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Objetivo: comparar si existe diferencia en resultados clínicos, radiológicos y funcionales con el uso de diferentes tipos de injertos óseos o sustitutos sintéticos, así como tiempo quirúrgico y consolidación para el tratamiento de fracturas de platillo tibial con hundimiento articular en pacientes mayores de 18 años. Material y método: se realizó una búsqueda sistematizada en bases de datos de literatura médica, PubMed, Lilacs, Scielo, Cochrane y portal Timbó. Se utilizaron términos "tibial plateau fracture", "bone grafting", "bone substitutes". Se incluyeron estudios comparativos en seres humanos, pacientes mayores de 18 años, fracturas de platillo tibial que asociaron hundimiento articular, en los cuales se realizó aporte de injerto óseo o material sintético. Artículos en español, inglés, portugués. Publicaciones enero 1980 y diciembre 2021. Se obtuvieron 10 artículos. Resultados: los tipos de injertos y sustitutos óseos encontrados fueron 10. Las muestras en sumatoria total 524 pacientes. La edad promedio fue 49 años. El promedio de seguimiento fue de 12 meses. Se dividieron los estudios en tres grupos: comparación entre injerto autólogo (IOA) e injerto alogénico, IOA con sustitutos sintéticos, y los que comparan sustitutos sintéticos entre sí. El aloinjerto y los sustitutos sintéticos demostraron no ser inferiores en resultados clínicos, funcionales e imagenológicos, mejorando los tiempos intraoperatorios y disminuyendo complicaciones en el sitio donante con respecto al IOA. Conclusiones: el IOA continúa siendo el gold standard a pesar de sus posibles complicaciones vinculadas al sitio donante. El aloinjerto y los sustitutos sintéticos representan una opción válida para tratar estas lesiones.
Objective: to find out whether there are clinical, radiological and functional differences when using different types of bone grafts or synthetic substitutes, as well as surgical times and consolidation to treat depressed tibial-plateau fractures in patients older than 18 years old. Method: a systematized search was conducted in medical literature, PubMed, Lilacs, Scielo, Cochrane and Timbó portal databases using the following terms: "tibial plateau fracture", "bone grafting", "bone substitutes". The study included comparative studies in human patients older than 18 years old with depressed tibial-plateau fractures who were treated with bone grafts or synthetic materials. Publications in Spanish, English and Portuguese, between January, 1980 and December, 2021 were included in the search, what resulted in 10 articles found. Results: there were 10 kinds of bone grafts and bone substitutes found. Samples added up to 524 patients. Average age was 49 years old. Average follow up was 12 months. Studies were divided into 3 groups: comparison between autologous bone grafts and allogenic bone grafts, comparison between autologous grafts and synthetic substitutes and studies comparing synthetic substitutes with one another. Allogenic grafts and synthetic grafts proved at least equivalent in terms of clinical, functional and imaging studies results, improving intraoperative times and reducing complications in donor site when compared to autologous grafts. Conclusions: autologous grafts continue to be the gold standard despite possible complications associated to the donor site, and allogenic grafts and synthetic substitutes constitute a valid option to treat these lesions.
Objetivo: comparar os resultados clínicos, radiológicos e funcionais com o uso de diferentes tipos de enxertos ósseos ou substitutos sintéticos, bem como tempo cirúrgico e consolidação para o tratamento de fraturas do platô tibial com colapso articular em pacientes com mais de 18 anos. Material e método: foi realizada busca sistemática nas bases de dados da literatura médica, PubMed, Lilacs, SciELO, Cochrane e portal Timbó. Utilizaram-se os termos "tibial plateau fracture", "bone grafting", "bone substitutes". Foram incluídos estudos comparativos incluindo seres humanos maiores de 18 anos e fraturas do platô tibial associadas a colapso articular, nas quais foi realizado enxerto ósseo ou sintético, publicados entre janeiro de 1980 e dezembro de 2021 em espanhol, inglês e português. Foram obtidos 10 artigos. Resultados: foram identificados 10 tipos de enxertos e substitutos ósseos. 524 pacientes com idade média de 49 anos foram estudados. O seguimento médio foi de 12 meses. Os estudos foram divididos em 3 grupos: comparação entre enxerto autólogo (IOA) e enxerto alogênico, IOA com substitutos sintéticos e substitutos sintéticos entre si. O aloenxerto e os substitutos sintéticos mostraram-se não inferiores nos resultados clínicos, funcionais e de imagem, melhorando os tempos intraoperatórios e reduzindo as complicações da área doadora em relação à IOA. Conclusões: o IOA continua a ser o padrão ouro apesar de suas possíveis complicações relacionadas ao local doador; tanto o aloenxerto como os substitutos sintéticos representam uma opção válida para tratar essas lesões.
