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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Niebuhr D, Mattson T, Jensen NM, Viberg B, Steenstrup Jensen S. Risk factors for tibial infections following osteosynthesis - a systematic review and meta-analysis. J Clin Orthop Trauma 2024; 50:102376. [PMID: 38444773 PMCID: PMC10909754 DOI: 10.1016/j.jcot.2024.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Aim This study aimed to quantitatively summarise risk factors associated with surgical site infection (SSI) following surgically managed tibial fractures. Method We searched the Embase/Medline, Cochrane Library, and Scopus databases for relevant studies in October 2023. We included original studies investigating risk factors for SSI following surgically managed traumatic tibial fractures that included ≥10 adult patients with SSIs. Meta-analysis was performed when >5 studies investigated the same risk factor. The risk of bias was assessed using the critical appraisal checklist from Joanna Briggs Institute for cohort studies. Results This study included 42 studies comprising 24,610 patients with surgically managed tibial fractures and 2,418 SSI cases. The following were identified as significant risk factors for SSI (p < 0.05): compartment syndrome (odds ratio [OR] = 3.8, 95% confidence interval [CI]: 2.4-6.0), blood transfusion (OR = 3.8, 95% CI: 2.1-6.6), open fracture (OR = 3.6, 95% CI: 2.5-5.1), Gustilo-Anderson classification >2 (OR = 3.1, 95% CI: 2.1-4.6), external fixation (OR = 2.9, 95% CI: 2.3-3.8), American Society of Anesthesiologists classification >2 (OR = 2.5, 95% CI: 1.5-4.1), polytrauma (OR = 2.4, 95% CI: 1.5-4.0), dual incision approach (OR = 2.1, 95% CI: 1.5-3.0), smoking (OR = 1.8, 95% CI: 1.5-2.1), male sex (OR = 1.6, 95% CI: 1.3-1.8), high energy trauma (OR = 1.5, 95% CI: 1.1-2.1), and prolonged surgery time (OR = 0.62, 0.43-0.82). Other factors, including diabetes, hypertension, and time to surgery, were not identified as risk factors for SSI. However, the included studies were generally of poor quality and at risk of bias. Conclusions The review provides a basis for preoperatively assessing a patient's risk of developing an SSI, which could be used to initiate adjusted antibiotic regimes and more frequent postoperative controls. Furthermore, it indicates the risk factors future research should include when adjusting for confounding factors.
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Affiliation(s)
- Diana Niebuhr
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
| | - Thomas Mattson
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Martin Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Vejle, Denmark
| | - Bjarke Viberg
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Signe Steenstrup Jensen
- Department of Orthopedic Surgery and Traumatology, Lillebaelt Hospital, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Glasgow K, Conway Y, Mihas AK, Coffin MD, Stallworth J, Cichos KH, Spitler CA. Does pes anserinus tenotomy affect surgical site infection rate in operative tibial plateau fractures? Eur J Orthop Surg Traumatol 2024; 34:615-620. [PMID: 37667112 DOI: 10.1007/s00590-023-03711-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To assess if pes anserinus tenotomy (PAT) during definitive open reduction and internal fixation (ORIF) of tibial plateau fractures is associated with a decreased risk of surgical site infection (SSI) and other postoperative complications. METHODS A retrospective review of all adults who underwent ORIF for tibial plateau fractures from April 2005 to February 2022 at single level 1 trauma center was performed. Patients who had a medial approach to the plateau with minimum three-month follow-up were required for inclusion. All patients with fasciotomy for compartment syndrome or with traumatically avulsed or damaged pes anserinus prior to ORIF were excluded. Two groups were created: those who received a pes anserinus tenotomy with repair (PAT group) and those whose pes anserinus were spared and left intact (control group). Patient demographics, injury and operative characteristics, and surgical outcomes were compared. The primary outcomes were rates of deep and superficial SSI. RESULTS The PAT group had significantly lower rates of deep SSI (9.2% vs. 19.7%, P = 0.009), superficial SSI (14.2% vs. 26.5%), P = 0.007), and any SSI (15.8% vs. 28.9%, P = 0.005). Multiple logistic regression showed that heart failure (aOR = 7.215, 95% CI 2.291-22.719, P < 0.001), and presence of open fracture (aOR = 4.046, 95% CI 2.074-7.895, P < 0.001) were independently associated with increased odds of deep SSI, while PAT was associated with a decreased odds of deep SSI (aOR = 0.481, 95% CI 0.231-0.992, P = 0.048). PAT had significantly lower rates of unplanned return to the operating room (20.8% vs. 33.7%, P = 0.010) and implant removal (10.0% vs. 18.0%, P = 0.042). CONCLUSION While these data do not allow for discussion of functional recovery or strength, pes anserinus tenotomy was independently associated with significantly lower rates of infection, unplanned operation, and implant removal. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Katie Glasgow
- Heersink School of Medicine, University of Alabama at Birmingham, 510 20th St S, Birmingham, AL, 35210, USA
| | - Yvonne Conway
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street S, Birmingham, AL, 35205-5327, USA
| | - Alexander K Mihas
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street S, Birmingham, AL, 35205-5327, USA
| | - Megan D Coffin
- Heersink School of Medicine, University of Alabama at Birmingham, 510 20th St S, Birmingham, AL, 35210, USA
| | - James Stallworth
- Heersink School of Medicine, University of Alabama at Birmingham, 510 20th St S, Birmingham, AL, 35210, USA
| | - Kyle H Cichos
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street S, Birmingham, AL, 35205-5327, USA
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street S, Birmingham, AL, 35205-5327, USA.
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 510 20th St South, Faculty Office Tower Suite 901, Birmingham, AL, 35294, USA.
