.S.C.)
| | - Alonso Escudero Martínez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (A.E.M.); (M.M.R.); (J.P.G.P.); (J.P.P.G.-S.)
| | - Miguel Martínez Ros
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (A.E.M.); (M.M.R.); (J.P.G.P.); (J.P.P.G.-S.)
| | - José Molina González
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Patología Séptica Osteoarticular, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.M.G.); (C.S.C.)
| | - María Carrillo García
- Servicio de Radiodiagnóstico, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Juan Pedro García Paños
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (A.E.M.); (M.M.R.); (J.P.G.P.); (J.P.P.G.-S.)
| | - José Pablo Puertas García-Sandoval
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (A.E.M.); (M.M.R.); (J.P.G.P.); (J.P.P.G.-S.)
| | - César Salcedo Cánovas
- Servicio de Cirugía Ortopédica y Traumatología, Unidad de Patología Séptica Osteoarticular, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain; (J.M.G.); (C.S.C.)
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Ghimire A, Devkota P, Bhandari KK, Kharel Y, Pradhan S. Fixação externa do anel de Ilizarov para fraturas complexas do platô tibial. Rev Bras Ortop 2022; 57:667-674. [PMID: 35966423 PMCID: PMC9365483 DOI: 10.1055/s-0041-1739171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 06/25/2021] [Indexed: 10/29/2022] Open
Abstract
Resumo
Objetivo Analisar os resultados clínicos, radiológicos e funcionais da fratura do planalto tibial (Schatzker Tipo V, VI) tratada com fixador externo do anel Illizarov com ou sem abertura mínima.
Métodos Um total de 52 fraturas do planalto tibial dos tipos V e VI foram tratadas com fixador externo do anel Ilizarov com ou sem fixação interna mínima. A avaliação do desfecho funcional foi feita utilizando-se o escore da American Knee Society (AKS, na sigla em inglês) com consolidação clínica, radiológica e complicações encontradas.
Resultados Foram 37 (71,15%) pacientes do sexo masculino e 15 (28,84%) do sexo feminino, com idade média de 39,07 ± 12,58 anos. Acidentes de trânsito (ATs) foram a principal causa das fraturas, contabilizando 32 casos (61,53%), seguidos por lesão por queda, com 16 casos (30,76%), e impacto direto, com 4 casos (7,69%). Foram 21 (40,38%) casos de fraturas tipo V, 31 (59,61%) casos do tipo VI e 24 (46,15%) casos de fratura exposta. Os escores médios da AKS para as fraturas tipo V e VI foram de 82,8 e 80,70, respectivamente, mas não foi estatisticamente significativo em p <0,05. O escore médio da AKS para fraturas fechadas e abertas também não foi estatisticamente significativo em p <0,05.
Conclusões Para a fratura do planalto tibial complexa dos tipos V e VI de Schatzker, a fixação externa de Ilizarov é um método de tratamento seguro, econômico e eficiente que resulta em resultados satisfatórios.
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Affiliation(s)
- Anil Ghimire
- Hospital Ortopédico do Nepal, Jorpati, Kathmandu 44601, Nepal and Patan Academy of Health Sciences, Patan Hospital, Lalitpur 44700 Nepal
| | - Pramod Devkota
- Departamento de Ortopedia e Cirurgia de Trauma, Patan Hospital, Academia Patan de Ciências da Saúde, Lalitpur, Kathmandu, Nepal
| | - Kailash Kumar Bhandari
- Hospital Ortopédico do Nepal, Jorpati, Kathmandu 44601, Nepal and Patan Academy of Health Sciences, Patan Hospital, Lalitpur 44700 Nepal
| | - Yubaraj Kharel
- Hospital Ortopédico do Nepal, Jorpati, Kathmandu 44601, Nepal and Patan Academy of Health Sciences, Patan Hospital, Lalitpur 44700 Nepal
| | - Saju Pradhan
- Hospital Ortopédico do Nepal, Jorpati, Kathmandu 44601, Nepal and Patan Academy of Health Sciences, Patan Hospital, Lalitpur 44700 Nepal
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Lu L, Chai L, Wan D, Li P, Chen D. Effect Comparison of Assisted Surgery Simulated by Preoperative 3D Reconstruction and Minimally Invasive Surgery with the Assist of Knee Arthroscopy in the Treatment of Tibial Plateau Fracture under the Background of Intelligent Medicine. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3397998. [PMID: 35619761 PMCID: PMC9129929 DOI: 10.1155/2022/3397998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect comparison of the assisted surgery simulated by preoperative 3D reconstruction and the minimally invasive surgery with the assist of knee arthroscopy in the treatment of tibial plateau fracture (TPF) under the background of intelligent medicine. Methods 100 patients with TPF admitted to our hospital from January 2021 to January 2022 were selected as the study subjects. According to the order of admission, the patients were divided into the simulation group with 3D reconstruction (n = 50) and the auxiliary group with knee arthroscopy (n = 50), and the clinical indicators were compared between the two groups. Results There was no significant difference in any other clinical treatment indexes between the two groups except the surgery time (P > 0.05), and there was no significant difference in knee flexion ability, walking ability, and Rasmussen scores between the two groups after treatment (P > 0.05). However, compared with the auxiliary group with knee arthroscopy, the mean posterior slope angle and varus angle of the patients were significantly higher (P < 0.001), and the total incidence of complications was significantly lower (P < 0.05). Conclusion Based on the analysis under the background of intelligent medicine, it is found that the assisted surgery simulated by preoperative 3D reconstruction has a better effect and a higher safety, but they have the similar effects on improving the knee joint function of patients.