Subject(s)
Tibial Fractures/surgery , Bone Substitutes , Tibial Plateau Fractures/surgeryABSTRACT
@#Introduction: Tibial bicondylar fractures are difficult fractures to treat and are usually associated with complications. Materials and methods: Thirty-five patients with Schatzker type V and VI fractures were managed from June 2016 to July 2018 with Ilizarov technique. The mean age of the patients was 46.5 ± 8.9 years, with 28 male and seven female patients. Sixteen patients had Schatzker type V fracture and the remaining had type VI. The functional outcome was assessed by using Modified functional evaluation system by Karlstrom - Olerud and the radiological outcome by Rasmussen's Radiological Score (RRS). Results: All patients achieved radiological union at a mean duration of 16 weeks for type 5 and 17 weeks for type 6 however, full weight-bearing was allowed at a mean of 18 weeks (14 - 22 weeks). Functional results were excellent in 24 cases, good in 10 and poor in one. Most patients achieved functional range of motion at the knee joint (average flexion 1280 ) except one, who had a flexion of less than 1100 . One patient with a delayed union united after bone marrow injection. Other complications included pin tract infections in 9 cases, axial malalignment of less than 100 in 4 cases and a prominent screw in one. Conclusion: Percutaneous restoration of articular anatomy and a ring external fixation with or without minimal internal fixation is an excellent method of treatment in this group of fractures caused by high energy trauma and with a usual association of severe comminution and a poor soft tissue envelope.
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Objective:To evaluate the outcomes of posterior-column dominating three-column tibial plateau fractures treated by raft-nailing and cannulated screwing via the posteromedian approach.Methods:From October 2017 to June 2019, 15 patients with posterior-column dominating three-column tibial plateau fracture were surgically treated at Department of Orthopedics, The First Affiliated Hospital to Harbin Medical University. They are 11 males and 4 females, aged from 26 to 65 years (average, 41.2 years). All patients were operated on under general anesthesia or spinal anesthesia. After full exposure via the posteromedian approach using a popliteal S-shaped incision, their fractures were treated with raft-nailing and cannulated screwing. Wound healing and neurovascular injury were observed after operation. X-ray films were taken regularly to monitor fracture union and measure the tibial plateau angle (TPA) and posterior slope angle (PA) of the tibial plateau. The knee function was assessed using The Hospital for Special Surgery (HSS) scoring system at 12 months after operation.Results:Incisions healed by the first intention after surgery in 14 patients but the healing was delayed due to fat liquefaction in one patient. No symptoms of neurovascular injury were observed in the 15 patients who were followed up for 12 to 29 months (average, 16.5 months). All fractures united after 12 to 20 weeks (average, 15.4 weeks). At 3 days and 12 months after operation, respectively, their PA was 9.3°±2.1° and 9.7°±1.6° and their TPA 4.3°±1.2° and 4.1°±1.1°, showing no significant difference ( P>0.05). At 12 months after operation, their HSS scores ranged from 84 to 95 (average, 89.3), their knee flexion from 105° to 138° (average, 126.5°) and their knee extension from 0° to 8° (average, 3.4°). Conclusions:In the treatment of posterior-column dominating three-column tibial plateau fractures, raft-nailing combined with cannulated screwing via the posteromedian approach can achieve not only full exposure by a single incision but also stable plateau fixation, reduce operative invasion, and simplify operative procedures, leading to fine surgical outcomes.