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Tapper V, Reito A, Pamilo K, Ylitalo A, Toom A, Paloneva J. Complications and secondary operations after non-operative and operative treatment of tibial plateau fractures: a population-based study of 562 patients with mean follow-up of 7 years. Arch Orthop Trauma Surg 2024; 144:269-280. [PMID: 37921992 DOI: 10.1007/s00402-023-05102-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION The incidence of tibial plateau fractures (TPF) is 1% of all fractures and increases with age. Whether non-operatively or operatively treated, complications (infection, malalignment, loss of reduction and delayed union or nonunion) and post-traumatic osteoarthritis are not uncommon, and the risk for complications has generally been assumed to rise with age. This study investigated all post-TPF complications and secondary surgery after non-operative and operative treatment. Secondary aims were to determine the incidence and epidemiology of TPF in the population of the Central Finland region. MATERIALS AND METHODS All patients over age 18 years with a TPF, including incidence, etiology, fracture type, and possible complications and reoperations, sustained during the period 1998-2019 were retrospectively identified from hospital records. RESULTS The annual mean incidence of TPF was 14.4/100,000, with older women at highest risk. The proportions of non-operative and operatively treated patients who had undergone at least one additional surgical operation were 6% and 26%, respectively. Age and female gender were identified as risk factors for complications and secondary operations. The risk peaked in patients aged 60-65 years, decreasing thereafter. Non-operative treatment showed low risk for both non-union and loss of reduction. CONCLUSIONS Older women were at the highest risk for TPF and for subsequent complications and secondary operations after TPF. Secondary operations after operatively treated TPF were not uncommon and patients aged 60-65 years were at highest risk. Given the low rates of complications and re-operations, non-operative treatment may be a safe option in cases of all minimally displaced TPF.
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Affiliation(s)
- Valtteri Tapper
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland.
| | - Aleksi Reito
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Antti Ylitalo
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Alar Toom
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland
| | - Juha Paloneva
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland
- University of Eastern Finland, Kuopio, Finland
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Pizzoli A, Bondi M, Piotto L, Tartaglia N, Saracino M, Vyrva O. Efficacy of Cal-Cemex as bone substitute for tibial plateau fractures. J Orthop Surg Res 2023; 18:836. [PMID: 37932755 PMCID: PMC10626643 DOI: 10.1186/s13018-023-04323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Various factors influence treatment and outcomes in tibial plateau fractures. Bone defects are among them. Many materials have been proposed to address this problem: allograft, bone-cements and various bone substitutes (BSM). Cal-Cemex (β-tricalciophosphate and polymethylmethacrylate) is a new hybrid bi-component BSM. A retrospective multicenter study was conducted based on the clinical experience of three European Hospitals, to demonstrate its clinical effectiveness, versatility and safety. MATERIALS AND METHODS From December 2016 to March 2022, 45 displaced tibial plateau fractures were treated with internal fixation and augmentation using Cal-Cemex. The average age was 55.9 years. According to Schatzker classification, we included 13 type II, 24 type III, 3 type V and 4 type VI fractures. The postoperative follow-up (FU) consisted of clinical and radiological examinations at 6 and 12 weeks and 1 year after surgery. A CT scan was performed preoperatively and 1 year after surgery. Full weight bearing was permitted after less than 6 weeks. Clinical data were collected from patient charts, while functional data were evaluated using the Rasmussen knee function score, the KOOS score and the Hospital for Special Surgery knee rating score (HSS), to evaluate the range of motion, axis and functionality of the knee. RESULTS The average FU was 42.8 months. CT scans taken at 1 year demonstrated a good surface osteointegration without radiolucent lines or osteolysis with good evidence of interdigitation and even bone ingrowth. At 1-year FU, the mean Rasmussen score was 24.7, the mean KOOS score was 90.7 and the mean HSS was 89.9 and the average full weight-bearing period 34.9. No patients had hardware failure or fracture secondary displacement. DISCUSSION Cal-Cemex combines biological features and good mechanical performances. It guarantees biocompatibility and osteoconductivity, although it is not fully reabsorbable; β-tricalciophosphate component gives macro- and microporosity that allow fluids to penetrate inside the material, to stimulate bone ingrowth. CONCLUSIONS The study suggests that Cal-Cemex is an option for tibial plateau fractures, where augmentation and support are necessary for early full weight bearing. The absence of major complications, ease of application, the possibility to cut and perforate this material support its extensive use in bone augmentation for trauma cases.
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Affiliation(s)
- Andrea Pizzoli
- Department of Orthopaedics and Traumatology, ASST - Mantova, Carlo Poma Hospital, Strada Lago Paiolo 10, 46100, Mantua, Italy
| | - Manuel Bondi
- Department of Orthopaedics and Traumatology, ASST - Mantova, Carlo Poma Hospital, Strada Lago Paiolo 10, 46100, Mantua, Italy.
| | - Laura Piotto
- Department of Orthopaedics and Traumatology, ASST - Mantova, Carlo Poma Hospital, Strada Lago Paiolo 10, 46100, Mantua, Italy
| | - Nicola Tartaglia
- U.O.S.D. Traumatology, Hospital Miulli, Acqua Viva Delle Fonti, Bari, Italy
| | - Michele Saracino
- U.O.S.D. Traumatology, Hospital Miulli, Acqua Viva Delle Fonti, Bari, Italy
| | - Oleg Vyrva
- Bone Tumor Department, Ukrainian National Academy of Medical Sciences, Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
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Grisdela P Jr, Olson J, Guild T, Dekhne M, Hresko A, Singh UM, Weaver MJ, von Keudell A, Stenquist D. Complications and timing of soft tissue coverage after complete articular, open tibial plateau fractures. Injury 2023; 54:722-7. [PMID: 36543739 DOI: 10.1016/j.injury.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/21/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Complete articular tibial plateau fractures are typically high-energy injuries associated with significant soft tissue trauma. The primary aim of this study was to evaluate the incidence of wound complications and need for soft tissue coverage after open, complete articular tibial plateau fractures. The secondary aim was to study the effect of timing of fixation and timing of flap coverage on deep infection rates in these injuries. METHODS This was a retrospective cohort study of consecutive patients > 18 years undergoing ORIF of a Bicondylar Tibial Plateau (BTP) fracture between 2001 and 2018. Surgical data were recorded for open fractures including number of debridements, timing of definitive ORIF and soft tissue coverage relative to injury. Primary outcomes included rates of deep infection and unplanned reoperation. RESULTS 508 AO/OTA 41C BTP fractures were identified, with 51 open fractures included in 50 patients with a mean (SD) age 45.7 (12.3) years and a mean (SD) follow up of 4.3 (3.8) years. There were 20 cases of deep infection, unplanned reoperation occurred in 26 cases. The majority of cases (28 fractures) had initial external fixation placed, while 24 had ORIF at the initial debridement. Twelve patients had a planned flap for definitive closure on average of 6.4 days (SD 3.9) after injury, 14 required a flap for wound complications. Among patients with IIB and C injuries, rates of deep infection (5/6 vs 1/6, p = 0.02) and reoperation (5/7 vs 2/6, p = 0.08) were higher in patients treated with flap coverage >7 days from injury compared to early flap coverage. There were no differences in complication rates between early (<24hrs) and delayed fixation. CONCLUSIONS Complete articular, open tibial plateau fractures are associated with high rates of complications. Time to flap coverage of seven days or more was a significant predictor of deep infection and unplanned reoperation in this cohort. Patients should be counseled about the high rate of unplanned reoperation and definitive soft tissue coverage should be accomplished within a week of injury whenever possible.
