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O'Neill D, Thorne TJ, Scolaro J, Haller JM. Evaluation and Management of Posterior Tibial Plateau Fractures. J Am Acad Orthop Surg 2024:00124635-990000000-00978. [PMID: 38739869 DOI: 10.5435/jaaos-d-23-01255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/01/2024] [Indexed: 05/16/2024] Open
Abstract
Tibial plateau fractures are caused by high-energy or low-energy trauma and result in complex injuries that require careful management of both osseous injuries and associated soft tissues. The posterior aspect of the tibial plateau can be involved in a variety of fracture patterns, requiring systematic evaluation, imaging, and advanced surgical planning to address these complex injuries. Early classification systems failed to classify posterior plateau fractures; however, three-dimensional imaging and newer classification schemes, including the Quadrant System and 3D systems, have incorporated posterior column lesions. There has been a growing body of literature focused on fixation principles and plating options for posterior column fractures. Furthermore, there are multiple approaches for surgeons to choose between, including a direct posterior, posteromedial, posterolateral (including Lobenhoffer and lateral condyle osteotomy), and combined posterior approach. This article presents a guide for managing posterior tibial plateau fractures, including the initial evaluation and management, descriptions of the surgical approaches, principles of fixation, and the associated outcomes and complications.
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Affiliation(s)
- Dillon O'Neill
- From the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT (O'Neill, Thorne, and Haller), Department of Orthopedic Surgery, University of California, Irvine, Costa Mesa, CA (Scolaro)
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Dobelle E, Fabre-Aubrespy M, Mandon B, Flecher X, Ollivier M, Argenson JN, Jacquet C. Bicondylar tibial plateau fracture osteosynthesis with double-plate fixation: Similar complication rates and clinical results but improved radiographic outcomes with dual compared to single approach. Orthop Traumatol Surg Res 2024; 110:103655. [PMID: 37423296 DOI: 10.1016/j.otsr.2023.103655] [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: 02/02/2022] [Revised: 12/30/2022] [Accepted: 05/16/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Associating posteromedial and anterolateral approaches should improve fracture line visualization and optimize bicondylar tibial plateau fracture reduction compared to a single midline approach. The present study aimed to compare postoperative complications rates and functional and radiographic results after double-plate fixation via either a single or a dual approach. The study hypothesis was that double-plate fixation using a dual approach provides equivalent complications rates with improved radiographic results compared to a single approach. MATERIAL AND METHODS A retrospective 2-center study compared bicondylar tibial plateau fractures treated by double-plate fixation on a single versus a dual approach between January 2016 and December 2020. Comparison focused on major complications requiring surgical revision, radiographic measurements of medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA); change from their respective baseline values of 87° and 83° (deltaMPTA and deltaPPTA), and functional results on KOOS, SF12 and EQ5D-3L self-reported questionnaires. RESULTS Major complications occurred in 2 of the 20 single approach group patients (10%) [1 surgical site infection (SSI) (5%), and 1 skin complication (5%)], and in 3 of the 39 dual approach group patients (7.69%) (p=0.763), at an average 29 months' follow-up. In the sagittal plane, deltaPPTA was significantly lower with dual than single approach (respectively, 4.67° versus 7.43°; p=0.0104). There were no significant intergroup differences in deltaMPTA or functional results at last follow-up. CONCLUSION The present study suggests an absence of significant difference in major complications, between single and dual approach for double-plate osteosynthesis of bicondylar tibial plateau fractures. Using a dual approach enabled improved anatomic restoration in the sagittal plane, without significant differences observed in the frontal plane or functional scores at an average 29months' follow-up. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Emile Dobelle
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France.
| | - Maxime Fabre-Aubrespy
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Bastien Mandon
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Xavier Flecher
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Jean-Noël Argenson
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Christophe Jacquet
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
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Yan Z, Zou C, Kenmegne GR, Pan X, Ghimire N, Silva KMN, Fang Y. Newly designed plate for the treatment of posterolateral tibial plateau fractures: a finite element analysis. J Orthop Surg Res 2024; 19:201. [PMID: 38532441 DOI: 10.1186/s13018-024-04686-z] [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: 12/17/2023] [Accepted: 03/16/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND This study investigated the biomechanical properties of a new plate used for the treatment of posterolateral tibial plateau fractures using finite element analysis. METHODS The study groups were as follows: group PM, model of the new plate with posteromedial tibial plateau fracture; group PL, model of the new plate with posterolateral tibial plateau fracture; and group PC, model of the new plate with posterior tibial plateau fracture. We used two loading modes: uniform loading on the entire plateau, and loading on the posterior plateau. Data such as the displacement of the fracture and distribution of stress on the new plate and screws were recorded and analyzed. RESULTS When the whole plateau was loaded, the displacement of fractures in groups PM, PL, and PC were 0.273, 0.114, and 0.265 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 118.131 MPa, 44.191 MPa, and 115.433 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 166.731, 80.330, and 164.439 MPa, respectively. When the posterior tibial plateau was loaded, the displacement of the fractures in groups PM, PL, and PC was 0.410, 0.213, and 0.390 mm, respectively. The maximum stresses on the plates in groups PM, PL, and PC were 194.012 MPa, 72.806 MPa, and 185.535 MPa. The maximum stresses on the screws in Groups PM, PL, and PC were 278.265, 114.839, and 266.396 MPa, respectively. CONCLUSION The results of this study revealed that titanium plates have good fixation effects in all groups; therefore, the use of the new plate for posterolateral tibial plateau fractures appears to be safe and valid.
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Affiliation(s)
- Zhaokui Yan
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Chang Zou
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Guy Romeo Kenmegne
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xuelin Pan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Nawin Ghimire
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Kuruwitage Manthi Nihara Silva
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yue Fang
- Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, 610041, China.
- Trauma center, West China Hospital of Sichuan University, Chengdu, 610041, China.
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Huang Y, Jiao J, Wang J, Xiao F, Chen M, Xiong W, Hu J, Wu S, Ma X. Utilization of cannulated screw fixation of Jail and TiRobot-assisted percutaneous indirect reduction technique for AO/OTA type 41B2 tibial plateau fracture treatment. Knee 2024; 47:43-52. [PMID: 38199041 DOI: 10.1016/j.knee.2023.12.013] [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: 06/05/2023] [Revised: 08/23/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE The present study was designed to investigate the precise procedure and effectiveness of percutaneous minimally invasive fixation assisted by TiRobot in managing AO/OTA type 41B2 tibial plateau fracture to provide an alternative solution for clinical application. METHODS In total, 10 participants with AO/OTA type 41B2 tibial plateau fractures diagnosed by preoperative imaging examinations were enrolled in this study between May 2019 and May 2022. They were 5 males and 5 females, with an average age of 45.6 ± 11.3 years old (range 27-62 years old). All of them had closed fractures, including 6 cases with anterior cruciate ligament (ACL) tibial insertion avulsion fractures, 1 case with medial collateral ligament (MCL) tear, and 4 cases with a lateral meniscus tear. From injury through surgery, the entire time frame was 4.0 ± 1.5 days (range, 2-7 days). Following indirect percutaneous reduction assisted by TiRobot, the Jail method was used to treat all patients with minimally invasive internal fixation. Patients with ligament or meniscus injurieswere treated with arthroscopic surgery in one stage. The standardized functional exercise was performed postoperatively. The knee function was measured using the Hospital for Special Surgery (HSS) score, and the fracture reduction was assessed through the Rasmussen radiology score. RESULTS All patients were followed up for 12.7 ± 6.8 months (6-24 months).The fracture healing time was 11.8 ± 0.8 weeks (10-13 weeks), and the X-rays revealed satisfactory fracture reduction.The knee joint's Rasmussen score was 17.8 ± 0.4 (in the range of 17-18) a year after the procedure, with 8 patients receiving outstanding ratings and 2 cases receiving satisfactory scores. The HSS score was 93.8 ± 2.3 (range, 89 to 96), of which 10 cases were excellent. The motion range of the kneewas 138.7°±2.7° (range, -5° to 0° to 135°). No adverse effects or serious complications, such as internal fixation failure, postoperative infection, popliteal vascular injury, and common peroneal nerve injury, were observed during the last follow-up visit. CONCLUSIONS The intelligent assistance and accurate guidance of TiRobot can simplify and standardize procedures of percutaneous minimally invasive fixation in theSchatzker type Ⅲ tibial plateau fracture treatment. This technique increases the precision of indirect percutaneous reduction and screw fixation while minimizing bone grafting.
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Affiliation(s)
- Yucheng Huang
- Department of Osteology, Wuhan Orthopaedic Hospital, Wuhan Fourth Hospital, Wuhan 430033, China.
| | - Jing Jiao
- Department of Osteology, Wuhan Orthopaedic Hospital, Wuhan Fourth Hospital, Wuhan 430033, China.
| | - Junwen Wang
- Department of Osteology, Wuhan Orthopaedic Hospital, Wuhan Fourth Hospital, Wuhan 430033, China
| | - Fei Xiao
- Department of Osteology, Wuhan Orthopaedic Hospital, Wuhan Fourth Hospital, Wuhan 430033, China
| | - Ming Chen
- Department of Osteology, Wuhan Orthopaedic Hospital, Wuhan Fourth Hospital, Wuhan 430033, China
| | - Wen Xiong
- Department of Osteology, Wuhan Orthopaedic Hospital, Wuhan Fourth Hospital, Wuhan 430033, China
| | - Jialang Hu
- Department of Osteology, Wuhan Orthopaedic Hospital, Wuhan Fourth Hospital, Wuhan 430033, China
| | - Shilei Wu
- Department of Osteology, Wuhan Orthopaedic Hospital, Wuhan Fourth Hospital, Wuhan 430033, China
| | - Xuan Ma
- Department of Osteology, Wuhan Orthopaedic Hospital, Wuhan Fourth Hospital, Wuhan 430033, China
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Huitema JM, van der Gaast N, Jaarsma RL, Doornberg JN, Edwards MJR, Hermans E. The effect of addition of 2DCT scans and 3DCT scans for the classification of tibial plateau fractures: a systematic review. Eur J Trauma Emerg Surg 2024; 50:71-79. [PMID: 37768386 PMCID: PMC10923987 DOI: 10.1007/s00068-023-02344-3] [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: 04/04/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE In this systematic review, we evaluate the effect of radiographs and 2D and 3D imaging techniques on the interobserver agreement of six commonly used classification systems for tibial plateau fractures. METHODS In accordance with PRISMA guidelines, PubMed, Cochrane, Embase and Web of Science were searched for studies regarding the effect of 2D and 3D imaging techniques on the interobserver agreement of tibial plateau classification systems. Studies validating new classification systems, not providing own data or only providing information on the interobserver agreement for radiographs were excluded. Studies were scored based on the ROBINS-I risk of bias tool. RESULTS Our review analysed 14 studies on different classification systems used for tibial plateau fractures in clinical practice, with the Schatzker classification being the most commonly used classification system. The results showed that the addition of 2D CT led to a significant improvement of interobserver agreement for one study. However, other included studies showed varying levels of interobserver agreement, ranging from fair to substantial according to the interpretation by Landis and Koch. The addition of 3D CT resulted in a significant deterioration in one study for the Schatzker classification. Similar to the addition of 2D CT, the interobserver agreement for the Schatzker classification with the addition of 3D CT were heterogeneous ranging from fair to almost perfect according to the interpretation by Landis and Koch. CONCLUSIONS The use of 2D CT can be recommended for classifying tibial plateau fractures with the Schatzker classification, AO/OTA classification and Hohl classification. The value of 3D CT on the interobserver agreement of commonly used classification systems remains uncertain and unproven. Therefore, we do not recommend the use of 3D CT for the classification of tibial plateau fractures. Overall, the advancement of imaging techniques is not in line with the advancement in interobserver agreement on fracture classification.