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Determinar prevalência de fraturas de platô tibial em pacientes internos em um Hospital Público do Piauí. MATERIAIS E MÉTODOS: Foram analisados 50 prontuários com Fraturas de Platô Tibial de Janeiro de 2017 a Janeiro de 2018. O instrumento de análise foi um questionário composto por informações relevantes, como: sexo, idade, raça, mecanismo de lesão, tipos de fratura e lado, para a coleta dos dados. Para análise dos dados utilizou-se a estatística descritiva com cálculos de médias, desvio padrão e frequências absoluta e relativa. RESULTADOS: A maior incidência das fraturas foi no sexo masculino (72%). A média de idade dos pacientes foi de 38 ± 13,86 anos, vítimas principalmente de acidentes automobilísticos (66%), sendo o lado mais acometido o direito (70%) com a incidência maior de fratura oblíqua (48%). CONCLUSÃO: há maior prevalência de fraturas do platô tibial no sexo masculino, faixa etária de 19-29 anos, vítima de acidente automobilísticos, com fraturas oblíquas.
To determine the prevalence of tibial plateau fractures in internal patients at a Public Hospital of Piauí. MATERIALS AND METHODS: Fifty medical records with Tibial Plateau Fractures from January 2017 to January 2018 were analyzed. The analysis instrument was a questionnaire composed of relevant information, such as: sex, age, race, injury mechanism, types of fracture and affected side, for data collection. For data analysis we used descriptive statistics with calculations of means, standard deviation and absolute and relative frequencies. RESULTS: The highest incidence of fractures was in males (72%). The mean age of the patients was 38 ± 13.86 years, mainly victims of automobile accidents (66%), with the right side most affected (70%) with the highest incidence of oblique fracture (48%). CONCLUSION: there is a higher prevalence of fractures of the tibial plateau in males, aged 19-29 years, victim of automobile accidents, with oblique fractures.
Subject(s)
Fractures, Bone , Tibial Fractures , Hospitals, PublicABSTRACT
PURPOSE@#Tibial plateau fracture (TPF) is a devastating injury as it shatters lower articular surface of the largest joint. Apart from bony injury, TPF can lead to great soft tissue envelope compromise which affects the treatment plan and outcome. In the present study, clinical results were assessed in cases of high energy TPFs treated in staged manner.@*METHODS@#Twenty-three (20 males and 3 females) patients of high energy communited TPFs (Schatzker type V and VI) were consecutively treated. All the patient had compromise of overlying skin conditions. They were all successively scheduled for staged treatment plan which comprised of application of bridging knee external fixator on the first day of admission and definitive internal fixation after skin and soft tissue overlying the fracture were healed. Schatzker type I, II, III and IV were excluded from the study. Primary survey was done and patient who had head injury, chest and abdominal injury, pelvic injury and contralateral limb injury and open fractures were excluded from the study. The patients were also evaluated in terms of wound complications, axial and rotary alignment of limb, fixation failure, articular congruity and range of motion of the knees and post injury employment. Statistical analysis was done using SPSS software.@*RESULTS@#Maximum follow-up period was 13 months. All the fractures were united at final follow-up. Clinical evaluation was done with the Tegner Lysholm knee scoring scale. Excellent results were found in 78% cases and good and fair results in 22% cases. There was significant correlation between range of motion and the Tegner Lysholm knee score (p < 0.001, Pearson correlation coefficient = 0.741). The correlation between the score and the radiographical union duration was significant (p = 0.006, Pearson correlation coefficient = -0.554).@*CONCLUSION@#A staged treatment plan allows healing of soft tissue envelope, with avoidance of dreadful complications such as compartment syndrome and chronic infection. In addition, a staged treatment strategy does not hamper the fracture reduction, bony union and the functional results.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Compartment Syndromes , Connective Tissue , Fracture Fixation, Internal , Methods , Fracture Healing , Fractures, Comminuted , General Surgery , Knee , Range of Motion, Articular , Tibial Fractures , General Surgery , Treatment OutcomeABSTRACT
Introduction: Tibial plateau are a diverse group of fractureswhich includes a wide spectrum of clinical presentation andseverity which was previously known as car bumper fractures.Clinically tibial plateau fractures ranges from simple injuriesmost commonly to the complex fracture often offers challengesfor successful management even to the most experiencedsurgeons globally. The present study was conducted to studythe clinical presentation of tibial plateau fractures presentingto a tertiary care center.Material and methods: It was a cross sectional studyconducted among 13 patients with tibial plateau fracturesduring January 2016 to December 2016 admitted underdepartment of orthopedics in a tertiary healthcare institute innorthern Maharashtra.Results: The majority of fracture (69%) was the consequenceof road traffic accidents. This clearly explains the synonymfor tibial condylar fractures as “bump fractures”, caused by hitby bumper f vehicle. Fall from height was the second majorcause.Conclusions: Tibial plateau fractures were observed to bemore common among males, in 30-40 years of age group.Road traffic accident being the most common cause.