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Affiliation(s)
- Lei Lu
- Department of Orthopedics and Trauma, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
| | - Leizi Chai
- Department of Orthopedics and Trauma, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
| | - Deyu Wan
- Department of Orthopedics and Trauma, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
| | - Peng Li
- Department of Orthopedics and Trauma, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
| | - Duozi Chen
- Department of Pediatrics, Bozhou People's Hospital, 236800 Bozhou, Anhui, China
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Oguzkaya S, Misir A, Kizkapan TB, Eken G, Ozcamdalli M, Basilgan S. A comparison of clinical, radiological, and quality-of-life outcomes of double-plate internal and Ilizarov external fixations for Schatzker type 5 and 6 tibia plateau fractures. Eur J Trauma Emerg Surg 2021; 48:1409-1416. [PMID: 34121146 DOI: 10.1007/s00068-021-01713-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare clinical, functional, and radiological outcomes in patients with bicondylar tibial fractures treated with either double-plate or Ilizarov external fixation. METHODS Patients with Schatzker type 5 and 6 tibial plateau fractures who were treated with double-plate (Group O) and Ilizarov external fixations (Group E) between March 2012 and April 2018 were selected. Demographic data and preoperative, intraoperative, and postoperative variables were analyzed and compared. In the last follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Knee Society Score-Knee (KSS-Knee), KSS-Function (KSS-F), and Short-Form Health Survey (SF-36) were used to measure clinical and functional outcomes. Treatment costs and complication rates were also recorded and compared. RESULTS A total of 64 patients (43 men and 21 women) were included in the study (group O: 36, group E: 28). WOMAC, KSS-F, KSS-Knee, and OKS scores were similar between the two groups (P > 0.05). The role limitations due to emotional problems, emotional well-being, and social functioning domains of SF-36 were higher in group O (P < 0.001). Three (8.3%) deep infections occurred in group O, whereas no deep infection was observed in group E (P = 0.035). The treatment cost was higher in group O (P < 0.001). CONCLUSION In bicondylar tibial plateau fractures, functional outcomes of ORIF and Ilizarov method milar were sibut, role limitations due to emotional problems, emotional well-being and social functioning domains of SF-36 score were higher in ORIF group. However, Ilizarov method is more cost-effective and related with lesser complications.
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Affiliation(s)
- Sinan Oguzkaya
- Department of Orthopedics and Traumatology, Sarkisla State Hospital, Yildirim Mah. Alper Tunga Cad. Kalecity evleri B blok No:6, 58400, Sivas, Turkey.
