Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment

PURPOSE: This study examined whether any fracture pattern shown in computed tomography (CT) scan is associated with the presence of lateral meniscus (LM) injury in a tibia plateau fracture. MATERIALS AND METHODS: Fifty-three tibia plateau fractures with both preoperative CT and magnetic resonance imagings (MRI) available were reviewed. The patient demographics, including age, sex, body mass index, and energy level of injury were recorded. The fracture type according to the Schatzker classification, patterns including the lateral plateau depression (LPD), lateral plateau widening (LPW), fracture fragment location, and the number of columns involved were assessed from the CT scans. The presence of a LM injury was determined from the MRI. The differences in the factors between the patients with (Group 1) and without (Group 2) LM injuries were compared and the correlation between the factors and the presence of LM injury was analyzed. RESULTS: The LM was injured in 23 cases (Group 1, 43.4%) and intact in 30 cases (Group 2, 56.6%). The LPD in Group 1 (average, 8.2 mm; range, 3.0–20.0 mm) and Group 2 (average, 3.8 mm; range, 1.4–12.1 mm) was significantly different (p < 0.001). The difference in LPW of Group 1 (average, 6.9 mm; range, 1.2–15.3 mm) and Group 2 (average, 4.8 mm; range, 1.4–9.4 mm) was not significant (p=0.097). The other fracture patterns or demographics were similar between in the two groups. Regression analysis revealed that an increased LPD (p=0.003, odds ratio [OR]=2.12) and LPW (p=0.048, OR=1.23) were significantly related to the presence of a LM tear. CONCLUSION: LPD and LPW measured from the CT scans were associated with an increased risk of concomitant LM injury in tibia plateau fractures. If such fracture patterns exist, concomitant LM injury should be considered and an MRI may be beneficial for an accurate diagnosis and effective treatment.

MODIFIED POSTEROLATERAL COUNTER-CURVED INCISION WITH DOUBLE INTERMUSCULAR APPROACH IN TREATING POSTEROLATERAL TIBIAL PLATEAU FRACTURES / 中国修复重建外科杂志

OBJECTIVE: To evaluate the effectiveness of the modified posterolateral counter-curved incision with double intermuscular approach for the treatment of posterolateral tibial plateau fractures. METHODS: A retrospective analysis was made on the clinical data of 32 patients with posterolateral tibial plateau fractures between September 2012 and October 2014. There were 22 males and 10 females, aged 19 to 55 years (mean, 40.5 years). The causes of injury included traffic accident in 17 cases, falling from height in 9 cases, and falling in 6 cases. They had fresh closed fracture; injury to hospitalization time was 3 hours to 5 days (mean, 2 days). According to Schatzker tibial plateau fracture classification criteria, 20 cases were rated as type II, and 12 cases as type III. All patients underwent a modified posterolateral counter-curved incision with double intermuscular approach to expose tibial posterolateral condyle and anterolateral condyle. After a good visual control of fracture reduction, the anterolateral and posterolateral fractures were fixed with two-dimensional buttress plate respectively. RESULTS: The incisions healed at stage I, with no major neurovascular injury. According to radiological assessment of the DeCoster score, the results were excellent in 21 cases, and fair in 11 cases. All of the 32 patients were followed up 18 to 30 months (mean, 20.5 months). The X-ray films showed that all patients obtained good fracture union, and the mean time of fracture union was 12.3 weeks (range, 10-16 weeks). No fixation failure or no obvious loss of articular surface reduction was observed during follow-up. The range of motion of the affected knees was 2-135° (mean, 120°). The mean American Hospital for Special Surgery (HSS) score was 90.05 (range, 83-96) at 18 months after operation. CONCLUSIONS: The modified posterolateral counter-curved incision with double intermuscular approach could fully expose posterolateral tibia plateau, and good fracture reduction and reliable fixation can be obtained under direct vision.

The Clinical Study on Double-plate Method for Complex Tibia Plateau Fracture / 浙江中医药大学学报

[Objective] To investigate and analyze the clinical effect of double-plate method on complex tibia plateau fracture. [Methods] A total of 62 pa-tients that had complex tibia plateau fracture from October 2010 to December 2012 in our hospital, were divided into the experimental group and the control group randomly, 31 patients per group. Patients of the experimental group received double steel plate internal fixation with double incision, and patients of the control group received locking plate internal fixation, and the clinical efficacy of two groups were compared. [Results] The excel ent rate of the experimental group was better than that of the control group(87.1% vs 64.5% χ2=4.309 P=0.038), and the difference of complications rate of two groups had no statistical significance(3.2%vs 6.5% χ2=0.350 P=0.554). [Conclusion] The clinical effect of double-plate method for complex tibia plateau fracture is good, and the complications rate is low, worthy of clinical promotion.