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Affiliation(s)
- Jellina Mariska Huitema
- Department of Trauma Surgery, Radboud University Medical Center, Radboud University, Geert Groteplein Zuid, 6525 GA, Nijmegen, The Netherlands.
| | - Nynke van der Gaast
- Department of Trauma Surgery, Radboud University Medical Center, Radboud University, Geert Groteplein Zuid, 6525 GA, Nijmegen, The Netherlands
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Ruurd Lukas Jaarsma
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Job Nicolaas Doornberg
- Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael John Richard Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Radboud University, Geert Groteplein Zuid, 6525 GA, Nijmegen, The Netherlands
| | - Erik Hermans
- Department of Trauma Surgery, Radboud University Medical Center, Radboud University, Geert Groteplein Zuid, 6525 GA, Nijmegen, The Netherlands
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Assink N, Vaartjes TP, Bosma E, van Helden SH, Ten Brinke JG, Hoekstra H, IJpma FFA. Tibial plateau fracture morphology based on injury force mechanism is predictive for patient-reported outcome and conversion to total knee arthroplasty. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02447-5. [PMID: 38244051 DOI: 10.1007/s00068-024-02447-5] [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: 11/13/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
PURPOSES The aim of this study was to assess the relationship between injury mechanism-based fracture patterns and patient-reported outcome as well as conversion rate to total knee arthroplasty (TKA) at follow-up. METHODS A multicenter cross-sectional study was performed including 1039 patients treated for a tibial plateau fracture between 2003 and 2019. At a mean follow-up of 5.8 ± 3.7 years, patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. For all patients, the injury force mechanism was defined based on CT images. Analysis of variance (ANOVA) was used to assess the relationship between different injury mechanisms and functional recovery. Cox regression was performed to assess the association with an increased risk on conversion to TKA. RESULTS A total of 378 (36%) patients suffered valgus-flexion, 305 (29%) valgus-extension, 122 (12%) valgus-hyperextension, 110 (11%) varus-flexion, 58 (6%) varus-hyperextension, and 66 (6%) varus-extension injuries. ANOVA showed significant different KOOS values between injury fracture patterns in all subscales (P < 0.01). Varus-flexion injuries had the lowest average KOOS scores (symptoms 65; pain 67; ADL 72; sport 35; QoL 48). Varus-flexion mechanism was associated with an increased risk on a TKA (HR 1.8; P = 0.03) whereas valgus-extension mechanism was associated with a reduced risk on a TKA (HR 0.5; P = 0.012) as compared to all other mechanisms. CONCLUSION Tibial plateau fracture patterns based on injury force mechanisms are associated with clinical outcome. Varus-flexion injuries have a worse prognosis in terms of patient-reported outcome and conversion rate to TKA at follow-up. Valgus-extension injuries have least risk on conversion to TKA.
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Affiliation(s)
- Nick Assink
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Thijs P Vaartjes
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Eelke Bosma
- Department of Trauma Surgery, Martini Hospital, Groningen, The Netherlands
| | - Sven H van Helden
- Department of Trauma Surgery, Isala Hospital, Zwolle, The Netherlands
| | - Joost G Ten Brinke
- Department of Trauma Surgery, Gelre Hospital, Apeldoorn, The Netherlands
| | - Harm Hoekstra
- Department of Traumatology, KU Leuven University Hospitals Leuven Gasthuisberg Campus, Louvain, Belgium
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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Ngo W, Craddock G, Frangenberg A, Park A, Basu N. Tibial Plateau Fracture With Use of Tibia Strut and Bone Filler in a 37-Year-Old Male: A Case Report. Cureus 2024; 16:e52913. [PMID: 38406058 PMCID: PMC10893992 DOI: 10.7759/cureus.52913] [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] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Tibial plateau fractures (TPFs) are orthopedic challenges with multiple injury modalities and clinical presentations. TPFs are often classified using the Schatzker classification system, which can dictate management. In our case, a 37-year-old male presented at an orthopedic specialty hospital with right knee pain after a fall from a truck ramp. X-rays and CT imaging demonstrated a comminuted bicondylar TPF in the emergency room with metaphyseal dissociation. The patient was placed in a knee immobilizer, made non-weight bearing, and scheduled for outpatient follow-up with a local orthopedic surgeon. The patient was lost to follow-up and referred to our clinic six months after the fall with the chief complaint of inability to ambulate with severe pain and instability in the knee. X-rays demonstrated a malunion of the bicondylar tibial plateau with fracture deformities of the medial femoral condyle and lateral tibial plateau. The patient's deformity was corrected with a medial opening wedge proximal tibial osteotomy with a fibula strut allograft and filled with beta-tricalcium bone filler. At the first month follow-up, the patient's pain was well controlled, fragments and the knee were appropriately aligned, and no significant soft tissue or joint effusion was appreciated on imaging. After failing nonoperative treatment, this patient with comminuted bicondylar TPF has received definitive treatment with open reduction and internal fixation. Higher rates of unacceptable results from nonoperative treatment are in line with the Schatzker series, in which operative treatment resulted in more acceptable outcomes. Because the fracture in this patient is consistent with a Schatzker VI classification with intra-articular depression, the patient should have initially been treated with an external fixator and not been sent home in a knee immobilizer. This led to a malunion that necessitated corrective surgery. Therefore, correctly classifying fracture severity is important for selecting the best treatment course and minimizing complications.
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Affiliation(s)
- Wayne Ngo
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Germain Craddock
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Alex Frangenberg
- Medicine, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, USA
| | - Amber Park
- Medicine, Lincoln Memorial University DeBusk College of Osteopathic Medicine, Knoxville, USA
| | - Niladri Basu
- Orthopedics, Dallas Orthopaedic Trauma Institute, Dallas, USA
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Liu Z, Zhang Y, Wang S, Wang S, Peng AQ. Introduction of 3D-classification and its derived surgical sequence of Schatzker type IV tibial plateau fractures. BMC Surg 2023; 23:373. [PMID: 38071372 PMCID: PMC10710716 DOI: 10.1186/s12893-023-02284-0] [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] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Schatzker IV tibial plateau fractures usually have a worse prognosis due to their high variability and the accompanied bony and soft tissue injuries. This study aimed to introduce an injury mechanism-based new classification of Schatzker IV tibial plateau fractures and evaluate its reliability. Additionally, this study aimed to evaluate the outcomes of operative Schatzker IV tibial plateau fractures treated according to the surgical sequences determined by the new classification. MATERIALS AND METHODS A total of 63 cases of operative Schatzker IV tibial plateau fractures that were treated following the new surgical sequences were enrolled in our study. The CT images of these patients were reviewed and classified twice according to the new 3D classification by 4 independent observers. The reliability of the classification was calculated through kappa analysis. The classification-determined surgical sequence was evaluated by observing the postoperative efficacy during the follow-up. RESULTS Both the intra-observer (the mean k = 0.897, CI 0.806-0.971) and inter-observer (the mean k = 0.883, CI 0.786-0.961) reliability of 3D-classification showed excellent agreement according to Landis and Koch. All the patients were followed up for 6-28 months (average 12.8 months). As for the evaluation of the postoperative efficacy, according to KSS, 53 cases were rated as excellent, 8 cases as good, and 2 cases as fair results. CONCLUSIONS The new proposed classification showed high intra-observer and inter-observer reliability in our study. The surgical sequence determined by the classification can help surgeons to acquire good reduction and rigid internal fixation. Therefore the new classification of Schatzker IV tibial plateau fractures and the derived surgical sequences are worthy of further popularization and application in clinical trials.
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Affiliation(s)
- Zihao Liu
- Department of Orthopaedic Trauma, Harrison International Peace Hospital, Hengshui, 053000, Hebei, China
| | - Yanlong Zhang
- Department of Trauma Surgery, First Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Shengjie Wang
- Department of Orthopaedic Trauma, Harrison International Peace Hospital, Hengshui, 053000, Hebei, China
| | - Shuai Wang
- Department of Orthopaedic Surgery, Hebei Chest Hospital, NO.372 Shengli Road, Shijiazhuang, 050051, Hebei, China
| | - AQin Peng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Shetty HB, Joe V, Mane P, Savur AD, Mahesan H, Nazeer ME. A comparative study on the use of ultra-low dose computed tomography scans with conventional computed tomography scans for the evaluation of proximal tibia intra-articular fractures. J Orthop 2023; 46:90-94. [PMID: 37969230 PMCID: PMC10641557 DOI: 10.1016/j.jor.2023.10.009] [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: 08/23/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 11/17/2023] Open
Abstract
Purpose A rise in the need of preoperative CT assessment of proximal tibial intra-articular fractures has given rise to an increased load of radiation exposure. This comparative study aims at assessing the efficacy of low dose CT scan by collating images of tibial plateau fractures produced by low dose CT scan with that of conventional dose CT scan. Furthermore, the study aims at computing the comprehensive reduction in the effective dosage of radiation when low dose CT scan is employed for assessing these fractures. Methods The study comprise of 23 cases of proximal tibial intra-articular fractures (confirmed by initial radiographs). Low-dose CT scan of the injured limb was preceded by conventional dose CT scan for generating images that were assessed and reported independently by five (single blinded) radiologists (using Schatzker's CT based classification). Quantification of fracture was done to compare them statistically. Results A sensitivity of 93.94 % and positive predictive value of 93.92 % was observed on comparing images from low dose and conventional dose CT scan. An effective reduction of 89.81 % in overall dosage of radiation exposure was observed. Conclusion Near equal quality images were generated by low dose CT scan as compared to conventional dose CT scan, thereby demonstrating its non-inferiority with an effective reduction of 89.81 % in overall dosage of radiation exposure.
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Affiliation(s)
- Harshit Bhaskar Shetty
- Department of Orthopaedics, Bharatratna Dr. Babasaheb Ambedkar Municipal General Hospital, Mumbai, Maharashtra, India
| | - Varghese Joe
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education MAHE, Manipal, Karnataka, India
| | - Prajwal Mane
- Department of Orthopaedics, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education MAHE, Manipal, Karnataka, India
| | - Amarnath D. Savur
- Department of Orthopaedics, Kanachur Institute of Medical Sciences, Deralakatte, Mangalore, Rajiv Gandhi University of Health Sciences, Karnataka, India
| | - Harish Mahesan
- Department of Orthopaedics, Ganga Hospital, Coimbatore, India
| | - Muhammed Ehsan Nazeer
- Department of Orthopaedics, Cumberland Infirmary, NHS, North Cumbria, United Kingdom
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Tseng HP, Bartels H, Noppe N, Vancleef S, Herteleer M, Hoekstra H. 3D-validation of a simple tool to measure tibiofemoral axial rotation in tibial plateau fractures. Eur Radiol 2023; 33:8627-8636. [PMID: 37452877 DOI: 10.1007/s00330-023-09947-9] [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: 12/26/2022] [Revised: 05/01/2023] [Accepted: 05/30/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Rotated tibial plateau fractures (TPF) frequently involve multiple planes of movement, yet current presurgical assessment methods do not account for tibiofemoral axial rotation. This study introduces and validates a simple tool to measure rotation-the Gerdy-Tibial-Tuberosity-Surgical-Epicondylar-Axis (GTT-SEA) angle. METHODS Forty-seven preoperative 2D CT from a TPF database at a tertiary trauma center were retrieved, and 3D models reconstructed. Three observers made repeated 2D and 3D measurements of the GTT-SEA angle, spaced 4 weeks apart, for 20 patients. Inter- and intra-observer agreement and 2D-3D correlation were calculated. A reference angle was defined from non-operated patients, to classify 28 patients with MRI into neutral, external rotation, and internal rotation groups. The classification agreement and soft tissue involvement between groups were analyzed. RESULTS Mean 2D GTT-SEA angle was 17.65 ± 2.36° in non-operated patients, and 13.86 ± 3.90° in operated patients. 3D GTT-SEA angle was 18.92 ± 4.53° in non-operated patients, and 14.76 ± 6.03° in operated patients. 2D-3D correlation was moderate to good (ICC 0.64 ~ 0.83). Two-dimensional (ICC 0.70) and 3D (ICC 0.55) inter-observer agreements were moderate; 2D (ICC 0.82 ~ 0.88) and 3D (ICC 0.76 ~ 0.95) intra-observer agreements were good to excellent. Rotation classification agreement was slight (kappa 0.17) for 2D and good (kappa 0.76) for 3D. More popliteofibular ligament injury was detected in rotated knees (p = 0.016). CONCLUSIONS The GTT-SEA angle offers simple, accessible, yet reliable measurement of tibiofemoral axial rotation. Though a true reference range remains to be determined, this tool adds valuable information to existing TPF classifications, potentially allowing assessment of soft tissue involvement in TPF. CLINICAL RELEVANCE STATEMENT The GTT-SEA angle will benefit patients who sustain tibial plateau fractures, by allowing physicians to more accurately measure and plan for the injury in 3D, and raising suspicion for otherwise undetected soft tissue injuries, which can impact operative outcomes. KEY POINTS • Traumatic fractures of the tibial plateau may contain rotation-induced soft tissue injuries. • A new tool to measure axial rotation between the femur and tibia was found to have moderate to excellent inter- and intra-rater reliability. • The tool may have potential in predicting soft tissue injury and assisting with the decision to receive MRI.