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Sobolevskiy Y, Burianov OA, Kvasha V, Skobenko Y, Omelchenko T, Parii V. BIOMECHANICAL STUDY OF MINIMALLY INVASIVE TECHNIQUES IN SURGICAL TREATMENT OF THE TIBIA PROXIMAL EPIMETAPHYSIS FRACTURES. Wiad Lek 2023; 76:1768-1775. [PMID: 37740969 DOI: 10.36740/wlek202308110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
OBJECTIVE The aim: Improving efficiency of the tibia proximal epimetaphysis fractures treatment by introducing minimally invasive techniques using the up-to-date metallic constructions. PATIENTS AND METHODS Materials and methods: The study is based on the results of examination and treatment of 119 patients, using arthroscopic technique. The results were evaluated regarding the P. Rasmussen scheme, post-traumatic arthrosis -Kellgren - Lawrence, life quality - «SF-36 Health Status Survey». RESULTS Results: The offered treatment method provided for the following: good outcomes in BI- 94.1%, satisfactory ones - 5.9%; respectively in BII - 91.7%, 8.3%; ВIII - 92.9%, 7.1%; СI- 87.5%,12.5%; СII - 91.7%, 8.3%; СIII -88.9%, 7.4%, unsatisfactory outcomes - 3.7. CONCLUSION Conclusions: The tibia proximal epimetaphysis fractures make up from 8.9% to 11% of all lower leg fractures and up to 87% of the knee joint fractures. Such fractures are accompanied with the knee joint soft tissue injuries in up to 56% of cases. The meniscus injury is diagnosed in 50-94% of the patients; collateral ligament injury: 20% - 83%; anterior cruciate ligament injury : 20% - 69%, femoral muscle ligament injury- up to 47%, joint capsule ruptures - up to 75%, fibular nerve injury - 3% of cases. The treatment fails in 24.2-50% of cases. Operative treatment of such injuries using arthroscopic method provides for mini-invasive intervention character, visualizing and splint reposition control; the opposite compression screw provides for strong fixation.
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Affiliation(s)
| | | | | | | | | | - Vasyl Parii
- BOGOMOLETS NATIONAL MEDICAL UNIVERSITY, KYIV, UKRAINE
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Jiang L, Li H, Huang L. The Efficacy of 3D Printing Model in the Intraarticular Osteotomy in the Treatment of Malunion of Tibial Plateau Fracture. Orthop Surg 2022; 15:85-92. [PMID: 36373339 PMCID: PMC9837246 DOI: 10.1111/os.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Three-dimensional (3D) printing technology has shown potential advantages in accurate and efficient tibial plateau fracture (TPF) treatment. This technology can provide structural morphology to repair fracture fragments. Here, we summarize our experience with the use of 3D printing technology during intraarticular osteotomy in the treatment of the malunion of TPF. METHODS The patients who were treated with malunion of TPF in our hospital between January 2015 and December 2018 were retrospectively analyzed. These patients were divided into two groups: the conventional group without 3D-printed model application and the 3D printing group with 3D-printed model application. All patients received the intraarticular osteotomy during operation, and we compared the operation time (min), fracture healing time (months), postoperative knee Rasmussen scores (0-30 points), knee mobility range (0-140°) (the independent t-test), fracture reduction evaluation (Biggi's method) (the chi-square test: Fisher's exact test), and postoperative complications of each group. RESULTS Twenty-six patients aged 18-65 years who underwent TPF revision operation were included in this study, including 18 patients in the conventional group, and eight patients in the 3D printing group. The follow-up time was 24-48 months, and the operation time was 185 min in the conventional group and 180 min in the 3D printing group. All patients received a bone union at the last follow-up. The healing time was 4.2 months in the conventional group and 3.75 months in the 3D printing group (p > 0.05). The respective postoperative Rasmussen scores were 24.6 and 26.2, and postoperative knee mobility was 103.5° and 118.5° in the conventional group and 3D printing group, respectively. Both the Rasmussen scores and degrees of mobility were significantly improved after surgery (p < 0.05), and the postoperative knee mobility was significantly better in the 3D printing group versus the conventional group (p < 0.05). Four patients still had a 2-mm collapse on the articular surface, and two patients still had slight valgus (<5°) in the conventional group. Only one case in the 3D printing group suffered from an articular surface collapse. Superficial wound infections occurred in two patients in the conventional group. CONCLUSION The results show that 3D printing technology is an effective preoperative preparation in the treatment of TPF malunion. This technology can facilitate accurate preoperative planning to select the optimal surgical approach, plan the implant placement, visualize the screw trajectory, and anticipate possible intraoperative difficulties.
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Affiliation(s)
- Liangjun Jiang
- Department of Orthopaedic Surgery, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina,Orthopaedics Research Institute of Zhejiang UniversityHangzhouChina,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang ProvinceHangzhouChina,Clinical Research Center of Motor System Disease of Zhejiang Province PR ChinaHangzhouChina
| | - Hang Li
- The Orthopaedics Department of 2nd Affiliated Hospital of Medical College of Zhejiang UniversityHangzhouChina
| | - Lu Huang
- Department of Orthopaedic Surgery, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina,Orthopaedics Research Institute of Zhejiang UniversityHangzhouChina,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang ProvinceHangzhouChina,Clinical Research Center of Motor System Disease of Zhejiang Province PR ChinaHangzhouChina
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Deemer AR, Jejurikar N, Konda S, Leucht P, Egol KA. Approach variation affects outcomes after operative repair of lateral tibial plateau fractures. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03343-7. [PMID: 35916931 DOI: 10.1007/s00590-022-03343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To determine if the type of approach used for treatment of lateral split-depression tibial plateau fractures affects clinical outcome and complications rate. METHODS This is a retrospective review of 169 patients who presented between 01/2005 and 12/2020 to a Level-I trauma center for operative management of an isolated lateral Schatzker II tibial plateau fractures (AO/OTA Type 41B3.1) treated through a single anterolateral approach: a 90-degree "L" (L), longitudinal vertical (V), or "lazy S" (S). Postoperative radiographic, clinical, and functional outcomes were assessed at 3, 6, 12 months, and beyond. RESULTS Average time to radiographic healing was longer in the S incision cohort (p < 0.05). Furthermore, patients within the S incision cohort developed more postoperative wound complications at follow-up when compared to those within the L and V incision cohorts (p < 0.05). Additionally, reoperation rates were greater in the S incision cohort (p < 0.05). Lastly, on physical examination of the knee, patients within the S incision cohort had significantly poorer knee range of motion (p < 0.05). CONCLUSIONS Our study demonstrates that skin incision type in the anterolateral approach to the proximal tibia has an association with outcomes following operative repair of tibial plateau fractures. The information from this study can be used to inform surgeons about the potential complications and long-term outcomes that patients may experience when undergoing operative repair of a tibial plateau fracture through a specific incision type. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexa R Deemer
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Neha Jejurikar
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Sanjit Konda
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, New York, NY, USA
| | - Philipp Leucht
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, NYU Langone Medical Center, 301 E 17th Street, New York, NY, 10003, USA.