Arthroscopically Assisted Reduction and Internal Fixation of Intra-Articular Fractures of Tibial Plateau / 대한정형외과학회잡지

PURPOSE: To evaluate clinical and radiological results of arthroscopically assisted reduction and internal fixation of intra-articular fractures of the tibial plateau. MATERIALS AND METHODS: Between July 2003 and June 2009, we performed arthroscopy and fluoroscopy-assisted reduction and internal fixation for tibia plateau fracture. Our study included 21 patients who had been followed-up for more than 18 months. We used the Knee Society Knee Score (KSS) and Knee Society Functional Score (KSFS) for the clinical evaluation. We used the Rasmussen Radiological Score for the radiological evaluation. RESULTS: At the last follow-up, all 21 cases showed bone union, and the mean range of movement was 115.5+/-8.5degrees. According to the KSS and KSFS, we obtained excellent or good results in 18 cases (85%). We obtained excellent or good results in 19 cases (90%) each by the Rasmussen Clinical Score and Rasmussen Radiological Score, respectively. CONCLUSION: The 2 year follow-up of arthroscopy assisted surgery showed relatively satisfactory results.

Injury to Soft Tissue Knee Structures in Patients with Tibia Plateau Fracture

PURPOSE: We wanted to analyze the incidence of soft tissue injury associated with fractures of the tibial plateau. MATERIALS AND METHODS: From November 2005 to December 2008, 36 patients with tibial plateau fractures were examined by radiologic studies. The fractures classified according to Schatzker's classification by using the plain radiographs and computed tomography, and then magnetic resonance imaging was done for assessing the accompanied injuries of the knee structure. RESULTS: For the 36 cases, accompanying lesions were observed in 30 cases (83.3%). Lateral meniscus damage was the most frequently associated damage, and this was observed in 17 cases (47.2%). Medial meniscus damage was found in 13 cases (36.1%). Anterior crucial ligament damage was found in 11 cases (30.6%). Posterior crucial ligament damage was found in 3 cases (8.3%). Medial collateral ligament damage was found in 16 cases (44.4%) and lateral collateral ligament was found in 8 cases (33.3%). CONCLUSION: Because soft tissue injury frequently accompanies tibial plateau fracture, MRI evaluation and proper management are necessary regardless of the severity of the fractures.

Treatment of Shatzker Type VI Tibia Plateau Fracture Using Lateral and Posteromedial Dual Incision Approach and Dual Plating

PURPOSE: To evaluate the radiologic and clinical results of treatment of the Shatzker type 6 tibia plateau fracture using the lateral and posteromedial dual incision approach and dual plating. MATERIALS AND METHODS: Twelve cases in eleven patients of Shatzker type 6 tibia plateau fracture which has been treated using the lateral and posteromedial dual incision approach and dual plating were analyzed with an average follow-up of 16 months. Times to union, alignment and reduction loss on radiograph and postoperative clinical outcome with checking the range of motion of the knee joint, Knee Society Score and UCLA activity scale were analyzed and evaluated. RESULTS: In all cases, bony union was obtained in an average fifteen weeks after the operation, and there was no reduction loss. The arc of motion of the knee joint at the latest follow-up was 132 degrees on average. Average of Knee Society Score was 85 and UCLA activity scale was decreased from 9.6 points preoperatively to 5.7 points postoperatively. CONCLUSION: The treatment of Shatzker type 6 tibia plateau fracture using the lateral and posteromedial dual approach and dual plating have shown clinically preferable results of excellent recovery of joint motion and good knee society score by early range of motion exercise after firm fixation. However, it was high energy injury, so the sports activity of patients was significantly decreased.

Treatment of tibia plateau fracture in senile patients / 中华创伤骨科杂志

Objective To sum up the clinical experience of operative management of tibia plateau fracture in senile patients. Methods 35 cases of senile tibia plateau fracture were treated with different ways of internal fixation, including screw, cannulated compression screw, L shaped plate, and T shaped plate. Results All the 35 cases were followed up and the time ranged from 6 months to 2 years. X ray films showed that the anatomical reduction was reached and the fractures healed in 33 cases. The final results were rated according to Merchant criteria: excellent in 22 cases, good in 9 cases, fair in 2 cases and poor in 2 cases. The excellent and good rates were 85.7%. Conclusions Operation on senile patients with tibia plateau fracture should be performed early so as to reconstruct the articular surface. Rigid fixation and bone transplantation are impartment means to avoid plateau collapse, and early functional exercise can reduce postoperative complications.