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Affiliation(s)
- Han-Po Tseng
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Hanne Bartels
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - Nathalie Noppe
- Department of Radiology, University Hospitals Leuven, B-3000, Leuven, Belgium
| | - Sanne Vancleef
- Human Movement Biomechanics Research Group, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Michiel Herteleer
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Harm Hoekstra
- Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
- Department of Development and Regeneration, KU Leuven - University of Leuven, B-3000, Leuven, Belgium.
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Rasappan K, Lim MJ, Chua ITH, Kwek EBK. Does the Schatzker III Tibial Plateau Fracture Exist? Indian J Orthop 2023; 57:1891-1900. [PMID: 37881286 PMCID: PMC10593631 DOI: 10.1007/s43465-023-01001-6] [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: 01/09/2023] [Accepted: 09/05/2023] [Indexed: 10/27/2023]
Abstract
Background The Schatzker classification system for tibial plateau fractures is one of the most commonly used systems. However, there has been controversy if a Schatzker III type fracture truly exists by their original definition. We aimed to correlate the radiographic and CT images of type III fractures, describe the additional propagating fracture patterns and determine if these fractures do exist by their original description. Methods This multicenter retrospective cohort observational study included patients with tibial plateau fractures across five trauma centers over 9 years were identified. All X-rays and CT scans were assessed. Two independent fellowship trained, Orthopaedic trauma surgeons reviewed all knee X-rays and classified them according to the Schatzker system. The CTs were subsequently reviewed and the fractures were reclassified based on CT findings. Results 569 Tibial plateau fractures in 566 patients were analyzed. All X-ray classified Schatzker III fractures were reclassified to a Schatzker II type after review of CT scans by both assessors independently as there were always at least two or more fracture lines propagating from the depressed fragment to the lateral cortex in all cases. The interobserver variability as assessed by the kappa correlation coefficient (κ) for X-rays and CT-based classifications were κ = 0.274 and κ = 0.906, respectively. The majority of cases had two lateral cortical breaks (83.8%). In addition, the depression occurred mostly in the anterolateral and posterolateral positions (60.3%) of the lateral tibial plateau. Conclusion This study did not support the existence of true Schatzker Type III fractures.
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Affiliation(s)
- Kumaran Rasappan
- Department of Orthopaedic Surgery, National University Hospital, 5 Lower Kent Ridge Rd, Singapore, 119074 Singapore
| | - Melvin Junchen Lim
- Ministry of Health Holdings, 1 Maritime Square, Singapore, 099253 Singapore
| | - Ivan Tjun Huat Chua
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433 Singapore
| | - Ernest Beng Kee Kwek
- Department of Orthopaedic Surgery, Woodlands Health Campus, 17 Woodlands Dr 17, Singapore, 737628 Singapore
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12
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Zublin CM, Guichet DM, Pellecchia T, Giordano V, Beatti MA. Modified gastrocnemius splitting anatomic approach to the tibial plateau. Medium-term evaluation. Injury 2023; 54 Suppl 6:111021. [PMID: 38143110 DOI: 10.1016/j.injury.2023.111021] [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: 02/27/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Posterior tibial plateau fractures, including avulsion fractures of the posterior cruciate ligament (PCL) insertion, represent a challenge for the orthopedic trauma surgeon. These injuries have gained a new perspective both diagnostically and therapeutically after the regular use of multiplanar computed tomography. In the herein study, we describe the outcome of patients sustaining a tibial plateau fracture with posterior articular involvement treated by open reduction and internal fixation (ORIF) using our modified gastrocnemius splitting anatomic approach. METHODS This observational retrospective descriptive study was conducted at Complejo Medico de la Policia Federal Argentina Churruca-Visca. All patients were treated by ORIF by our team through our modified gastrocnemius splitting anatomic approach, and followed-up for a minimum of 12 months. RESULTS A total of 18 patients sustaining plateau fracture were treated by this approach. Satisfactory tomographic reduction with articular gap and/or step-off <2 mm was achieved in 16. The mean time to the return to activities of daily living was 192.2 days. CONCLUSION The modified gastrocnemius splitting anatomic approach represents a good alternative for the management of tibial plateau fractures involving the posterior quadrants.
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Affiliation(s)
- Carlos Miguel Zublin
- Departamanto de Trauma y Reconstrucción Esquelética - Complejo Medico de la Policia Federal Argentina Churruca-Visca, Uspallata 3400, Buenos Aires C1437 JCP, Argentina
| | - Diego Martin Guichet
- Departamanto de Trauma y Reconstrucción Esquelética - Complejo Medico de la Policia Federal Argentina Churruca-Visca, Uspallata 3400, Buenos Aires C1437 JCP, Argentina
| | - Tomas Pellecchia
- Departamanto de Trauma y Reconstrucción Esquelética - Complejo Medico de la Policia Federal Argentina Churruca-Visca, Uspallata 3400, Buenos Aires C1437 JCP, Argentina
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117, Rio de Janeiro 22430-160, RJ, Brazil
| | - Matías Alejo Beatti
- Departamanto de Trauma y Reconstrucción Esquelética - Complejo Medico de la Policia Federal Argentina Churruca-Visca, Uspallata 3400, Buenos Aires C1437 JCP, Argentina
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13
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Durigan JR, Moraes CDMS, Hamra P, Zamboni C, Mercadante MT, Hungria JOS, Christian RW, Santili C. Depression fractures of the posterolateral tibial plateau: Treatment by lateral femoral epicondyle osteotomy approach. Injury 2023; 54 Suppl 6:110620. [PMID: 36801173 DOI: 10.1016/j.injury.2023.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE The best surgical exposure and fixation method for fractures affecting the posterolateral corner of the tibial plateau remain debatable. This study describes a surgical approach to treat lateral depressions of the posterolateral tibial plateau with or without rim involvement by osteotomy of the lateral femoral epicondyle associated with osteosynthesis with a one-third tubular horizontal belt plate to stabilize the fracture fragment. METHOD We evaluated 13 patients with fractures of the tibial plateau affecting the posterolateral region. Assessments included the degree of the depression (in millimeters), quality of the reduction, complications, and function. RESULTS All fractures and osteotomies consolidated. The patients had a mean age of 48 years and were mostly men (n=8). Regarding the quality of the reduction, the mean reduction obtained was 15.8 mm, and 8 patients achieved anatomical reduction. The mean (± standard deviation) Knee Society Score was 92±13 (range 65-100), and the mean Function Score was 95±9.6 (range 70-100). The mean Lysholm Knee Score was 92±11.7 (range 66-100), and the mean International Knee Documentation Committee Score was 85±12.6 (range 63-100). All these scores reflect good results. None of the patients developed superficial or deep infection or presented healing disorders. Sensitive or motor complications of the fibular nerve were not observed. CONCLUSIONS In this series of patients with depression fractures of the posterolateral tibial plateau, a surgical approach through osteotomy of the lateral femoral epicondyle allowed direct reduction and stable osteosynthesis of the fractures without functional impairment.
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Affiliation(s)
| | | | - Pedro Hamra
- Fellow of Trauma Surgery Group of the Department of Orthopedics and Traumatology, Santa Casa de São Paulo
| | - Caio Zamboni
- Assistant of the Trauma Surgery Group of Santa Casa de São Paulo
| | | | | | | | - Claudio Santili
- Chief of the Pediatric Orthopedic Group of Santa Casa de São Paulo
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Liu Y, Fang R, Tu B, Zhu Z, Zhang C, Ning R. Correlation of preoperative CT imaging shift parameters of the lateral plateau with lateral meniscal injury in Schatzker IV-C tibial plateau fractures. BMC Musculoskelet Disord 2023; 24:793. [PMID: 37803358 PMCID: PMC10557321 DOI: 10.1186/s12891-023-06924-7] [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: 02/04/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Schatzker IV-C is a high-energy tibial plateau fracture often accompanied by lateral meniscus injuries. While imaging examinations are routine preoperative measurements, the correlation between CT imaging shift parameters of the lateral plateau and lateral meniscal injury in Schatzker IV-C fractures remains uncovered. METHODS This retrospective study enrolled a total of 60 patients with Schatzker IV-C tibial plateau fractures at the First People's Hospital of Hefei. Prior to surgery, CT imaging was used to measure the numerical values of lateral plateau depression (LPD) and lateral plateau widening (LPW). The degree of lateral meniscus injury was confirmed based on intraoperative direct vision, with patients being classified into meniscus injury and non-meniscus injury groups. Dichotomous logistic regression was employed to evaluate the correlation between LPD, LPW, and lateral meniscus injury, while the optimal cut-off points for predicting lateral meniscal injury with LPD and LPW were determined using receiver operator characteristic (ROC) curves. RESULTS The meniscus injury group exhibited a mean LPD of 15.3 ± 3.5 mm, which was significantly higher than the non-meniscus injury group's mean LPD of 8.4 ± 3.4 mm (P < 0.05). Similarly, the meniscus injury group had a larger mean LPW of 9.4 ± 1.8 mm compared to the non-meniscus injury group's mean LPW of 6.9 ± 0.9 mm (P < 0.05). The optimal cut-off points for predicting lateral meniscal injury were determined to be 8.40 mm for LPD (with a sensitivity of 95%, specificity of 85%, and AUC of 0.898) and 7.90 mm for LPW (with a sensitivity of 75%, specificity of 90%, and AUC of 0.897). CONCLUSIONS Patients with Schatzker IV-C tibial plateau fractures are at a significantly higher risk of lateral meniscal injury when the LPD exceeds 8.40 mm and/or the LPW exceeds 7.90 mm. Our results may provide novel reference metrics for the early diagnosis of lateral meniscal injury in Schatzker IV-C tibial plateau fracture patients when the MRI examination is not available.
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Affiliation(s)
- Yulong Liu
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Run Fang
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Bizhi Tu
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Zheng Zhu
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Chengnan Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Rende Ning
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China.
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Raj M, Singh SK, Rajput AK, Gill SP, Verma SK, Sonarkar SS. The Comparative Analysis of Single Plating Versus Double Plating in the Treatment of Unstable Bicondylar Proximal Tibial Plateau Fractures. Cureus 2023; 15:e46840. [PMID: 37954723 PMCID: PMC10637009 DOI: 10.7759/cureus.46840] [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] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction In the present study, we aimed to compare the clinical and radiological results of the single lateral locking plate fixation method to the dual plate (DP) fixation method in cases of unstable bicondylar proximal tibial plateau fractures. Materials and methods Fifty-six patients managed surgically with internal fixation for unstable bicondylar tibial plateau fractures (UBTF) (Schatzker type V and type VI or Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association {AO/OTA} type 41-C) over 36 months from January 2017 to December 2020 were included in this prospective study. All the fractures were fixed surgically either using dual locking plates through double incisions (DP group) or with a single lateral locking plate (single plate {SP} group). All intraoperative and postoperative complications were assessed and recorded. Oxford Knee Score (OKS), Rasmussen's functional grading system, and Rasmussen's radiological scoring system were used to evaluate the functional and radiological outcomes. Result All of the patients were followed for at least 12 months. Twenty-six patients were fixed with a single lateral locking plate, and 30 patients were fixed with a double-incision dual locking plate. The mean Oxford Knee Score (OKS) was 43.24 ± 4.46 in the DP group and 42.7 ± 2.57 in the SP group (P = 0.544). The mean Rasmussen's functional score (RFS) score in the present study was 26.6 ± 2.21 in the DP group and 24.97 ± 3.92 in the SP group (P = 0.056). At the final follow-up, the mean Rasmussen's radiological score (RRS) was 9.06 ± 1.01 in the DP group and 8.1 ± 0.81 in the SP group (P = 0.0003). Conclusion There are no statistically significant differences in the functional outcomes between the two groups, but higher benefits were found in the radiological outcomes in the dual plating group as compared to single lateral locking plate group.