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Keil LG, Mullis BH, Iii PT, Alley MC, Olszewski NP, Wheeler JA, von Kaeppler EP, Morshed S, Matar RN, Archdeacon MT, Smith TW, Miller AN, Horwitz DS, Baig MS, Telgheder ZL, Azer E, Manzano GW, Vallier HA, Barnett SA, Krause PC, Bornes TD, Ricci WM, Dunne PJ, Yarboro SR, Ment AJ, Marcantonio AJ, Alqudhaya RS, Leighton RK, Ostrum RF. Proximal tibia fracture dislocations: Management and outcomes of a severe and under-recognized injury. Injury 2022; 53:1260-1267. [PMID: 34602250 DOI: 10.1016/j.injury.2021.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/05/2021] [Accepted: 09/17/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Proximal tibia fracture dislocations (PTFDs) are a subset of plateau fractures with little in the literature since description by Hohl (1967) and classification by Moore (1981). We sought to evaluate reliability in diagnosis of fracture-dislocations by traumatologists and to compare their outcomes with bicondylar tibial plateau fractures (BTPFs). METHODS This was a retrospective cohort study at 14 level 1 trauma centers throughout North America. In all, 4771 proximal tibia fractures were reviewed by all sites and 278 possible PTFDs were identified using the Moore classification. These were reviewed by an adjudication board of three traumatologists to obtain consensus. Outcomes included inter-rater reliability of PTFD diagnosis, wound complications, malunion, range of motion (ROM), and knee pain limiting function. These were compared to BTPF data from a previous study. RESULTS Of 278 submitted cases, 187 were deemed PTFDs representing 4% of all proximal tibia fractures reviewed and 67% of those submitted. Inter-rater agreement by the adjudication board was good (83%). Sixty-one PTFDs (33%) were unicondylar. Eleven (6%) had ligamentous repair and 72 (39%) had meniscal repair. Two required vascular repair. Infection was more common among PTFDs than BTPFs (14% vs 9%, p = 0.038). Malunion occurred in 25% of PTFDs. ROM was worse among PTFDs, although likely not clinically significant. Knee pain limited function at final follow-up in 24% of both cohorts. CONCLUSIONS PTFDs represent 4% of proximal tibia fractures. They are often unicondylar and may go unrecognized. Malunion is common, and PTFD outcomes may be worse than bicondylar fractures.
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Affiliation(s)
- Lukas G Keil
- Departmentof Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, United States.
| | - Brian H Mullis
- Indiana University Department of Orthopaedics, Indianapolis, IN
| | - Paul Tornetta Iii
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, United States
| | - Maxwell C Alley
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, United States
| | - Nathan P Olszewski
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, United States
| | | | - Ericka P von Kaeppler
- Department of Orthopaedic Surgery, University of San Francisco, California, San Francisco, CA, United States
| | - Saam Morshed
- Department of Orthopaedic Surgery, University of San Francisco, California, San Francisco, CA, United States
| | - Robert N Matar
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Michael T Archdeacon
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Tyler W Smith
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Anna N Miller
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Daniel S Horwitz
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, PA, United States
| | - Mirza Shahid Baig
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, PA, United States
| | | | - Emil Azer
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - Givenchy W Manzano
- Department of Orthopaedic Surgery, MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, OH, United States
| | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, OH, United States
| | - Scott A Barnett
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, LA, United States
| | - Peter C Krause
- Department of Orthopaedic Surgery, Louisiana State University, New Orleans, LA, United States
| | - Troy D Bornes
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - William M Ricci
- Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - Patrick J Dunne
- Department of Orthopaedics, University of Virginia, Charlottesville, VA, United States
| | - Seth R Yarboro
- Department of Orthopaedics, University of Virginia, Charlottesville, VA, United States
| | - Alexander J Ment
- Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA, United States
| | - Andrew J Marcantonio
- Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA, United States
| | | | - Ross K Leighton
- Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Robert F Ostrum
- Departmentof Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, United States
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Warren D, Domingue G, Riehl JT. Management of unicondylar tibial plateau fractures: a review. Current Orthopaedic Practice 2022; 33:85-93. [DOI: 10.1097/bco.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Jiahao L, Kun Z, Binfei Z, Yan Z, Hanzhong X, Shuangwei Q, Chen F, Na Y, Ding T, Pengfei W. Relationship Between the Incidence of Deep Vein Thrombosis During Hospitalization and the Energy of Injury in Tibial Plateau Fractures. Clin Appl Thromb Hemost 2021; 26:1076029620913948. [PMID: 32988241 PMCID: PMC7545747 DOI: 10.1177/1076029620913948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to investigate the relationship between the incidence of deep vein thrombosis (DVT) during hospitalization and the energy of injury in tibial plateau fractures (TPFs). One hundred and forty patients were enrolled between September 1, 2014, and October 1, 2017. According to Schatzker's classification, they were classified into the low-energy (type I-III) and high-energy (type IV-VI) groups. For DVT evaluation, duplex ultrasonography was performed in the lower extremities preoperatively and postoperatively. The location and changes of DVT were recorded. All patients underwent mechanical and chemical thromboprophylaxis. The incidence of DVT in TPFs was 36.43% and 46.43% preoperatively and postoperatively, respectively. The DVT incidence was 31.75% (20/63) in the low-energy group and 40.26% (31/77) in the high-energy group preoperatively, and 44.44% (28/63) in the low-energy group and 48.05% (37/77) in the high-energy group postoperatively. There was no significant difference between the 2 groups preoperatively (P = .298) and postoperatively (P = .785). The days between operation and discharge (P = .016), blood loss during surgery (P = .016), and preoperative d-dimer level (P = .02) showed differences between the 2 groups. Additionally, 29 new thrombi (14 [48.28%] in the high-energy group and 15 [51.72%] in the low-energy group) appeared and 16 preoperative thrombi disappeared postoperatively. Despite mechanical and chemical thromboprophylaxis, the DVT risk in patients with TPFs remains high. Although the DVT incidence is not significantly different between high-energy and low-energy injuries, the occurrence of DVT should be carefully monitored.
