Comparison of the intraarticular osteotomy and the "window" osteotomy in the treatment of tibial plateau fracture involving depressed posterolateral fragments

Evaluating the outcomes of three dimensional printing-assisted osteotomy on treating varus knee deformity from old tibial plateau fractures

PURPOSE

This study aimed to evaluate the outcomes of three-dimensional (3D) Printing-Assisted Osteotomy in treating varus knee deformity from old tibial plateau fractures.

METHODS

The study retrospectively analyzed patients with varus deformity induced by old-tibial plateau fractures between January 2019 and June 2023. All patients utilized 3D printed models for surgical planning. The Lysholm Knee Score (LKS), Visual Analog Scale (VAS) and Knee Society Score (KSS) were measured for functional outcomes. Medial Proximal Tibial Angle (MPTA), Joint Line Convergence Angle (JLCA), Mechanical Axis (%MA), Medial Tibial Plateau Depression (MTPD), and Femorotibial Angle (FTA) were measured for radiological outcomes.

RESULTS

15 patients (12 males and 3 females) were included in this study and followed up for 21.9 ± 8.6 (range, 12 to 28) months. Healing of the osteotomy sites were achieved in all patients at 15.8 ± 1.5 (range, 13 to 18) weeks. The knee varus deformities were significantly corrected as reflected by %MA (2.13 ± 13.1°(range, -20 to 22) versus 57.06 ± 9.8°(range, 41 to 70), p < 0.01), FTA (186.7 ± 3.2°(range, 181 to 193) versus 172.3 ± 2.1°(range, 169 to 175), p < 0.01), JLCA (5.8 ± 1.7°(range, 3 to 8) versus 1.3 ± 0.8°(range, 0 to 3), p < 0.01), and MPTA (5.6 ± 1.2°(range, 3 to 8) versus 1.2 ± 1.1°(range, -1 to 3), p < 0.01). Postoperative knee function showed dramatic improvements as reflected by VAS (4.6 ± 1.6 (range, 1 to 7) versus 0.7 ± 0.9 (range, 0 to 2), p < 0.01), KSS (50.1 ± 16.5 (range, 27 to 88) versus 88.5 ± 5.2 (range, 80 to 95), p < 0.01), and LKS (49.5 ± 10.2 (range, 37 to 69) versus 89.2 ± 2.5 (range, 87 to 94), p < 0.01).

CONCLUSIONS

3D printing technology provides a valuable tool for understanding deformities and optimizing osteotomy strategies, thereby improving surgical efficacy and treatment outcomes. Its clinical application is highly recommended.

Surgical treatment of AO/OTA 41B3 and 41C tibial plateau fractures with a temporary bi-frame fixator combined with the MIPPO technique

BACKGROUND

This study evaluated the clinical effects of the use of a temporary bi-frame fixator in conjunction with minimally invasive percutaneous plate osteosynthesis (MIPPO) for treating AO/OTA 41B3 and 41C tibial plateau fractures (TPFs).

METHODS

This was a retrospective analysis of 30 patients with TPFs affected by vertical compression seen from October 2019 to October 2020. All patients were treated with a bi-frame fixator to correct the vertical shortening deformity, with the MIPPO technique used after reduction. All patients underwent routine examinations at 1, 3, 6, 12 and 24months postoperatively and then annually. Clinical parameters assessed included the Hospital for Special Surgery score (HSS), number of assistants, intraoperative hemorrhage, intraoperative fluoroscopy frequency, length of hospital stay, and time to fracture healing. Radiographic findings were assessed using Rasmussen scores.

RESULTS

All patients had satisfactory fracture reduction on postoperative imaging. The average operating time was 112.03 ± 20.9 min, with 15.79 ± 3.45 fluoroscopic exposures; the average blood loss was 66.63 ± 10.88 mL, the average length of hospital stay was 12.86 ± 5.11 days, and the average fracture healing time was 10.33 ± 1.48 weeks. The mean follow-up time was 23.18 ± 2.59 months. At the last follow-up, the Rasmussen anatomical score was excellent in 22 (75.3%) patients, good in 5 (16.7%), and fair in 3 (10%). The average HSS was 65.7 ± 3.26, 82.26 ± 2.28, and 87.66 ± 2.4 after 1, 6, and 12 months, respectively, and it was 92.56 ± 2.96 at the last follow-up (F = 1073.073, P < 0.001). No complications occurred in any patient during follow-up.

CONCLUSION

For AO/OTA 41B3 and 41C fractures of the tibial plateau, the use of a temporary bi-frame fixator combined with the MIPPO technique can correct the compressed displacement, reduce soft tissue damage, and facilitate surgical reduction, which aid the recovery of joint function.

A feasibility study of robot-assisted percutaneous reduction and fixation technique for treating posterolateral depression tibial plateau fractures

Posterolateral (PL)-depression fractures of the tibial plateau are difficult to manage. The aim of this study was: (1) to present our experience with a novel technique of robot-assisted percutaneous reduction and fixation and (2) to compare it with the traditional percutaneous screw osteosynthesis (PSO) technique for the treatment of PL-depression tibial plateau fractures. The clinical data of patients with PL-depression tibial plateau fractures treated by robot-assisted percutaneous reduction and fixation technique and traditional PSO technique from January 2017 to January 2021 were retrospectively analyzed. Among them, there were 18 cases in the robot-assisted group (RA group) and 23 cases in the PSO group. All fractures were unilateral, closed and fresh PL-depression fractures of the tibial plateau. Patients in the RA group were treated by robot assisted reduction and minimally invasive absorbable screw fixation. The PSO group was treated by closed reduction and percutaneous absorbable screw osteosynthesis. The incision length, operation time, intraoperative blood loss, fluoroscopic times, inpatient time, weight training time and postoperative complications of the two groups were statistically analyzed. The Rasmussen radiological score was used to assess the reduction quality after operation while the Rasmussen functional score was used to evaluate knee joint functions at one year postoperatively. All patients were followed for at least one year. There was no significant difference in demographic information between the two groups (p > 0.05). Compared with the PSO group, the RA group showed less fluoroscopic times and better Rasmussen radiological and functional scores (p < 0.05). Besides, there was no significant difference in the incidence of postoperative complications between the two groups (p > 0.05). The novel robot-assisted percutaneous reduction and fixation technique had the characteristics of less radiation, accurate reduction and fixation. It could accelerate the rehabilitation of patients with PL-depression fractures of the tibial plateau and enable patients to obtain good joint functions.