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Affiliation(s)
- Manish Raj
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Deoghar, IND
| | - Santosh Kumar Singh
- Department of Orthopedics, Maa Vindhyavasini Autonomous State Medical College, Mirzapur, IND
| | - Ajay K Rajput
- Department of Orthopedics, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, IND
| | - Simrat Pal Gill
- Department of Orthopedics, Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, IND
| | - Satyendra K Verma
- Department of Orthopedics, Rajarshi Dashrath Autonomous State Medical College (RDASMC), Ayodhya, IND
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16
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Tseng HP, Hoekstra H. Pediatric proximal tibial fractures: How does the trauma mechanism guide the operative strategy? Injury 2023; 54:110969. [PMID: 37542789 DOI: 10.1016/j.injury.2023.110969] [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: 11/15/2022] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE Pediatric proximal tibial fractures (PTF) are rare but potentially debilitating. So far, no system for guiding surgical treatment based on injury-force mechanism has been documented, while adult tibial plateau fractures have benefited greatly from such an approach. This study reviews the diagnosis and treatment experience at a tertiary trauma center and introduces the reduction-traction method. METHODS Pediatric patients (0-17 years old) diagnosed with PTF were identified in the hospital database from 2017 to 2021. Their injury mechanism, injury location, treatment type, and treatment outcomes were recorded. Images were reviewed to establish an injury-force classification according to Mubarak et al., 2009. When appropriate, patients were treated using a "reduction-traction" approach. RESULTS Twenty-nine patients were identified, and followed-up for a mean of 6.8 months. The most common cause of injury was falling from height < 2 m, often from a trampoline. The tibial plateau and proximal tibial metaphysis were most commonly involved. Thirteen patients were treated non-operatively, 10 with open reduction and internal fixation, and six with arthroscopic surgery. A bimodal distribution according to age was noted in the injury mechanism, injury site, and treatment type. No adverse outcomes were recorded, and all patients resumed sports activities. The "reduction-traction" technique produced favorable outcomes in three patients. CONCLUSIONS Pediatric PTF has a bimodal distribution with high risk before three years and after 15 years. The injury-force classification can supplement the Salter-Harris classification in guiding surgical treatment. The "reduction-traction" approach in children differs from adults, and results in good outcomes.
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Affiliation(s)
- Han-Po Tseng
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium
| | - Harm Hoekstra
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium.
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17
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Herbst E, Oeckenpöhler S, Riesenbeck O, Kittl C, Glasbrenner J, Michel P, Katthagen JC, Raschke MJ. [Intra-articular proximal tibia fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:715-726. [PMID: 37552247 DOI: 10.1007/s00113-023-01352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 08/09/2023]
Abstract
The incidence of proximal intra-articular tibial fractures is continuously increasing. In addition to high-energy trauma in young patients, osteoporotic fractures occur more frequently in geriatric patients. After a thorough clinical examination including X‑ray and computed tomography (CT) imaging, consolidation of the soft tissue is followed by surgical treatment to achieve the best possible anatomic reconstruction of the articular surface. Nonanatomic reduction with articular gaps >2.5 mm leads to a significantly increased risk of osteoarthritis. Selection of the surgical approach and planning of the osteosynthesis are based on the fracture morphology and the existing soft tissue damage. In addition to arthroscopically assisted percutaneous procedures, sophisticated osteosynthesis is often necessary, which requires several surgical approaches. In this context, posterior surgical approaches are becoming increasingly more important. Primary knee arthroplasty can also play a role, particularly in older patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
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18
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Bormann M, Neidlein C, Neidlein N, Ehrl D, Jörgens M, Berthold DP, Böcker W, Holzapfel BM, Fürmetz J. High Prevalence of Persistent Measurable Postoperative Knee Joint Laxity in Patients with Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation (ORIF). J Clin Med 2023; 12:5580. [PMID: 37685647 PMCID: PMC10488731 DOI: 10.3390/jcm12175580] [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: 07/20/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
The development of post-traumatic osteoarthrosis after tibial plateau fracture (TPF) is multifactorial and can only be partially influenced by surgical treatment. There is no standardized method for assessing pre- and postoperative knee joint laxity. Data on the incidence of postoperative laxity after TPF are limited. The purpose of this study was to quantify postoperative laxity of the knee joint after TPF. Fifty-four patients (mean age 51 ± 11.9 years) were included in this study. There was a significant increase in anterior-posterior translation in 78.0% and internal rotation in 78.9% in the injured knee when compared to the healthy knee. Simple fractures showed no significant difference in laxity compared to complex fractures. When preoperative ligament damage and/or meniscal lesions were present and surgically treated by refixation and/or bracing, patients showed higher instability when compared to patients without preoperative ligament and/or meniscal damage. Patients with surgically treated TPF demonstrate measurable knee joint laxity at a minimum of 1 year postoperatively. Fracture types have no influence on postoperative laxity. This emphasizes the importance of recognizing TPF as a multifaceted injury involving both complex fractures and damage to multiple ligaments and soft tissue structures, which may require further surgical intervention after osteosynthesis.
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Affiliation(s)
- Markus Bormann
- 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
| | - Niels Neidlein
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dennis Ehrl
- Department of Hand, Plastic and Aesthetic Surgery, LMU Munich, 81377 Munich, Germany
| | - Maximilian Jörgens
- 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
| | - 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 Trauma Surgery, Trauma Center Murnau, 82418 Murnau am Staffelsee, Germany
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Fleming TA, Torrie PAG, Murphy TA, Dodds AL, Engelke DM, Curwen CH, Gosal HS, Pegrum J. The influence of pre-operative Computed Tomography (CT) on surgical approach and fixation for fractures of the tibial plateau. J Orthop 2023; 42:50-53. [PMID: 37502121 PMCID: PMC10368533 DOI: 10.1016/j.jor.2023.07.004] [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: 05/10/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/29/2023] Open
Abstract
Background It is well known that a computed tomography (CT) scan improves the classification of tibial plateau fractures (TPF) compared with radiographs. However, it is less clear how this translates into clinical practice. The aim of this study is to establish to what extent a pre-operative CT scan alters the approach, setup and fixation choice in TPF compared to radiographs. Methods 50 consecutive TPF with a preoperative CT and radiographic imaging available, were assessed by 4 consultant surgeons. First, anonymised radiographs were classifying according to the column classification and the planned setup, approach, and fixation technique documented. At a 1-month interval, randomised matched CT scans were assessed and the same data collected. A tibial plateau disruption score (TPDS) was derived for all 4 quadrants (no injury = 0, split = 1, split/depression = 2 and depression = 3). Radiograph and CT TPDS were assessed using an unpaired T-test. Results 26 female and 24 male patients, mean age 50.3, were included. Mean TPDS on radiographs and CT scans were 2.77 and 3.17 respectively. A significantly higher CT TPDS, of 0.4 (95%CI 0.10-0.71)[P = 0.0093] was observed, demonstrating that radiographs underestimate the extent of injury. The surgical approach changed in 28.5% of cases, thus influencing a change in the patient setup in theatre in 27% of cases. Identification of fractures within a column changed in 34% of cases. A high intra-observer reliability was observed when surgeons were asked to repeat their assessment in a third round at a further one month interval. Conclusion A pre-operative CT scan has a significant effect on the approach required to fix TPF. This therefore influences the setup of the patient and can justifiably be requested as part of pre-operative planning.
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Arya N, Harjpal P. Otago Exercise Program as an Adjunct to Routine Physiotherapy in a Patient With Tibial Plateau Injury: A Case Report. Cureus 2023; 15:e44136. [PMID: 37753011 PMCID: PMC10518427 DOI: 10.7759/cureus.44136] [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: 07/20/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
The tibia is a long bone in the lower limb. Tibial fractures account for approximately 20% of adults and 8% of older people. A tibial plateau fracture may result from low-energy forces, most commonly in older people with low bone density. The tibial plateau fractures vary widely, from stable non-displaced fractures with little soft tissue damage to severely comminated unstable fractures with severe soft tissue damage. Fractures of the tibia plateau had a significant impact on patients' lives, lowering their quality of life and limiting their participation in sports. Other effects of the injury itself, such as arthritis later developing, muscle, bone wasting, and joint stiffness, can have an impact on patients' lives. For these patients, physical therapy can target areas to improve some of such conditions. A 50-year-old female was diagnosed with lateral tibial plateau injury in the left knee and post tibial plateau injury in the right knee joint on an X-ray after a road accident, and a bilateral above-knee cast was applied for four weeks, following a period of non-weight-bearing. Along with this, a physiotherapy treatment plan was advised, which included a variety of exercises, electrotherapy, and an Otago exercise program, which resulted in pain reduction and improvements in range of motion (ROM), strength, balance, and gait ability. A structured physiotherapy program with an Otago exercise program gradually improved the functional goals, balance, and gait patterns progressively.
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Affiliation(s)
- Neha Arya
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kumar A, Arora R, Sinha S, Haidery TH, Jameel J, Khan R, Qureshi OA, Kumar S. Top 50 Cited Papers on Tibial Plateau Fracture Management: A Bibliometric Analysis and Review. Indian J Orthop 2023; 57:1226-1238. [PMID: 37525733 PMCID: PMC10386977 DOI: 10.1007/s43465-023-00932-4] [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: 04/04/2022] [Accepted: 06/06/2023] [Indexed: 08/02/2023]
Abstract
Purpose The orthopaedic surgeons, especially the young budding surgeons should have a well-balanced knowledge of the past evidence as well the current evidence in the literature for the appropriate as well as optimum management of tibial plateau fractures. Bibliometric analysis of the top-cited papers on tibial plateau fracture management can help know their concurrent interests, deficiencies and conflicting issues regarding their management. This study aimed to identify the 50 most cited research articles in tibial plateau research and analyse their characteristics. Methods We searched the Thompson Reuters Web of Science database for articles relevant to tibial plateau fracture and prepared a list of top 50 cited articles that included original articles and review articles concerning tibial plateau fractures. The included articles were analysed for contributing journals, corresponding author's country, publication year, cumulative citations, annual citations, citation trends over time, level of evidence and a qualitative review. Results The search strategy resulted in 2263 articles. The top 50 cited articles were published from 1974 to 2014 and belonged to 12 journal sources. There were 47 original articles and 3 review articles. The average citations per article were 126.2, and the annual citations per article were 6.478 per year. The top-cited articles were relevant to the strategies in the management, classification, fracture reduction, articular restoration, types and number of fixation devices, surgical approaches, associated menisco-ligamentous injuries and applicability of bone grafts/substitutes in tibial plateau fractures. Conclusion The current bibliometric analysis summarises the top-cited evidence concerning tibial plateau fractures and can be a potential resource for reviewing and locating the same. The analysis shows that most top-cited evidence belongs to the year 2000 onwards. Also, recent articles have a higher annual citation rate. A limited number of journals and mostly, western countries have contributed to the top-cited evidence. Whilst the top-cited evidence has touched several aspects of tibial plateau fractures, it is in the form of level IV case series. It needs better prospective evidence to establish sound recommendations. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00932-4.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics (JPNATC), All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Arora
- Department of Orthopaedics, University College of Medical Sciences, New Delhi, India
| | - Siddhartha Sinha
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Tariq Hasan Haidery
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Javed Jameel
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Rizwan Khan
- K G Medident Medical & Dental Care Center, Ghaziabad, India
| | - Owais Ahmed Qureshi
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sandeep Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Laurent Tsai SH, Lin CR, Lin YR, Liu YC, Tischler EH, Tang HC, Chen CH, Su CY, Chan YS. Comparative Analysis of Posterior Approach Versus Anterior Approach for Posterior Tibial Plateau Fractures: A Systematic Review and Meta-analysis. JBJS Rev 2023; 11:01874474-202307000-00002. [PMID: 37433013 PMCID: PMC10337318 DOI: 10.2106/jbjs.rvw.23.00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Posterior tibial plateau fractures can lead to significant posttraumatic instability if not treated properly. It remains unclear which surgical approach achieves better patient outcomes. The objective of this systematic review and meta-analysis was to assess postoperative outcomes in patients undergoing anterior, posterior, or combined approach for posterior tibial plateau fractures. METHODS The PubMed, Embase, Web of Science, The Cochrane Library, and Scopus were searched for studies published before October 26, 2022, comparing anterior, posterior, or combined approaches for posterior tibial plateau fractures. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Outcomes included complications, infections, range of motion (ROM), operation time, union rates, and functional scores. Significance was set at p < 0.05. Meta-analysis was conducted with STATA software. RESULTS In total, 29 studies with a total of 747 patients were included for quantitative and qualitative analysis. Compared with other approaches, the posterior approach for posterior tibial plateau fractures was associated with a better ROM and shorter operative time. The complication rates, infection rates, union time, and hospital for special surgery (HSS) scores were not significantly different between surgical approaches. CONCLUSIONS The posterior approach for posterior tibial plateau fractures offers advantages such as improved ROM and shorter operative time. However, there are concerns regarding prone positioning in patients with medical or pulmonary comorbidities and indications in polytrauma cases. Further prospective studies are needed to determine the optimal approach for these fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sung Huang Laurent Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center, and Chang Gung University, Keelung, Taiwan
| | - Chun Ru Lin
- Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan
| | - You-Rui Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center, and Chang Gung University, Keelung, Taiwan
| | - Yi-Chen Liu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center, and Chang Gung University, Keelung, Taiwan
| | - Eric H Tischler
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, New York, New York
| | - Hao-Che Tang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center, and Chang Gung University, Keelung, Taiwan
| | - Chien-Hao Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center, and Chang Gung University, Keelung, Taiwan
| | - Chun-Yi Su
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center, and Chang Gung University, Keelung, Taiwan
| | - Yi-Sheng Chan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Bone and Joint Research Center, and Chang Gung University, Keelung, Taiwan
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Mohamed J, Bouaicha W, Lamouchi M, Ammar AB, Jaziri S, Daas S. Comparison of the results of the synthesis of Schatzker II and III tibial plateau fractures by screwing versus plate. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05849-z. [PMID: 37289239 DOI: 10.1007/s00264-023-05849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Lateral tibial plateau fractures with depression are the most common. Their treatment is currently surgical. Many therapeutic procedures have been described. Our aim is to evaluate the results of open surgery and to compare the two internal fixation methods used: lag screw versus plates. MATERIALS AND METHODS This is a retrospective comparative study of two series of tibial plateau fractures Schatzker types II and III treated surgically over a period of ten years with two different methods: Group A: Internal fixation using screws for 86 patients. Group B: Internal fixation using plates for 71 patients. Functional and anatomical results were assessed according to Rasmussen's clinical and radiological scores. RESULTS The patients' average age was 44 years (range from 18 to 76). The male gender was predominant (104 males and 53 females). Road traffic accidents were the most common aetiology with over two thirds of the cases. The fractures were type Schatzker II in 61% of the cases. The mean follow-up was five years. Although the clinical and radiological Rasmussen scores were better in group A (internal fixation with lag screws), those differences were statistically insignificant (p = 0.6 and p = 0.8). Group A clinical and radiological scores were 26.06 and 16.57, respectively and those of group B were 25.72 and 16.45. We noticed more sepsis and skin complications and a longer operating time (95 min versus 70 min) in group B patients with a statistically significant difference. None of the patients of our series had bone grafting. CONCLUSION For Schatzker II and III fractures, an internal fixation with lag screws would be preferable when possible especially in the case of a pure depression fracture. It yields satisfactory results with a shorter operating time and less complication rate.