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Affiliation(s)
- Li Jiahao
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
- Department of Hand and Foot Microsurgery, Baoji Hospital of Traditional Chinese Medicine, Shaanxi, China
| | - Zhang Kun
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Zhang Binfei
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Zhuang Yan
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Xue Hanzhong
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Qu Shuangwei
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Fei Chen
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Yang Na
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Tian Ding
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
| | - Wang Pengfei
- Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China
- Wang Pengfei, Department of Orthopedics and Traumatology, Xi’an Honghui Hospital, Xi’an JiaoTong University Health Science Center, Xi’an, China.
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Fraind-Maya G, Laniado D, Ilsar I, Chaimsky G, Mosheiff R, Weil Y. Meniscal Entrapment After Tibial Plateau Fracture and Fixation: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00082. [PMID: 34014849 DOI: 10.2106/jbjs.cc.20.01012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 40-year-old man presented with limited in range of motion, pain, and tenderness over the medial joint line after an open reduction and internal fixation (ORIF) because of a bicondylar tibial plateau fracture (TPF). The cause of his pain was inconclusive on Magnetic Resonance Image (MRI), so arthroscopy was performed and identified an incarcerated medial meniscus at the fracture site. An osteotomy with medial joint elevation was performed followed by a meniscus release, with excellent results at the 1-year follow-up. CONCLUSION To our knowledge, this is the first case reporting a trapped/incarcerated meniscus in a healed TPF after ORIF.
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Matsumura T, Nakashima M, Takahashi T, Takeshita K. Clinical outcomes of open reduction and internal fixation for intra-articular complex tibial plateau non-union with 3-year minimum follow-up. J Orthop Sci 2021; 26:403-408. [PMID: 32389354 DOI: 10.1016/j.jos.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND A tibial plateau fracture is one of the most challenging fractures for both knee and trauma surgeons because of the high incidence of post-traumatic knee osteoarthritis. To our knowledge, there has been no study concerning the clinical outcomes after surgery in patients with non-union of complex intra-articular tibial plateau fractures. Thus, the present study aimed to assess and report the clinical outcomes in them. METHODS The study included four patients with non-union of complex tibial plateau fractures who underwent failed initial fixation treatment or could not undergo initial fixation owing to concomitant injury and who were followed up with a diagnosis of non-union for a minimum of 6 months. At the latest follow-up, patient-reported outcome measures, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford 12-item Knee Score (OKS), were assessed. Additionally, the knee range of motion (ROM) was evaluated. RESULTS The mean duration from the initial surgery to revision surgery was 8.8 months, and the mean duration from the revision surgery to fracture union was 4.8 months. At the latest follow-up, the mean WOMAC score was 9.8 and the mean OKS was 43.5. Additionally, the mean knee ROM values were -11 degrees of extension and 100 degrees of flexion. All four patients had become able to walk without any aid after averaged 4.5-years follow up. CONCLUSION Favorable clinical outcomes can be achieved following revision surgery involving open reduction and IF in patients with non-union of complex tibial plateau fractures after failed initial treatment. LEVEL OF EVIDENCE Level IV, Case report.
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Affiliation(s)
- Tomohiro Matsumura
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Mitsuharu Nakashima
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan.
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Shimotsuke, Japan
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Telis AL, Tucker DW, Compton E, DeSanto DJ, Carney JJ, Scolaro JA, Marecek GS, Lee AK. Treatment of tibial plateau fractures with a novel fenestrated screw system for delivery of bone graft substitute. Eur J Orthop Surg Traumatol 2021; 31:1321-1327. [PMID: 33486537 DOI: 10.1007/s00590-021-02871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to describe the incidence of subsidence in patients with AO/OTA 41 (tibial plateau) fractures which were repaired with a novel fenestrated screw system to used to deliver CaPO4 bone substitute material to fill the subchondral void and support the articular reduction. METHODS Patients with unicondylar and bicondylar tibial plateau fractures were treated according to the usual technique of two surgeons. After fixation, the Zimmer Biomet N-Force Fixation System®, a fenestrated screw that allows for the injection of bone substitute was placed and used for injection of the proprietary calcium phosphate bone graft substitute into the subchondral void. For all included patients, demographic information, operative data, radiographs, and clinic notes were reviewed. Patients were considered to have articular subsidence if one or more of two observations were made when comparing post-operative to their most recent clinic radiographs: > 2 mm change in the distance between the screw and the lowest point of the tibial plateau, > 2 mm change in the distance between the screw and the most superior aspect of the plate. Data were analyzed to determine if there were any identifiable risk factors for complication, reoperation, or subsidence using logistic regression. Statistical significance was set at p < 0.05. RESULTS 34 patients were included with an average follow-up of 32.03 ± 22.52 weeks. There were no overall differences between height relative to the medial plateau or the plate. Two patients (5.9%) had articular subsidence. Six patients (15.2%) underwent reoperation, two (6%) for manipulations under anaesthesia due to arthrofibrosis, and four (12%) due to infections. There were 6 (19%) total infections as 2 were superficial and required solely antibiotics. One patient had early failure. CONCLUSION Use of a novel fenestrated screw system for the delivery of CaPO4 BSM results in articular subsidence and complication rates similar to previously published values and appears to be a viable option for addressing subchondral defects in tibial plateau fractures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alexander L Telis
- Department of Orthopaedic Surgery, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA, USA
| | - Douglass W Tucker
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Edward Compton
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Donald J DeSanto
- Department of Orthopaedic Surgery, University of California Irvine, Orange, CA, USA
| | - John J Carney
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - John A Scolaro
- Department of Orthopaedic Surgery, University of California Irvine, Orange, CA, USA
| | - Geoffrey S Marecek
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Adam K Lee
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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Niccolini G, Manuello A, Capone A, Marongiu G, Dell'Osa AH, Fois A, Velluzzi F, Concu A. Possible Assessment of Calf Venous Pump Efficiency by Computational Fluid Dynamics Approach. Front Physiol 2020; 11:1003. [PMID: 33013438 PMCID: PMC7510250 DOI: 10.3389/fphys.2020.01003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Abstract
Three-dimensional simulations of peripheral, deep venous flow during muscular exercise in limbs of healthy subjects and in those with venous dysfunction were carried out by a computational fluid-dynamics (CFD) approach using the STAR CCM + platform. The aim was to assess the effects of valvular incompetence on the venous calf pump efficiency. The model idealizes the lower limb circulation by a single artery, a capillary bed represented by a porous region and a single vein. The focus is on a segment of the circuit which mimics a typical deep vein at the level of the calf muscle, such as the right posterior tibial vein. Valves are idealized as ball valves, and periodic muscle contractions are given by imposing time-dependent boundary conditions to the calf segment wall. Flow measurements were performed in two cross-sections downstream and upstream of the calf pump. Model results demonstrate a reduced venous return for incompetent valves during calf exercise. Two different degrees of valvular incompetence are considered, by restricting the motion of one or both valves. Model results showed that only the proximal valve is critical, with a 30% reduction of venous return during calf exercise in case of valvular incompetence: the net flow volume ejected by the calf in central direction was 0.14 mL per working cycle, against 0.2 mL for simulated healthy limbs. This finding appeared to be consistent with a 25% reduction of the calf ejection fraction, experimentally observed in chronic venous disease limbs compared with healthy limbs.