| | - Abdulhamit Misir
- Department of Orthopedics and Traumatology, Istanbul Basaksehir Pine and Sakura City Training and Research Hospital, Istanbul, Turkey
| | - Turan Bilge Kizkapan
- Department of Orthopedics and Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey
| | - Gokay Eken
- Department of Orthopaedics and Traumatology, Bursa Acibadem Hospital, Bursa, Turkey
| | - Mustafa Ozcamdalli
- Department of Orthopedics and Traumatology, Istanbul Basaksehir Pine and Sakura City Training and Research Hospital, Istanbul, Turkey
| | - Seckin Basilgan
- Department of Orthopaedics and Traumatology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
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Pedrazzini A, Garzia A, Bertoni N, Yewo Simo H, Bisaschi R, Medina V, Pogliacomi F. High energy trauma with complex fracture of the right tibial plateau, compartment syndrome and infection in a professional freestyler motorcyclist. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020018. [PMID: 33559640 PMCID: PMC7944711 DOI: 10.23750/abm.v91i14-s.10980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK High-energy tibial plateau fractures are complex lesions that may be associated with extensive soft tissue damages and severe complications, such as compartment syndrome and neurological injuries. This case report interests a professional motocross freestyler with complex tibial plateau fracture associated to compartment syndrome and partial common peroneal nerve impairment which complicated with a dehiscence of the surgical wound and infection after plate and screws fixation. One year later, despite the complexity of the fracture, the gravity of the soft tissue lesions and subsequent complications, the patient healed. This satisfactory result depended on the correct management in terms of type of treatment and timing.
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Affiliation(s)
| | - Alice Garzia
- Orthopaedic and Traumatology Clinic. Department of Medicine and Surgery, University of Parma, Parma, Italy .
| | - Nicola Bertoni
- Orthopaedic Unit, Oglio Po Hospital, Vicomoscano (CR), Italy .
| | - Henry Yewo Simo
- Orthopaedic Unit, Oglio Po Hospital, Vicomoscano (CR), Italy .
| | | | - Vanni Medina
- Orthopaedic Unit, Oglio Po Hospital, Vicomoscano (CR), Italy .
| | - Francesco Pogliacomi
- PARMA UNIVERSITY DEPARTMENT OF SURGICAL SCIENCES ORTHOPAEDIC AND TRAUMATOLOGY SECTION.
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齐 欣, 徐 永, 夏 燊, 赵 泽, 吕 乾, 浦 绍, 朱 跃. [Application of simple Ilizarov ring external fixation technique in treatment of tibial plateau fracture complicated with osteofascial compartment syndrome]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1248-1252. [PMID: 33063488 PMCID: PMC8171881 DOI: 10.7507/1002-1892.202003135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/05/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the effectiveness of simple Ilizarov ring external fixation technique in treatment of tibial plateau fractures complicated with osteofascial compartment syndrome. METHODS Between September 2013 and March 2017, 30 patients with tibial plateau fractures complicated with osteofascial compartment syndrome were treated with simple Ilizarov ring external fixation technique. There were 23 males and 7 females, with an average age of 34.4 years (range, 23-43 years). The injuries were caused by traffic accident in 12 cases, by falling from height in 4 cases, by falling in 8 cases, and by a crashing object in 6 cases. The time from injury to admission was 1-12 hours (mean, 4.8 hours). According to the Schatzker classification, there was 1 case of type Ⅱ, 3 cases of type Ⅲ, 10 cases of type Ⅳ, 7 cases of type Ⅴ, and 9 cases of type Ⅵ. All patients underwent fasciotomy due to osteofascial compartment syndrome; the interval between fasciotomy and operation was 10-15 days (mean, 12.5 days). Knee Society Score (KSS) and Ilizarov Method Research and Application Association (ASAMI) protocol were used to evaluate knee function. RESULTS The operation time was 110-155 minutes (mean, 123.1 minutes); the intraoperative blood loss was 100-500 mL (mean, 245 mL); the postoperative hospital stay was 3-5 days (mean, 3.8 days). All patients were followed up 20-24 weeks (mean, 22.7 weeks). Except for 2 patients with signs of needle tract infection, no other complication occurred. X-ray films showed that the fractures healed, and the healing time was 10-20 weeks (mean, 14.6 weeks). At last follow-up, the KSS clinical score was 70- 95 with an average of 87.5; the functional score was 70-90 with an average of 79.0. According to ASAMI protocol evaluation, the effectiveness was rated as excellent in 24 cases, good in 3 cases, fair in 2 cases, and poor in 1 case. CONCLUSION For tibial plateau fractures complicated with osteofascial compartment syndrome, simple Ilizarov ring external fixation technique can basically restore joint function and has fewer complications. It is a relatively safe and effective treatment method.
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Affiliation(s)
- 欣 齐
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 永清 徐
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 燊 夏
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 泽雨 赵
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 乾 吕
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 绍全 浦
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
| | - 跃良 朱
- 联勤保障部队第九二〇医院骨科(昆明 650100)Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650100, P.R.China
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