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Affiliation(s)
- Jlidi Mohamed
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia.
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Walid Bouaicha
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mouldi Lamouchi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia
| | - Ahmed Ben Ammar
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia
| | - Salma Jaziri
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Anaesthesia and Intensive Care, Mohamed Bourguiba Hospital, Kef, Tunisia
| | - Selim Daas
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, AFH City, 8050, Mrezgua, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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24
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Wang X, Yang H, Xu C, Xu X, Zhang C, Jing J. Effect of Schatzker type VI tibial plateau fractures combined with a proximal fibular and/or posterolateral joint facet fracture on early postoperative functional recovery. J Orthop Surg Res 2023; 18:412. [PMID: 37287007 DOI: 10.1186/s13018-023-03887-2] [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: 01/04/2023] [Accepted: 05/28/2023] [Indexed: 06/09/2023] Open
Abstract
PURPOSE The objective of this study was to investigate the effect of proximal fibular and/or posterolateral joint facet (PJF) fractures on early functional recovery after Schatzker type VI tibial plateau fractures (TPFs). METHODS Seventy-nine patients with Schatzker type VI TPFs sustained from November 2016 to February 2021 were divided into three groups according to the integrity of the proximal fibula and PJF (groups A, B, and C). Details including demographics, duration of surgery, and complications were recorded. The Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) score, Hospital for Special Surgery (HSS) score, lateral knee pain and lateral hamstring tightness were ascertained at the final follow-up. The HSS and WOMAC scores have high reliability in evaluating knee function and osteoarthritis. RESULTS There was a significant difference in the HSS score between groups A and C (P < 0.001) and between groups B and C (P = 0.036). The hospital stay was significantly different between groups A and C (P = 0.038) and between groups B and C (P = 0.013). There was a significant difference in lateral knee pain and lateral hamstring tightness between groups A and C (P < 0.001) and between groups B and C (P < 0.001). CONCLUSION Our study demonstrates that proximal fibular and PJF fractures do not increase the time from injury to surgery, the incidence of complications, or the duration of surgery for Schatzker type VI TPFs. However, fractures of the proximal fibula significantly increase the hospital stay, reduce knee function, and cause lateral knee pain and lateral hamstring tightness. Combined proximal fibular fracture is more decisive than PJF involvement for prognosis.
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Affiliation(s)
- Xuezi Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Hu Yang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Chungui Xu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Xinzhong Xu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Chun Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China
| | - Juehua Jing
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Economic and Technological Development Zone, Hefei, 230601, China.
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25
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Hughes JD, Godshaw BM, Lucidi GA, Setliff J, Sansone M, Karlsson J, Musahl V. Response to letter to the editor of "posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis". Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07460-6. [PMID: 37217795 DOI: 10.1007/s00167-023-07460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA.
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Brian M Godshaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Gian Andrea Lucidi
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Joshua Setliff
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, UPMC Rooney Sports Complex, 3200 South Water Street, Pittsburgh, PA, 15203, USA
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Franulic N, Pineda T, Laso J, Valiente D, Gaggero N. Posteromedial Submeniscal Arthrotomy and Fixation with a Posteromedial Rim Plate in a Comminuted Medial Tibial Plateau Fracture. Case Rep Orthop 2023; 2023:3635067. [PMID: 37251550 PMCID: PMC10212676 DOI: 10.1155/2023/3635067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/01/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Medial tibial plateau fractures generally present as simple metaphyseal fractures; however, certain cases may present as comminuted articular fractures. Medial and posteromedial anatomical plates have traditionally been used for their management; nevertheless, not all cases can be successfully managed using these implants. We present a comminuted posteromedial Schatzker type VI tibial plateau fracture case. Direct visualization and subsequent fixation using a posteromedial rim plate were achieved through a posteromedial approach and submeniscal arthrotomy. The adequate joint reduction and the obtained stability allowed satisfactory clinical and radiological outcomes. This variation of the classic posteromedial approach and the use of a posteromedial rim plate provide an alternative when facing comminuted medial tibial plateau fractures.
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Affiliation(s)
- Nicolás Franulic
- Hospital del Trabajador ACHS, Santiago, Chile
- Hospital Militar de Santiago, Santiago, Chile
| | | | - José Laso
- Hospital del Trabajador ACHS, Santiago, Chile
- Hospital Barros Luco Trudeau, Santiago, Chile
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27
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Krause M, Korthaus A, Frings J, Berninger MT, Drenck TC, Eggeling L, Akoto R, Frosch KH. Letter to the editor of: "posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis". Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07361-8. [PMID: 36947235 PMCID: PMC10356670 DOI: 10.1007/s00167-023-07361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/23/2023]
Affiliation(s)
- M Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - A Korthaus
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - J Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - M T Berninger
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - T C Drenck
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - L Eggeling
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - R Akoto
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - K H Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
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28
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Morphological Characteristics of Proximal Ulna Fractures: A Proposal for a New Classification and Agreement for Validation. Healthcare (Basel) 2023; 11:healthcare11050693. [PMID: 36900697 PMCID: PMC10000609 DOI: 10.3390/healthcare11050693] [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: 12/29/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Historically, proximal ulna fractures have been simplistically diagnosed and treated as simple olecranon fractures, leading to an unacceptable number of complications. Our hypothesis was that the recognition of lateral, intermediate, and medial stabilizers of the proximal ulna and ulnohumeral and proximal radioulnar joints would facilitate decision-making, including the choice of approach and type of fixation. The primary aim was to propose a new classification for complex fractures of the proximal ulna based on morphological characteristics seen on three-dimensional computed tomography (3D CT). The secondary aim was to validate the proposed classification regarding its intra- and inter-rater agreement. Three raters with different levels of experience analyzed 39 cases of complex fractures of the proximal ulna using radiographs and 3D CT scans. We presented the proposed classification (divided into four types with subtypes) to the raters. In this classification, the medial column of the ulna involves the sublime tubercle and is where the anterior medial collateral ligament is inserted, the lateral column contains the supinator crest and is where the lateral ulnar collateral ligament is inserted, and the intermediate column involves the coronoid process of the ulna, olecranon, and anterior capsule of the elbow. Intra- and inter-rater agreement was analyzed for two different rounds, and the results were evaluated according to Fleiss kappa, Cohen kappa, and Kendall coefficient. Intra- and inter-rater agreement values were very good (0.82 and 0.77, respectively). Good intra- and inter-rater agreement attested to the stability of the proposed classification among the raters, regardless of the level of experience of each one. The new classification proved to be easy to understand and had very good intra- and inter-rater agreement, regardless of the level of experience of each rater.
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29
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Preoperative Mixed-Reality Visualization of Complex Tibial Plateau Fractures and Its Benefit Compared to CT and 3D Printing. J Clin Med 2023; 12:jcm12051785. [PMID: 36902573 PMCID: PMC10002526 DOI: 10.3390/jcm12051785] [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: 01/12/2023] [Revised: 01/28/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Various studies have shown the benefit of three-dimensional (3D) computed tomography (CT) reconstruction and especially 3D printing in the treatment of tibial plateau fractures (TPFs). This study aimed to investigate whether mixed-reality visualization (MRV) using mixed-reality glasses can provide a benefit for CT and/or 3D printing in planning treatment strategies for complex TPFs. METHODS Three complex TPFs were selected for the study and processed for 3D imaging. Subsequently, the fractures were presented to specialists in trauma surgery using CT (including 3D CT reconstruction), MRV (hardware: Microsoft HoloLens 2; software: mediCAD MIXED REALITY) and 3D prints. A standardized questionnaire on fracture morphology and treatment strategy was completed after each imaging session. RESULTS 23 surgeons from 7 hospitals were interviewed. A total of 69.6% (n = 16) of those had treated at least 50 TPFs. A change in fracture classification according to Schatzker was recorded in 7.1% of the cases and in 78.6% an adjustment of the ten-segment classification was observed after MRV. In addition, the intended patient positioning changed in 16.1% of the cases, the surgical approach in 33.9% and osteosynthesis in 39.3%. A total of 82.1% of the participants rated MRV as beneficial compared to CT regarding fracture morphology and treatment planning. An additional benefit of 3D printing was reported in 57.1% of the cases (five-point Likert scale). CONCLUSIONS Preoperative MRV of complex TPFs leads to improved fracture understanding, better treatment strategies and a higher detection rate of fractures in posterior segments, and it thus has the potential to improve patient care and outcomes.
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Vesseur MA, van Haasteren JC, Verstraelen FU, Boonen B. Osteochondral impression fracture of the patella after sports collision injury. BMJ Case Rep 2023; 16:e253825. [PMID: 36731939 PMCID: PMC9896215 DOI: 10.1136/bcr-2022-253825] [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] [Indexed: 02/04/2023] Open
Abstract
This article reports a case of a teenager who suffered a frontal collision sports injury. Computed Tomography (CT) revealed a fracture of the inferior pole of the patella without obvious displacement and retro patellar cortical impression with 5 mm step off. Surgical intervention was performed using β-tricalcium phosphate (β-TCP) and 3.0 cannulated screw fixation.At 3-month follow-up, the wound showed good healing. No pain was observed. The patient was able to flex up to 100° with full extension. There were no signs of hydrops with full stability of the knee.Good postoperative results can be obtained in osteochondral impression fractures of the patella using surgical intervention to elevate the osteochondral fragment, graft it with β-TCP and raft it with 3.0 cannulated screws.