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Affiliation(s)
- Gianni Niccolini
- Department of Structural, Geotechnical and Building Engineering, Politecnico di Torino, Turin, Italy
| | - Andrea Manuello
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Antonio Capone
- Orthopedic Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giuseppe Marongiu
- Orthopedic Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonio Hector Dell'Osa
- Instituto de Desarrollo Economico e Innovación, Universidad Nacional de Tierra del Fuego, Antartida e Islas del Atlantico Sur, Ushuaia, Argentina
| | - Andrea Fois
- Biosignal Acquisition System, Nomadyca Ltd., Kampala, Uganda
| | - Fernanda Velluzzi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alberto Concu
- 2C Technologies Ltd., Academic Spin-Off, University of Cagliari, Cagliari, Italy
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Wennergren D, Bergdahl C, Selse A, Ekelund J, Sundfeldt M, Möller M. Treatment and re-operation rates in one thousand and three hundred tibial fractures from the Swedish Fracture Register. Eur J Orthop Surg Traumatol 2020; 31:143-154. [PMID: 32743684 PMCID: PMC7815548 DOI: 10.1007/s00590-020-02751-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Approximately, 50 persons per 100,000 per year sustain a tibial fracture. There is, however, a lack of large cohort studies that describe the treatment and re-operation frequencies of tibial fractures. The aim of this study was to describe the treatment and re-operation rates of tibial fractures in all segments of the tibia. METHODS Data related to all patients aged 16 and above treated for tibial fractures (ICD-10 S82.10-31) at Sahlgrenska University Hospital in 2011-2015 were extracted from the Swedish Fracture Register. To make sure all re-operations were included in the study, the operation planning system was checked for all patients included in the study. RESULTS The study comprised 1371 tibial fractures - 712 proximal, 417 diaphyseal and 242 distal tibial fractures. Among the proximal and distal tibial fractures, plate fixation was the most commonly used surgical method, whereas among tibial shaft fractures, an intramedullary nail was the most commonly used surgical method. Almost 30% (29.8%) of all surgically treated tibial fractures underwent re-operation. Among proximal tibial fractures, 24.0% underwent re-operation; tibial shaft fractures 37.0% and distal tibial fractures 26.8%. Re-operations due to infection were more or less equally common in all segments (3.9-5.4%). CONCLUSION This study describes the treatment and re-operation rates after tibial fractures in a cohort of 1371 tibial fractures at Sahlgrenska University Hospital during a period of 5 years. The study shows an overall re-operation rate of 29.8% for fractures in all segments of the tibia.
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Affiliation(s)
- David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Orthopaedics, Sahlgrenska University Hospital, SE-413 45, Mölndal, Gothenburg, Sweden.
| | - Carl Bergdahl
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, SE-413 45, Mölndal, Gothenburg, Sweden
| | - Amanda Selse
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jan Ekelund
- Centre of Registers, Western Healthcare Region, Gothenburg, Sweden
| | - Mikael Sundfeldt
- Department of Orthopaedics, Sahlgrenska University Hospital, SE-413 45, Mölndal, Gothenburg, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, SE-413 45, Mölndal, Gothenburg, Sweden
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19
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Stewart CC, O'Hara NN, Mascarenhas D, Manson TT, Reahl GB, Connelly D, Baker M, Slobogean GP, O'Toole RV. Predictors of Symptomatic Implant Removal After Open Reduction and Internal Fixation of Tibial Plateau Fractures: A Retrospective Case-Control Study. Orthopedics 2020; 43:161-167. [PMID: 32191945 DOI: 10.3928/01477447-20200314-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/17/2019] [Indexed: 02/03/2023]
Abstract
A retrospective case-control study was conducted at a level I trauma center to assess whether radiographic details of tibial plateau fixation can predict symptomatic implant removal. Nine hundred fifty-one tibial plateau fractures were treated with open reduction and internal fixation from 2007 to 2016. Eighty-two (9%) were treated with implant removal for localized pain over the implant. A control group was selected from the remaining patients using cumulative sampling. Records and radiographs were reviewed for predictors hypothesized to be associated with implant removal. Based on the authors' multivariable model, implant removal was associated with each additional protruding screw (adjusted odds ratio, 1.32; 95% confidence interval, 1.13-1.55; P<.001), bicondylar fractures (adjusted odds ratio, 2.13; 95% confidence interval, 1.11-4.11; P=.02), and lower body mass index (P=.05). Associations that approached significance were observed with decreased age (adjusted odds ratio, 0.82 per 10 years; 95% confidence interval, 0.66-1.01; P=.06) and closed fractures (adjusted odds ratio, 0.34; 95% confidence interval, 0.10-1.19; P=.09). The model discriminated fractures requiring implant removal with moderate accuracy (area under the curve=0.71). Each additional screw that radiographically protrudes beyond the far cortex increases the odds of symptomatic implant removal by 32%. Bicondylar fractures and lower body mass index are also associated with symptomatic implant removal. These findings might help inform patients and guide fixation techniques to reduce the likelihood of symptomatic implant removal. [Orthopedics. 2020;43(3):161-167.].
