Clinical outcomes of open reduction and internal fixation for intra-articular complex tibial plateau non-union with 3-year minimum follow-up

Biomechanical comparisons of plate placement for medial tibial plateau fractures (Schatzker type IV): A biomechanical study using porcine tibias

INTRODUCTION

Biomechanical studies on medial tibial plateau fractures (MTPFs) (Schatzker classification type IV) are currently few, while studies using locking plates (LPs) placed on medial proximal tibias are unavailable. Hence, we compared the biomechanical properties of plate osteosynthesis at the medial and anteromedial placements using large- and small-fragment LPs in porcine bones.

MATERIALS AND METHODS

MTPFs were internally fixed using LPs on 40 porcine tibias. Specimens were equally divided into four groups: medial placement using a large-fragment LP (LPs for the medial (LM) group), anteromedial placement using a large-fragment LP (LAM group), medial placement using a small-fragment LP (SM group), and anteromedial placement using a small-fragment LP (SAM group). The translation patterns of the constructs in each group were examined by cycling loading test (displacement and translation along the mechanical axis at 10-100, 100-500, 500-1000, 1000-1500, and 1500-2000 cycles). Then, articular gaps and step-off changes after 2000 cycles were compared among the four groups.

RESULTS

One-way analysis of variance (ANOVA) revealed no significant differences in displacement and translation during cyclic loading. One-way ANOVA followed by post hoc analysis revealed that the anterior gap was lower in LPs for the medial (LM) than in SM (P = 0.029) and SAM (P = 0.0026). The central gap was also lower in LM than in SM (P = 0.042) and SAM (P < 0.001), and it was lower in LAM than in SAM (P = 0.047). Likewise, the posterior gap was lower in LM than in LAM (P = 0.025) and SAM (P < 0.001). Furthermore, the central step-off of SAM was higher than that of LM, LAM, and SM (P < 0.001, P = 0.0014, and P = 0.0077, respectively). The posterior step-off was lower in LM than in SAM and LAM (P = 0.037 and P < 0.001), and it was also lower in SM than in SAM (P = 0.0082).

CONCLUSION

Medial LP placement for MTPFs in porcine bones resulted in significantly lower posterior step-offs after cyclic loading than anteromedial placement, and large-fragment LPs for MTPFs caused significantly lower fracture gaps in the central articular after cyclic loading than small-fragment LPs.

Treatment of tibial plateau fractures: A comparison of two different operation strategies with medium-term follow up

Background

The objective of this study was to compare the clinical and radiological outcomes of two surgical methods for tibial plateau fractures (TPFs): minimally invasive surgery (MIS) using a double reverse traction repositor and traditional open reduction internal fixation (ORIF).

Methods

From our prospectively collated database, 187 consecutive adult patients with 189 operatively treated TPFs in our level I trauma center were included from January 2015 to March 2018 who had a minimum of three years’ follow-up. All cases were performed by the senior surgeon using either MIS (group 1, 84 patients with 84 TPFs) or ORIF (group 2, 103 patients with 105 TPFs). Details of the demographics, injury mechanism, pre- and postoperative follow-up imaging, operative procedures and complications were collected. The final results from the 36-Item Short-Form Health Survey (SF-36), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Hospital for Special Surgery (HSS) were obtained at the final follow-up.

Results

Clinically, significant differences were observed in the WOMAC (pain, P ​= ​0.001; stiffness, P ​< ​0.001), HSS (P ​= ​0.003) and SF-36 (P ​= ​0.001). Radiologically, significant intergroup differences were observed in the loss of immediate postoperative reduction rates, secondary loss of reduction rates and signs of osteoarthritis (Kellgren–Lawrence). Two and ten superficial infections in group 1 (2.4%) and group 2 (9.5%), respectively, and 6 lateral popliteal nerve palsy cases occurred (0 MIS, 6 ORIF), with significant intergroup differences.

Conclusion

Our study shows that the MIS using a double reverse traction repositor is promising and safe technique for the TPFs when used for the correct indications.

The translational potential of this article

The current status of using a minimally invasive surgery for the treatment of TPFs have been analyzed and a new method of using a double reverse traction repositor for the treatment of TPFs have been proposed in this study, which updated treatment concept of TPFs.

Characteristics, Treatments, and Outcomes of Tibial Plateau Nonunions: A Systematic Review

BACKGROUND

Due to the rare incidence of tibial plateau nonunions, current studies are limited to small sample sizes and patient demographics. The aim of this systematic review is to quantify and report patient and fracture traits, possible risk factors, and treatment outcomes of tibial plateau nonunions.

METHODS

PubMed, Clinical Key, and MEDLINE were searched for articles published prior to August 2020 in accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The authors used varying combinations of the following terms to identify relevant articles: "tibial," "plateau," "nonunion," "non-union." Studies were assessed for patient demographics, pre-revision nonunion characteristics, treatment, and post-revision outcomes.

RESULTS

Eight studies were included, yielding 31 tibial plateau nonunions (21 males, 10 females). The majority of nonunions were associated with high energy trauma (52.2%) and were Schatzker class VI (54.8%). Schatzker class I and II nonunions were not attributed to neglect, contradicting previous suggestions. Time to union was 4.0 months, the most common treatments being autologous bone grafting (76.7%) and revision plating (63.3%).

CONCLUSION

This study demonstrates the effectiveness of autologous bone grafts and revision plating for tibial plateau nonunions. Physicians may use these findings to guide decision making in the event of high energy plateau nonunions. Lastly, various limitations exist within the current literature, emphasizing the need for standardized reporting measures.