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Affiliation(s)
- Maud Am Vesseur
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
| | | | - Freek U Verstraelen
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
| | - Bert Boonen
- The Department of Orthopaedic and Trauma Surgery, Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
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31
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Bormann M, Neidlein C, Gassner C, Keppler AM, Bogner-Flatz V, Ehrnthaller C, Prall WC, Böcker W, Fürmetz J. Changing patterns in the epidemiology of tibial plateau fractures: a 10-year review at a level-I trauma center. Eur J Trauma Emerg Surg 2023; 49:401-409. [PMID: 36057677 DOI: 10.1007/s00068-022-02076-w] [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: 04/16/2022] [Accepted: 08/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Mobility patterns of western societies have been changing due to ongoing demographic change. Therefore, continuously updated epidemiological data on fracture morphology and treatment strategies are needed. METHODS This retrospective single-center study included all tibial plateau fractures (TPF) between January 2011 and December 2020 in a level-I trauma center in Central Europe. Epidemiology, trauma mechanism and fracture morphology were analyzed. Age- and sex-specific differences regarding fracture classification (Schatzker, AO/OTA, Moore) and changes during the study period are highlighted. RESULTS A total of 607 patients (55.2% women, 44.8% men, mean age 52.9 years (± 17.9)) were included in the study, 462 (76.1%) thereof having undergone surgical treatment. Over the decade, an increase in mean age (+ 7.4 years; p = 0.10), incidence (+ 68%; p < 0.05) and low-energy trauma was observed, with the highest peak in elderly women. Within classifications, AO/OTA 41-B3 (24.9%), Schatzker II (26.8%) and Moore V (46.6%) fractures were the most common. CONCLUSION Incidence (+ 68%), mean age and fractures with signs of knee dislocation of tibial plateau fracture increased over the last decade and low-energy trauma mechanism are more frequent. As the increase in incidence is mainly seen in older women, the comorbidities and need for immediate postoperative full weight-bearing have to be considered in treatment strategies.
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Affiliation(s)
- Markus Bormann
- 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
| | - Christoph Gassner
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Alexander Martin Keppler
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Viktoria Bogner-Flatz
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Christian Ehrnthaller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Wolf Christian Prall
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,Devision of Knee, Hip, Shoulder and Ellbow Surgery, Schoen Clinic Munich, Harlachinger Straße 51, 81547, Munich, Germany
| | - Wolfgang Böcker
- 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, Professor-Küntscher-Straße 8, 82418, Murnau am Staffelsee, Germany.
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The influence of 3D printing on inter- and intrarater reliability on the classification of tibial plateau fractures. Eur J Trauma Emerg Surg 2023; 49:189-199. [PMID: 35941251 PMCID: PMC9925517 DOI: 10.1007/s00068-022-02055-1] [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: 03/14/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Tibial plateau fractures continue to be a challenging task in clinical practice and current outcomes seem to provide the potential for further improvement. Especially presurgical understanding of the orientation of fracture lines and fracture severity is an essential key to sufficient surgical treatment. The object of this study was to evaluate the reliability of modern axial CT-based classification systems for tibial plateau fractures. In addition, the diagnostic-added value of 3D printing on the classification systems was investigated. METHODS 22 raters were asked to classify 22 tibial plateau fractures (11 AO B- and 11 AO C-fractures) with the AO, the 10-Segment and the Revisited Schatzker classification in a three-step evaluation: first only using CT scans, second with 3D volumetric reconstructions and last with 3D-printed fracture models. Inter- and intraobserver agreement and the subjective certainty were analyzed. Statistics were done using kappa values, percentage match and a univariant one-way analysis of variance. RESULTS The AO classifications interobserver percentage match and kappa values improved for all raters and recorded an overall value of 0.34, respectively, 43% for the 3D print. The 10-Segment classification interobserver agreement also improved with the 3D-printed models and scored an overall kappa value of 0.18 and a percentage match of 79%. Equally the Revisited Schatzker classification increased its values to 0.31 and 35%. The intraobserver agreement showed a moderate agreement for the AO (0.44) and Revisited Schatzker classification (0.42) whereas the 10-Segment classification showed a fair agreement (0.27). Additionally, the raters changed their classification in 36% of the cases after evaluating the fracture with the 3D-printed models and the subjective certainty regarding the decisions improved as categories of self-reliant diagnostic choices were selected 18% (p < 0.05) more often after using the 3D-printed models. CONCLUSION Based on the measured outcomes it was concluded that the new classification systems show an overall slight to fair reliability and the use of 3D printing proved to be beneficial for the preoperative diagnostics of tibial plateau fractures. The 10-Segment classification system showed the highest percentage match evaluation of all classification systems demonstrating its high clinical value across all levels of user experience.
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Kambhampati SBS, Chodavarapu MNS, Kambhampati APS, Chittoor SP, Chinta SK. "Flipped Lid" Fracture of the Lateral Tibial Plateau with Dislocated Lateral Meniscus: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00012. [PMID: 36821402 DOI: 10.2106/jbjs.cc.22.00634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
CASE We present a rare "flipped lid" type of fracture of the lateral tibial plateau with dislocation of the lateral meniscus into the notch with intact roots. This was fixed using headless screws through arthrotomy and peripheral suturing of the meniscus. At the 1-year follow-up, although there was terminal restriction of 10° flexion with redislocation of the lateral meniscus, the patient was able to perform all daily activities and declined further surgery. CONCLUSION Flipped lid-type fracture is rare and results in good outcome when fixed early. Meniscal dislocation repair requires close monitoring to detect failure.
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Affiliation(s)
- Srinivas B S Kambhampati
- Sri Dhaatri Orthopaedic, Maternity & Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh, India
| | | | - Anirudh P S Kambhampati
- Sri Dhaatri Orthopaedic, Maternity & Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh, India
| | - Sai Prasad Chittoor
- Viswa Chakra Orthopedic Hospital, Buttaipet, Machilipatnam, Andhra Pradesh, India
| | - Shyam Kumar Chinta
- Department of Orthopaedics, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India
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Medial Head of the Gastrocnemius Tenotomy Through a Posteromedial Approach Significantly Improves Surgical Accessibility of the Tibial Plateau. J Orthop Trauma 2023; 37:44-49. [PMID: 35947746 DOI: 10.1097/bot.0000000000002462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Compare accessible area of the posterior tibial plateau through a modified posteromedial (PM) approach before and after tenotomy of the medial head gastrocnemius. We report the outcomes of 8 patients who underwent gastrocnemius tenotomy during PM approach. METHODS A modified PM approach was performed on 10 cadaveric legs, and the surgically accessible area was outlined. Next, a medial head gastrocnemius mid substance tenotomy was completed, and the accessible area was again outlined. Tibia specimens were imaged in a micro-CT scanner to measure accessible surface area and linear distance along the joint line. In addition, 8 patients who underwent tenotomy for tibial plateau fracture had outcomes recorded. RESULTS The modified PM approach with tenotomy provided significantly more access to the posterior plateau than without tenotomy. The modified PM approach before tenotomy allowed access to 1774 mm 2 (SD = 274) of the posterior plateau surface and 2350 mm 2 (SD = 421, P < 0.0001) with tenotomy. A linear distance of 38 mm (SD = 7) and 57 mm (SD = 7, P < 0.00001) was achieved before and after tenotomy, respectively. In the clinical series, the average knee arc of motion was 116 degrees (95-135). CONCLUSIONS The modified PM approach with medial head gastrocnemius tenotomy significantly improves surgical access to the posterior plateau. Patients who received tenotomy have acceptable functional outcomes. This cadaveric study provides an alternative approach for treatment of posterolateral tibial plateau fractures which may mitigate damage to neurovascular structures.
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Kahmann SL, Rausch V, Plümer J, Müller LP, Pieper M, Wegmann K. The automized fracture edge detection and generation of three-dimensional fracture probability heat maps. Med Eng Phys 2022; 110:103913. [PMID: 36564138 DOI: 10.1016/j.medengphy.2022.103913] [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: 05/06/2022] [Revised: 09/29/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
With proven impact of statistical fracture analysis on fracture classifications, it is desirable to minimize the manual work and to maximize repeatability of this approach. We address this with an algorithm that reduces the manual effort to segmentation, fragment identification and reduction. The fracture edge detection and heat map generation are performed automatically. With the same input, the algorithm always delivers the same output. The tool transforms one intact template consecutively onto each fractured specimen by linear least square optimization, detects the fragment edges in the template and then superimposes them to generate a fracture probability heat map. We hypothesized that the algorithm runs faster than the manual evaluation and with low (< 5 mm) deviation. We tested the hypothesis in 10 fractured proximal humeri and found that it performs with good accuracy (2.5 mm ± 2.4 mm averaged Euclidean distance) and speed (23 times faster). When applied to a distal humerus, a tibia plateau, and a scaphoid fracture, the run times were low (1-2 min), and the detected edges correct by visual judgement. In the geometrically complex acetabulum, at a run time of 78 min some outliers were considered acceptable. An automatically generated fracture probability heat map based on 50 proximal humerus fractures matches the areas of high risk of fracture reported in medical literature. Such automation of the fracture analysis method is advantageous and could be extended to reduce the manual effort even further.
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Affiliation(s)
- Stephanie L Kahmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, Cologne 50937, Germany.
| | - Valentin Rausch
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, Cologne 50937, Germany
| | - Jonathan Plümer
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, Cologne 50937, Germany; Department of Orthopedic and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, Bochum 44789, Germany
| | - Lars P Müller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, Cologne 50937, Germany
| | - Martin Pieper
- University of Applied Sciences Aachen, Heinrich-Mußmann-Str. 1, Jülich 52428, Germany
| | - Kilian Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, Cologne 50937, Germany
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Pes anserine detachment in posteromedial approach to the tibial plateau fracture provides better intraoperative exposure without compromising the flexor muscle strength. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03447-0. [PMID: 36446957 PMCID: PMC9708505 DOI: 10.1007/s00590-022-03447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE During the posteromedial approach to the tibial plateau fracture (TPF), pes anserine is generally retracted. However, pes anserine detachment could provide a better fracture site exposure. Even so, the general conception is that the latter could negatively affect flexor muscle strength. We aimed to evaluate the effect of pes anserine detachment on the flexion force and functional outcomes of TPF with posteromedial involvement. METHODS In this retrospective-prospective cohort study, 22 TPF patients with Schatzker type IV who were managed with posteromedial approach and pes anserine detachment were included. The knee flexion force was measured 12 months after the surgery at several angles of flexion (30°, 60°, and 90°) and rotations (internal and external). The International Knee Documentation Committee (IKDC) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess knee function. A visual analog scale (VAS) was used to measure knee pain. RESULTS The mean strength of the knee flexor muscle was not statistically different between the involved and non-involved sides at 30°, 60°, and 90° knee flexion, and also at the internal and external rotation. The mean IKDC score of the patients was 81.6 ± 7.8. The mean KOOS score of the patients was 82.2 ± 9.1. The mean VAS for pain was 2.4 ± 1.8. The mean knee range of motion was 124 ± 10.5°. CONCLUSION Pes anserine release and re-attachment in the posteromedial approach to the TPF has no detrimental effect on the flexion muscle strength and knee function. LEVEL OF EVIDENCE Therapeutic Level IV.
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[Application of a new universal locking anatomical plate in treatment of tibial plateau posterolateral column fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1351-1356. [PMID: 36382451 PMCID: PMC9681591 DOI: 10.7507/1002-1892.202207093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the effectiveness of a new tibial plateau posterolateral column universal locking anatomical plate (hereinafter referred to as "new universal locking anatomical plate") in the treatment of tibial plateau posterolateral column fractures. METHODS Between October 2020 and December 2021, 14 patients with tibial plateau posterolateral column fracture were treated with a new universal locking anatomical plate. There were 7 males and 7 females with an average age of 59 years ranging from 29 to 75 years. There were 5 cases on the left side and 9 cases on the right side. The causes of injury included falling from height in 5 cases, traffic accident in 7 cases, and other injuries in 2 cases. The time from injury to operation ranged from 3 to 10 days, with an average of 6 days. According to Schatzker classification, there were 4 cases of type Ⅱ, 8 cases of type Ⅴ, and 2 cases of type Ⅵ. All fractures involved the posterolateral tibial plateau. Three column classification: two columns (anterolateral column+posterior column) in 4 cases, three columns in 10 cases. The operation time, intraoperative blood loss, fracture healing, and complications were recorded. The reduction of tibial plateau fracture was evaluated by Rasmussen radiographic score, and the recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score. RESULTS All 14 cases completed the operation successfully. The operation time was 95-180 minutes, with an average of 154 minutes, and the intraoperative blood loss was 100-480 mL, with an average of 260 mL. All patients were followed up 6-19 months, with an average of 12.5 months. All fractures healed, and the healing time was 15-24 weeks, with an average of 18.7 weeks. During the follow-up, there was 1 case of common peroneal nerve palsy and 1 case of traumatic osteoarthritis. There was no other complication such as vascular injury, incision infection, deep venous thrombosis of lower limbs, heterotopic ossification, bone nonunion, and failure of internal fixation. The reduction of tibial plateau fractures was good immediately after operation, and the Rasmussen radiological score was 10-18, with an average of 15.7; 3 cases were excellent, 10 cases were good, and 1 case was fair, with an excellent and good rate of 92.9%. The scores and grades of HSS at 3 months after operation and at last follow-up significantly improved when compared with those before operation ( P<0.05). There was no significant difference between 3 months after operation and last follow-up ( P>0.05). CONCLUSION For the fractures involving the posterolateral column of the tibial plateau, the new universal locking anatomical plate can provide strong fixation, satisfactory postoperative fracture reduction, and good recovery of knee function.