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Gonzalez LJ, Hildebrandt K, Carlock K, Konda SR, Egol KA. Patient function continues to improve over the first five years following tibial plateau fracture managed by open reduction and internal fixation. Bone Joint J 2020; 102-B:632-637. [DOI: 10.1302/0301-620x.102b5.bjj-2019-1385.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. Methods In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired t-test. Results Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA). Conclusion Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: Bone Joint J 2020;102-B(5):632–637.
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Affiliation(s)
- L. J. Gonzalez
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - K. Hildebrandt
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - K. Carlock
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - S. R. Konda
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
- Jamaica Hospital Medical Center, New York, New York, USA
| | - K. A. Egol
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
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21
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Liangjun J, Qiang Z, Zhijun P, Li H. Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment. Acta Orthop Traumatol Turc 2019; 53:432-41. [PMID: 31543383 DOI: 10.1016/j.aott.2019.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/19/2019] [Accepted: 08/24/2019] [Indexed: 12/03/2022]
Abstract
Objective The aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment. Methods Our revision strategy was as follows: First, we determined the presence of any infection. Second, we determined whether the patient required total knee arthroplasty (TKA). Third, based on the characteristics of the tibial plateau fracture malunion, patients underwent one of the following surgical methods to achieve reduction: original fracture line osteotomy, tibial tubercle + original fracture line osteotomy, fibula head + original fracture line osteotomy, and metaphyseal open window reduction rod technique. The results was assessed with healing time, Rasmussen score, knee range of motion and complication rates. Results A total of 25 patients 16 men and 9 women; Mean age: 47.4 years (range: 35–63 years) underwent tibial plateau fracture revision operation. The time interval between the two surgeries was 2–24 months. The follow-up time was 12–30 months, and the operation time was 120–300 min. All patients received bone union at the last follow-up. The healing time was 3–6 months. The postoperative Rasmussen score was 19–29 (mean 23.8) compared with 14.4 points before the operation (p < 0.05). The postoperative knee joint activity was 60–110° (mean 95.0°), compared with 57.8° before the operation (p < 0.05). Six patients still had a 2-mm collapse on the articular surface, and 4 patients still had slight valgus (<5°). Except for 2 TKA cases, fracture reduction was excellent in 15 cases and good in 8 cases, with a good rate of 100%. Superficial wound infections occurred in 3 patients. Conclusion Because revision of tibial plateau fracture malunion caused by failure of initial treatment is difficult, it is necessary to create a detailed surgical plan before the operation. Satisfactory clinical effects can be obtained if the correct revision strategy is used. The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion. Level of Evidence Level IV, Therapeutic Study.
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22
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Norris GR, Checketts JX, Scott JT, Vassar M, Norris BL, Giannoudis PV. Prevalence of Deep Surgical Site Infection After Repair of Periarticular Knee Fractures: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e199951. [PMID: 31441940 PMCID: PMC6714463 DOI: 10.1001/jamanetworkopen.2019.9951] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Surgical management of periarticular knee fractures can be challenging, and adverse outcomes may be severe. Recent literature indicates that the rate of periarticular knee surgical site infection (SSI) may range from 2% to 88% depending on the fracture site. OBJECTIVE To examine the prevalence of deep SSI and the rate of septic arthritis after surgical repair of fractures around the knee. DATA SOURCES The electronic databases MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to July 1, 2018. STUDY SELECTION Eligible studies had to specifically report deep SSI rates and include fractures in the distal femur, patella, tibial plateau, or proximal tibia. Risk factors that were associated with increased the risk of deep SSI were also examined. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were extracted by multiple investigators. Comprehensive Meta-Analysis software was used for the pooling of data, using either random-effects or fixed-effects models, with respect to the degree of statistical heterogeneity present. Data analyses were conducted in October 2019. MAIN OUTCOMES AND MEASURES The primary outcome was overall prevalence of deep SSI after periarticular knee fracture repair. The secondary outcomes were the overall prevalence of septic arthritis, risk factors associated with deep SSI, and the most commonly cultured bacteria specimens found periarticular knee infections. RESULTS Of 6928 articles screened, 117 articles met inclusion criteria and were included in analysis. Among 11 432 patients included in analysis, 653 patients (5.7%) experienced deep SSIs, most commonly among patients with proximal tibia fractures (56 of 872 patients [6.4%]). Among studies that included information on septic arthritis, 38 of 1567 patients (2.4%) experienced septic arthritis. The 2 most commonly reported bacteria were methicillin-resistant Staphylococcus aureus, found in 67 SSIs, and methicillin-susceptible S aureus, found in 53 SSIs. Sixty-two studies (53.0%) in the sample received a Coleman Methodological Score of poor (<50 points). CONCLUSIONS AND RELEVANCE Deep SSIs occurred in nearly 6% of periarticular knee fracture repairs, and 2.4% of SSIs were associated with septic arthritis. Surgeons managing these injuries should be vigilant when wounds are not pristine. Efforts should be made to elevate the quality of research conducted not only in this subject but also in orthopedic surgery as a whole.
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Affiliation(s)
| | | | - Jared T. Scott
- Oklahoma State University Center for Health Sciences, Tulsa
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Brent L. Norris
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
- Orthopedic & Trauma Services of Oklahoma, Tulsa
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Abstract
Tibial plateau fracture is an injury commonly seen by those who treat trauma around the knee and/or sports-related injuries. In this video article, we present our protocol for surgical treatment of a tibial plateau fracture, which includes definitive fixation with use of a plate-and-screw construct, addressing of all associated soft-tissue injuries at the time of the surgical procedure, filling of any residual voids with bone cement, and early rehabilitation with weight-bearing beginning at 10 to 12 weeks postoperatively. The major steps of the procedure are (1) preoperative planning with digitally templated plates and screws, (2) patient positioning and setup, (3) anterolateral approach toward the proximal aspect of the tibia, (4) submeniscal arthrotomy, (5) booking open of the proximal aspect of the tibia at the fracture site, (6) tagging of the meniscus, (7) fracture reduction and placement of the Kirschner wire, (8) confirmation of reduction with C-arm image intensification, (9) internal fixation with a plate-and-screw construct, and (10) closure.
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Affiliation(s)
- Dylan T Lowe
- Department of Orthopedic Surgery (D.T.L., M.T.M) and Division of Trauma Surgery (K.A.E.), NYU Langone School of Medicine (L.J.G.), NYU Langone Orthopedic Hospital, New York, NY
| | - Michael T Milone
- Department of Orthopedic Surgery (D.T.L., M.T.M) and Division of Trauma Surgery (K.A.E.), NYU Langone School of Medicine (L.J.G.), NYU Langone Orthopedic Hospital, New York, NY
| | - Leah J Gonzalez
- Department of Orthopedic Surgery (D.T.L., M.T.M) and Division of Trauma Surgery (K.A.E.), NYU Langone School of Medicine (L.J.G.), NYU Langone Orthopedic Hospital, New York, NY
| | - Kenneth A Egol
- Department of Orthopedic Surgery (D.T.L., M.T.M) and Division of Trauma Surgery (K.A.E.), NYU Langone School of Medicine (L.J.G.), NYU Langone Orthopedic Hospital, New York, NY
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Michel N, Aubert K, Germaneau A, Gayet LE, Valle V, Brèque C, Rigoard P, Vendeuvre T. Surface analysis during surgical balloon reduction of a tibial Plateau depression fracture. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- N. Michel
- Pédiatrie - Chirurgie orthopédique, traumatologique et plastique, Hôpital des enfants, CHU Toulouse, Toulouse, France
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Spine & Neuromodulation Function Unit. PRISMATICS Lab CHU – Poitiers, Poitiers, France
| | - K. Aubert
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - A. Germaneau
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - L.-E Gayet
- Chirurgie orthopédique-traumatologie, CHU Poitiers, Poitiers, France
| | - V. Valle
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - C. Brèque
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
| | - P. Rigoard
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Chirurgie orthopédique-traumatologie, CHU Poitiers, Poitiers, France
| | - T. Vendeuvre
- Institut Pprime, UPR 3346 CNRS – Université de Poitiers – ISAE-ENSMA, Poitiers, France
- Chirurgie orthopédique-traumatologie, CHU Poitiers, Poitiers, France
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Song Z, Wang Q, Ma T, Wang C, Yang N, Xue H, Li Z, Zhu Y, Zhang K. Failure analysis of primary surgery and therapeutic strategy of revision surgery for complex tibial plateau fractures. J Orthop Surg Res 2019; 14:110. [PMID: 31014377 DOI: 10.1186/s13018-019-1147-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 04/09/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To analyze the cause of failure of the primary surgery for complex tibial plateau fractures and to define the therapeutic strategy of the revision surgery for the same. METHODS Twenty-one cases with failure of primary surgery for complex tibial plateau fractures were treated in our hospital from January 2012 to September 2016. There were 13 males and 8 females with an average age of 39.4 years (ranged between 27 and 58 years). Patients presented with different types of complex tibial plateau fractures like Schatzker type V (n=9), VI (n=12), type 41.C1 (n=9), type 41.C2 (n=6), and type 41.C3 (n=6). The therapeutic strategy for revision surgery in individual patients was decided following careful analysis and accurate assessment of the causes of failure of the primary surgery. All the patients were followed-up with Rasmussen radiographic scores and Hospital for Special Surgery (HSS) knee scores. RESULTS All 21 patients underwent clinical and radiological examination after a mean follow-up time of 32.6 months. The average time of fracture healing was 4.5 months (ranged between 3 and 6 months). During the last follow-up, the mean range of motion of knee extension was 2.3° and knee flexion was 123.8°. The mean radiological Rasmussen score was 15.6 points, with an overall success rate of 85.7%. The average HSS knee score was 84.3 points, with an overall success rate of 80.9%. CONCLUSION The common reasons for the failure of primary surgery of complex tibial plateau fractures were inadequate experience of the surgeon, inaccurate diagnosis and management, improper selection of implants, and poor surgical techniques. The key factors to succeed revision surgery were adequate preoperative evaluation, accurate intraoperative procedures, and proper postoperative rehabilitation. LEVEL OF EVIDENCE Level IV, case series, treatment study.
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26
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Abstract
Tibial plateau fractures have a broad spectrum of presentations, depending on the mechanism and energy of the trauma. Many classification systems are currently available to describe these injuries. In 1974, Schatzker proposed a classification based on a two-dimensional representation of the fracture. His classification with the six-principles types became one of the most utilized classification systems for tibial plateau fractures. More than four decades after this original publication, we are revisiting each fracture type in the light of information made available by computed tomography, which today comprises a standard tool in assessing articular fractures. The classification we are proposing relies on the fact that the tibial plateau has two anatomical columns, lateral and medial. We are introducing a virtual equator which splits the articular surface in the coronal plane. The equator divides each column into two quadrants, the anterior (A) and the posterior (P). Unicondylar fracture types (I to IV) have now additional modifiers A (anterior) and P (posterior) to describe the exact spatial location of the primary fracture plane. Bicondylar fracture types (V and VI) have the modifiers (A and P) of the main fracture plane for each column, and lateral (L) and medial (M) to denote the column. We are introducing the concept of the main fracture plane. Recognition of the exact location of the principal fracture plane is essential for preoperative planning of patient positioning, surgical approach and for determining where to apply the hardware to achieve stable fixation. The new three-dimensional classification is based on the template of the original Schatzker classification. It covers the mechanism of the injury, the energy of the trauma, the morphologic characteristics of the fracture and its location in three dimensions.
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Affiliation(s)
- Mauricio Kfuri
- Department of Orthopedics, University of Missouri, Columbia, MO, United States; Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
| | - Joseph Schatzker
- Division of Orthopedics, Sunnybrook Health Sciences Center, University of Toronto, Ontario, Canada
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Hanson LF, Hanson CG, Barner KL. Idiopathic Charcot Arthropathy of the Knee Presenting as a Bicondylar Tibial Plateau Fracture. J Am Acad Orthop Surg Glob Res Rev 2018; 2:e032. [PMID: 30280143 DOI: 10.5435/JAAOSGlobal-D-18-00032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Charcot arthropathy is an infrequent condition that primarily involves the foot and ankle; rarely, it has been reported to affect the knee. Risk factors for Charcot arthropathy are well described with diabetes being the most common cause. Idiopathic Charcot arthropathy without a secondary etiology is extremely rare, with only a few cases described involving the foot and shoulder. Clinically, idiopathic Charcot arthropathy presents a notable challenge because delayed diagnosis can lead to surgical complications and advancement of joint destruction. We report idiopathic Charcot arthropathy of the knee presenting as a bicondylar tibial plateau fracture successfully managed with total knee arthroplasty after failed open reduction internal fixation. We diagnosed the patient when the clinical/surgical presentation was indicative of Charcot arthropathy and after excluding all other diagnoses. This previously unreported case describes the complexity of idiopathic Charcot arthropathy with subsequent fractures and highlights the importance of patient history, presentation, and surgical intervention.
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