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Zeng C, Ren X, Xu C, Hu M, Li J, Zhang W. Stability of internal fixation systems based on different subtypes of Schatzker II fracture of the tibial plateau: A finite element analysis. Front Bioeng Biotechnol 2022; 10:973389. [PMID: 36159683 PMCID: PMC9490054 DOI: 10.3389/fbioe.2022.973389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Schaztker II fracture is the most common type of the tibial plateau fractures (TPF). There has been a large number of cadaveric biomechanical studies and finite element simulation studies to explore the most stable fixation methods for this type of fracture, which were based on a single fracture morphology. But differences among fracture morphologies could directly affect the stability of internal fixation systems. In this sense, we verified the stability of existing internal fixation modalities by simulating Schatzker II fractures with different fracture morphologies. Objectives: To compare the stability of different filler types combined with locked compression plate/screw in different subtypes of Schatzker II TPF. Methods: Four subtypes of Schatzker II were created based on 3D map of TPF. Each of the subtypes was fixed with LCP/screw or LCP/screw combined with different fill types. Stress distribution, displacement distribution, and the load sharing capacity of the filler were assessed by applying the maximum load during gait. In addition, repeated fracture risks of depressed fragment were evaluated regarding to the ultimate strain of bone. Results: The stress concentration of the implant in each scenario was located on the screw at the contact site between the plate and the screw, and the filler of the defect site significantly reduced the stress concentration of the implant (Subtype A: Blank group 402.0 MPa vs. Experimental group 315.2 ± 5.5 MPa; Subtype C: Blank group 385.0 MPa vs. Experimental group 322.7 ± 12.1 MPa). Displacement field analysis showed that filler significantly reduced the reduction loss of the depressed fragment (Subtype A: Blank group 0.1949 mm vs. Experimental group 0.174 ± 0.001 mm; Subtype C: 0.264 mm vs. 0.253 ± 0.002 mm). Maximum strain was in subtype C with the value of 2.3% ± 0.1% indicating the greatest possibility of failure risk. And with the increase of its modulus, the bearing capacity of filler increased. Conclusion: The existence of filler at the defect site can effectively reduce the stress concentration of the implant and the reduction loss of the collapsed block, thus providing good stability for Schatzker II fracture. In subtype A fracture, the modulus of filler presented the slightest influence on the stability, followed by subtype C, while the stability of subtype B was most influenced by the modulus of filler. Therefore, it is necessary to evaluate the preoperative patient imaging data adequately to select the appropriate stiffness of the filler.
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Affiliation(s)
- Chuyang Zeng
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Xiaomeng Ren
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Cheng Xu
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Mengmeng Hu
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Jiantao Li
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
- *Correspondence: Jiantao Li, ; Wei Zhang,
| | - Wei Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Jiantao Li, ; Wei Zhang,
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Ahmad S, Arora R, Aggarwal AN, ul-Haq R, Khan K, Tandon A. Comparison between reliability of Schatzker's classification and CT based four quadrant classification for tibial plateau fractures. J Clin Orthop Trauma 2022; 32:101986. [PMID: 36039049 PMCID: PMC9418491 DOI: 10.1016/j.jcot.2022.101986] [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: 01/29/2022] [Revised: 07/20/2022] [Accepted: 08/03/2022] [Indexed: 10/15/2022] Open
Abstract
Introduction Conventionally used Schatzker and AO/OTA classification, do not identify posterior column injuries in tibial plateau fractures. CT based Four quadrant classification, has been proposed to identify fractures of tibial plateau and help in surgical planning of treatment. However, to assess its validity, there is scanty literature about its reliability (inter and intra-observer variation) and comparison of its reliability with that of the more popular Schatzker classification in classifying tibial plateau fracture. Material and methods X-rays and CT scans of 35 patients (18-65 years) of closed tibial plateau fractures were assessed by 5 Orthopaedic surgeons and classified by both Schatzker's and Four Quadrant Classification. A similar observation was recorded after 2 months. All observers were blinded for the demographic and clinical details of the patients. Their responses were noted and interobserver and Intraobserver variation was calculated. Kappa Test of Cohen was used to determine the level of agreement, as per Landis and Koch's criteria. The reliability of four quadrant classification was also compared with that of Schatzker's classification. Results There was a moderate agreement in interobserver variation in observations for Schatzker's classification (on X-rays) which improved to substantial agreement when the observations were recorded after showing both CT and X-rays. The intraobserver variation had substantial agreement. On the other hand, there was a perfect agreement in both intra- and interobserver variation for Four Quadrant Classification. This difference between the reliability of both classifications was statistically significant (p < 0.001). Conclusions Four Quadrant classification is a more reliable classification having a better agreement on interobserver and intraobserver variation.
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Affiliation(s)
- Sageer Ahmad
- Department of Orthopaedics, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, 110095, India
| | - Rajesh Arora
- Department of Orthopaedics, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, 110095, India
| | - Aditya N. Aggarwal
- Department of Orthopaedics, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, 110095, India
| | - Rehan ul-Haq
- Department of Orthopaedics, AIIMS Bhopal, Saket Nagar, Bhopal, 462020, Madhya Pradesh, India
| | - Karimullah Khan
- Department of Orthopaedics, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, 110095, India
| | - Anupama Tandon
- Department of Radiodiagnosis, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, 110095, India
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Gálvez-Sirvent E, Ibarzábal-Gil A, Rodríguez-Merchán EC. Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management. EFORT Open Rev 2022; 7:554-568. [PMID: 35924649 PMCID: PMC9458943 DOI: 10.1530/eor-22-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis. The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA. Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection. In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage). Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.
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Affiliation(s)
- Elena Gálvez-Sirvent
- Department of Orthopaedic Surgery, "Infanta Elena" University Hospital, Valdemoro, Madrid, Spain.,Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Aitor Ibarzábal-Gil
- Department of Orthopaedic Surgery, "La Paz" University Hospital, Madrid, Spain
| | - E Carlos Rodríguez-Merchán
- Department of Orthopaedic Surgery, "La Paz" University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Lateral locking plate plus antero-posterior lag screws techniques for the management of posterolateral tibial plateau fracture: preliminary clinical results and biomechanical study. Arch Orthop Trauma Surg 2022; 143:3163-3172. [PMID: 35907003 DOI: 10.1007/s00402-022-04554-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/15/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION To date, there is no consensus on the optimal surgical strategy for the treatment of posterolateral tibial plateau fracture (PLF). This study introduced a novel, simple technique for treating PLF with a lateral locking plate plus antero-posterior lag screws (LPpLS). METHODS We conducted a retrospective case series of 42 patients (Female/Male 19/23) with PLF treated with LPpLS between 1 July 2016 and 30 June 2019. Several pre- and postoperative outcomes were recorded, including operative time, intraoperative blood loss, CT findings, HSS, and ROM. For biomechanical studies, seventy synthetic tibiae with a simulated posterolateral split fracture were divided into seven groups. The biomechanical evaluation included displacement measurement at axial compression and fatigue testing. RESULTS Forty-two eligible patients were followed up for an average of 18 months (range 14-21 months). Postoperative radiographs and CT showed good positioning of plates and screws, no fracture fragment loss, and normal articular surfaces in all 42 cases. The biomechanical study showed that the axial stiffness of LPpLS was in the same fashion as the posterior buttress plate and better than the other fixation methods (P < 0.05). Additionally, the LPpLS group had a smaller displacement of fracture fragments along the X-axis (medial to lateral direction) than the BP group (P < 0.01). CONCLUSIONS The LPpLS technique could implement good reconstruction of the PLF, showing satisfactory therapeutic effect. The biomechanical evaluation demonstrated that the LPpLS had better stability in three-dimensional directions for PLF than other fixation strategies.
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Naja AS, Bouji N, Eddine MN, Alfarii H, Reindl R, Tfayli Y, Issa M, Saghieh S. A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures. Strategies Trauma Limb Reconstr 2022; 17:105-116. [PMID: 35990176 PMCID: PMC9357793 DOI: 10.5005/jp-journals-10080-1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim This article aims to compare the outcomes between open reduction and internal fixation (ORIF) and external fixation (ExFix) in tibial plateau fractures. Background Open reduction and internal fixation and external fixation are common methods for managing tibial plateau fractures without a consensus of choice. Materials and methods PubMed, Cochrane Library, Ovid, CINAHL®, Scopus, and Embase were searched. Clinical studies in humans comparing ExFix and ORIF for tibial plateau fractures were included. Case reports, pathological, and biomechanical studies were excluded. Two investigators reviewed the studies independently, and any discrepancies were resolved. The quality and heterogeneity of each study were assessed in addition to calculating the odds ratio (OR) of the surgical outcomes and complications at a 95% confidence interval, with p <0.05 as statistical significance. Results Of the 14 included studies, one was a randomised trial, one was a prospective study, and 12 were retrospective studies. The 865 fractures identified across the studies constituted 458 (52.9%) in the ExFix group and 407 (47.1%) in the ORIF group. Most studies indicated a better outcome for ORIF as compared to ExFix. Open reduction and internal fixation had a lower incidence of superficial infection and postoperative osteoarthritis, while ExFix revealed a lower proportion with heterotopic ossification (HTO). Conclusion ExFix has a higher rate of superficial infections and osteoarthritis, whereas ORIF has a higher incidence of HTO. Larger studies are needed to compare outcomes and investigate the findings of this study further. Clinical significance This up-to-date meta-analysis on tibial plateau management will help surgeons make evidence-based decisions regarding the use of ORIF versus ExFix. How to cite this article Naja AS, Bouji N, Eddine MN, et al. A Meta-analysis Comparing External Fixation against Open Reduction and Internal Fixation for the Management of Tibial Plateau Fractures. Strategies Trauma Limb Reconstr 2022;17(2):105–116.
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Affiliation(s)
- Ahmad S Naja
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Bouji
- Clinical and Translational Science Institute, West Virginia University, Morgantown, West Virginia, United States of America
| | - Mohamad Nasser Eddine
- Department of Orthopedics, McGill University Health Center, Montreal, Quebec, Canada
| | - Humaid Alfarii
- Department of Orthopedics, McGill University Health Center, Montreal, Quebec, Canada
| | - Rudolf Reindl
- Department of Orthopedics, McGill University Health Center, Montreal, Quebec, Canada
| | - Yehia Tfayli
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Issa
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Said Saghieh
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- Said Saghieh, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon, Phone: +961 (1) 350000x5444, e-mail:
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Sidhu GAS, Hind J, Ashwood N, Kaur H, Bridgwater H, Rajagopalan S. Systematic Review of Current Approaches to Tibia Plateau: Best Clinical Evidence. Cureus 2022; 14:e27183. [PMID: 36039265 PMCID: PMC9395202 DOI: 10.7759/cureus.27183] [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] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
If not treated adequately, tibia plateau fractures result in premature osteoarthritis and lifelong disability. The advent of newer implants and techniques to improve outcomes has necessitated the development of different surgical approaches. A Medline and EMBASE search (June 2020) was conducted to identify publications during the last 10 years that focused on surgical approaches for proximal tibia fractures/ tibia plateau management. A total of 2107123 and 2715399 articles were found related to fractures in this area with 133 and 103 review articles looking at the approach on MEDLINE and EMBASE, respectively. This article reviews the continued development of the surgical approaches to aid understanding for surgeons and identify areas for future research to help improve outcomes. Although the anterolateral approach is the most commonly applied surgical technique, having the knowledge of newer approaches (medial, posteromedial, posterolateral, or direct posterior) in the armamentarium is necessary to treat the vast array of fracture patterns. There has been a shift amongst trauma surgeons of using a combination of approaches for complex tibia plateau fractures.
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Giordano V, Pires RE, Pimenta FS, Campos TVDO, Andrade MAPD, Giannoudis PV. Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm. J Knee Surg 2022; 35:959-970. [PMID: 33167054 DOI: 10.1055/s-0040-1721026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High-energy fractures of the proximal tibia with extensive fragmentation of the posterolateral (PL) quadrant of the tibial plateau are challenging to manage. Herein, we present a review of the literature on the patterns and options of approach and fixation of the PL fragment of the tibial plateau to optimize the treatment of this specific injury pattern. We searched PubMed (1980-May 2020) to identify and summarize the most relevant articles evaluating both the morphology and treatment recommendations, including the choice of approach and fixation strategy, for the PL tibial plateau fracture. We found PL fragment can present in several patterns as a pure split, split depression, contained pure depression, and noncontained depression (rim crush), which are mostly determined by the position of the knee and the force magnitude applied during the course of the accident. Based on previous concepts described by Schatzker and Kfuri, we suggest a simplified treatment algorithm highlighting the two concepts (buttressing and containment) used for plating the PL tibial plateau fragments. Based on the available current evidence, we propose an algorithm for these two morphological types of PL tibial plateau fracture. Shear-type fractures need buttressing (the "rule of thumb"), whereas noncontained peripheral rim-type fractures need peripheral repair and containment. Contained pure depression fractures are not frequent and need percutaneous-assisted elevation and subchondral rafting, either controlled by fluoroscopy or arthroscopically. It is believed that such an approach would simplify their assessment and preoperative planning and would assist the clinicians to appreciate and manage more consistently these complex injuries.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil.,Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil
| | - Robinson Esteves Pires
- Departamento de Ortopedia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom
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Vendeuvre T, Ferrière V, Bouget P, Billot M, Germaneau A, Severyns M, Roulaud M, Rigoard P, Pries P. Percutaneous surgery with balloon for tibial plateau fractures, results with a minimum of 5 years of follow-up. Injury 2022; 53:2650-2656. [PMID: 35643555 DOI: 10.1016/j.injury.2022.05.033] [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: 12/21/2021] [Revised: 04/22/2022] [Accepted: 05/14/2022] [Indexed: 02/02/2023]
Abstract
Tibial plateau fracture is a frequent entity for which surgical management is difficult both surgically and postoperatively, with multiple complications and often delayed recovery. The challenge lies in the anatomical reduction of the joint, the limitation of complications and the rapid functional recovery. Tuberoplasty appears to be an innovative technique that meets current expectations. The objective is to evaluate the reliability of tuberoplasty in reducing surgical risks and improving postoperative clinical results. This single-centre retrospective study included 30 patients with depressed tibial plateau fractures who underwent tuberoplasty from September 2011 to March 2014. Reduction analysis was performed by comparing pre-operative and post-operative depression from computed tomography (CT) data. Clinical outcomes were assessed by measuring flexion joint ranges, time to weight-bearing, KOOS questionnaire and a pangonogram. The mean depression was 7.4mm pre-operatively and 2.6mm [0;9] post-operatively, with 47% (14/30) having a residual depression of 2mm or less. Mean flexion at 6 weeks was 103° [30; 130]. Partial and total weight-bearing were allowed on day 47 [3; 150] and day 58 [20; 150], respectively. The mean KOOS score was 25.43 [1.15; 62.30] at a minimum of 5 years after surgery and the mean axis was 176.54° [172; 180]. There was one case of thrombophlebitis and one sensory-motor deficit in the common fibular nerve territory. The reduction of the tibial plateau observed in our study from tuberoplasty is in line with the literature results obtained from a conventional approach. Our results indicate that tuberoplasty is stable in the long term, has good functional results and early recovery with few complications. This preliminary study presents results that need to be investigated in a prospective randomised double-blind study.
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Affiliation(s)
- Tanguy Vendeuvre
- CHU de Poitiers, 2 rue de la Milétrie, Service d'Orthopédie-Traumatologie et Chirurgie de la Colonne, 86021 Poitiers, France; Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - Victor Ferrière
- CHU de Poitiers, 2 rue de la Milétrie, Service d'Orthopédie-Traumatologie et Chirurgie de la Colonne, 86021 Poitiers, France.
| | - Pierre Bouget
- CHU de Poitiers, 2 rue de la Milétrie, Service d'Orthopédie-Traumatologie et Chirurgie de la Colonne, 86021 Poitiers, France
| | - Maxime Billot
- CHU de Poitiers, 2 rue de la Milétrie, PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), 86021 Poitiers, France
| | - Arnaud Germaneau
- CHU de Poitiers, 2 rue de la Milétrie, PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), 86021 Poitiers, France
| | - Mathieu Severyns
- Institut Pprime UPR 3346, CNRS - Université de Poitiers - ISAE-ENSMA, France
| | - Manuel Roulaud
- CHU de Poitiers, 2 rue de la Milétrie, PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), 86021 Poitiers, France
| | - Philippe Rigoard
- CHU de Poitiers, 2 rue de la Milétrie, PRISMATICS (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), 86021 Poitiers, France
| | - Pierre Pries
- CHU de Poitiers, 2 rue de la Milétrie, Service d'Orthopédie-Traumatologie et Chirurgie de la Colonne, 86021 Poitiers, France
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Ahmad SS, Konrads C, Stöckle U. Essential concepts in the treatment of common joint fractures: A narrative review. Injury 2022; 53:2395-2399. [PMID: 35613965 DOI: 10.1016/j.injury.2022.05.013] [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: 02/10/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023]
Abstract
Proximal fractures of the humerus are at high risk of osteonecrosis if the medial calcar is disrupted and the metaphyseal extension of the head fragment is <8mm. Risk factors for failure of osteosynthesis include: poor bone stock, varus dislocation, head dislocation and medial comminution. During surgical treatment of distal humerus fractures, one should aim to restore the arc and stabilize the columns. Several technical rules have been outlined by O´Driscoll and are mentioned in this article in detail. In fractures of the distal radius, the length, the joint surface, and joint angles (palmar inclination ca. 11°, radial inclination ca. 22°) should be reconstructed. Several surgical factors are associated with the development of radiocarpal osteoarthritis including the sagittal depth of the articular cavity and the anterior-posterior diameter of the fossa lunata of the distal radius. When managing fractures of the proximal tibia, a four- or more column classification system should be used to plan the surgical steps and choose the appropriate approach(es). In ankle fractures, intraoperative 3-D-Scan should be considered especially in the case of syndesmotic involvement or involvement of the posterior malleolus.
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Affiliation(s)
- Sufian S Ahmad
- Department of Orthopaedic Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Konrads
- Department of Orthopaedic Surgery, University of Tübingen, Tübingen, Germany.
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery, Charité - University Medical Center Berlin, Berlin, Germany
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An anterolateral approach for the flexion-valgus type unicondylar tibial plateau depression fracture pattern a technical note. Injury 2022; 53:2373-2378. [PMID: 35337659 DOI: 10.1016/j.injury.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/12/2022] [Accepted: 03/05/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The approach to pure depression fractures (PDF) of the posterolateral tibial plateau (PTP) is classically a posterior approach via a metaphyseal osteotomy window with elevation of the depressed articular fragment. Other posterolateral approaches have been described but have been criticized for affecting reduction quality, and risks to the common peroneal nerve. METHODS In this case series, we describe a standard anterolateral approach with a window osteotomy through the metaphysis. Elevation of the PTP fracture is done through the osteotomy site. RESULTS The standard anterolateral approach avoids limitations of posterior or posterolateral approaches. Adequate reduction and good fixation of PDF of the PTP is attained. CONCLUSION The anterolateral approach with osteotomy of the lateral condyle is reproducible and familiar. This avoids the need for a fibula osteotomy and the risks of neurovascular injury, while allowing adequate visualisation and fracture reduction. LEVEL OF EVIDENCE IV.
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Abstract
Three-dimensional imaging has changed the understanding and management of tibial plateau fractures. In the 1970s, Schatzker proposed a classification for tibial plateau fractures, which highlighted the morphology of the six principal types. More recently, this original classification was complimented by an extended one underscoring the importance of understanding where the split wedge fragment(s) is/are located in three dimensions. The extended classification introduced the split wedge fragment and the continuity of the rim as the determinants of joint stability and the critical role that this plays in the management of tibial plateau fractures. The current manuscript re-emphasizes contemporary concepts of tibial plateau stability and depicts key issues which must be considered when planning the definitive surgical fixation of tibial plateau fractures.
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Mansur H, Corrêa VLB, Abdo B, Ramos LS, Castiglia MT. Avaliação da reprodutibilidade da classificação de Schatzker revisada por Kfuri para as fraturas do planalto tibial. Rev Bras Ortop 2022; 57:502-510. [PMID: 35785118 PMCID: PMC9246522 DOI: 10.1055/s-0041-1729577] [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: 09/03/2020] [Accepted: 11/03/2020] [Indexed: 11/05/2022] Open
Abstract
Objective
The Schatzker classification is the most used for tibial plateau fractures. Kfuri et al.
12
reviewed Schatzker's initial classification describing in more detail the involvement of the tibial plateau in the coronal plane, allowing a better understanding of the fracture pattern and a more accurate surgical planning. The objectives of the present study are to evaluate the interobserver agreement of these classifications and to evaluate the influence of the experience of the observer on the reproducibility of the instruments.
Methods
An observational and retrospective study was conducted by evaluating the radiological study of 20 adult individuals with tibial plateau fractures, including radiographs and computed tomography (CT). The fractures were classified once by 34 examiners with varied experience (24 specialists and 10 residents in Orthopedics and Traumatology), according to the Schatzker classification and to the modification proposed by Kfuri. The Fleiss Kappa index was used to verify interobserver agreement.
Results
The interobserver agreement index was considered moderate for the Schatzker classification (κ = 0.46) and mild for the Kfuri modification (κ = 0.30). The Schatzker classification showed moderate agreement, with κ = 0.52 for residents and κ = 0.45 among specialists. The Kfuri classification showed mild agreement, with Kappa values for residents and specialists of 0.39 and 0.28, respectively.
Conclusion
The Schatzker classification and the classification modified by Kfuri presented moderate and mild interobserver agreement, respectively. In addition, the residents presented higher agreement than the specialists for the two systems studied.
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Affiliation(s)
- Henrique Mansur
- Serviço de Ortopedia e Traumatologia, Departamento de Ortopedia e Traumatologia, Hospital Santa Helena, DF, Brasil
| | | | - Bruno Abdo
- Departamento de Ortopedia e Traumatologia, Hospital das Forças Armadas, Brasília, DF, Brasil
| | - Lucas Sacramento Ramos
- Serviço de Ortopedia e Traumatologia, Departamento de Ortopedia e Traumatologia, Hospital Regional de Planaltina, Planaltina, DF, Brasil
| | - Marcello Teixeira Castiglia
- Serviço de Ortopedia e Traumatologia, Departamento de Ortopedia e Traumatologia, Hospital São Lucas, Ribeirão Preto, SP, Brasil
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Tibial plateau fractures: three dimensional fracture mapping and morphologic measurements. INTERNATIONAL ORTHOPAEDICS 2022; 46:2153-2163. [PMID: 35579696 PMCID: PMC9371999 DOI: 10.1007/s00264-022-05434-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/05/2022] [Indexed: 11/11/2022]
Abstract
Purpose The injury mechanisms and classifications of tibial plateau fractures (TPFs) are still controversial. The aim of this study is to show 3D fracture mapping of different types of tibial plateau fractures. Moreover, combined with Schatzker and ten-segment classification, we aimed to analyze the injury frequency and characteristics of different segments. Methods In total, 346 patients with TPFs treated at level I trauma centres from 2017 to 2021 were reviewed. The CT files of the included cases were typed and categorized. 3D reconstruction of TPFs patients’ CT files were performed using software. All fracture lines were superimposed on the standard model by the software to create TPFs 3D fracture mapping. Results This study included 204 male and 142 female patients (average age, 47 years [range, 18 to 83 years]) with a tibial plateau fracture. Using the Schatzker classification, we found 39 type I (11.27%), 103 type II (29.77%), nine type III (2.60%), 71 type IV (20.52%), 52 type V (15.03%), 59 type VI (17.05%) fractures, and 13 others (3.76%). The density areas of fracture lines are mainly located in the ALC and PLC segments (74.3%, 69.1%). In different views, fracture lines of different Schatzker types showed distinct distribution characteristics. Conclusions Schatzker classification combined with 3D fracture mapping provides a new presentation of tibial plateau fracture morphology. According to the 3D fracture mapping, different types of TPFs have distinctly different distribution characteristics of fracture lines. There are significant differences between different types of fracture injury segments.
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