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Tibial plateau fractures are intra-articular fractures caused by high-velocity trauma. They are usually associated with neurovascular injury, compartment syndrome, compounding of fractures, and crushing of soft tissues. The aim of our study is to investigate the benefits of using posterior approach and the surgical technique is beneficial for the union of fractures and prevention of postoperative complications in posterior fractures of the tibial plateau. Methods: This is a comparative prospective study on 50 adult patients was carried out in a tertiary level trauma center, after getting ethical committee clearance by the Institutional Review Board. All skeletally mature patients with closed tibial plateau fractures involving the posterior condyles confirmed on CT scan were included in the study. Open fractures, polytrauma, old or maluniting fractures, pathological fractures, and floating knee injuries or those associated with patella fractures were excluded from the study. Preoperative planning consisted of anteroposterior and lateral views in all cases and amount of displacement, depression and angulation were recorded. Computed tomography (CT) scan was kept as an option in cases where fracture pattern or amount of depression was unclear. Results: There were 22 male and 3 female in group A and in group B 21 Male and 4 female patients were mostly affected by traffic accidents. Most common mode of injury was road traffi c accidents; the second most common mode of injury was fall from height. Complications were not found to be significant in between the two groups. Perioperative parameters showed significant differences in both the groups; time for undertaking surgery posttrauma was significantly different. Conclusion: The fixation does not expedite the fracture healing, but rehabilitation and patient‑related scores are significantly better in our study. Surgical treatment with adequate physiotherapy can give good results in tibial plateau fractures.
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PURPOSE@#To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation.@*METHODS@#This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures; 15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up.@*RESULTS@#Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome.@*CONCLUSION@#Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Antigens, Neoplasm , Follow-Up Studies , Fracture Fixation, Internal , Methods , Fractures, Bone , Therapeutics , Ilizarov Technique , Knee , Mitogen-Activated Protein Kinases , Retrospective Studies , Tibia , Wounds and Injuries , Time Factors , Treatment OutcomeABSTRACT
Objective To investigate the effect of arthroscopic balloon angioplasty on the recovery of limb function in patients with tibial plateau fractures (FTP). Methods Sixty-eight patients with FTP were enrolled from April 2015 to August 2016. The patients were divided into control group (traditional incisional surgery) and observation group (arthroscopic balloon angioplasty) by random number method. The efficacy and the recovery of limb function in patients of the two groups,with a retrospective analysis. Results The excellent operative rate (92.18%) in observation group was significantly higher than that in control group (70.59%), and the operative rate was significantly higher than that in control group (P < 0.05). The surgical parameters (the amount of bleeding, the time of operation, the time of getting out of bed and the postoperative flowrate) in observation group were significantly better than those in control group. The SF-36 score of observation group was significantly higher than the control group (P < 0.05). Conclusion In the treatment of arthroplasty with bronchial angioplasty, the curative effect is more accurate, which can improve the patient's limb function and improve the patients.
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<p><b>OBJECTIVE</b>To discusses the clinical effects of arthroscopy combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in treating Schatzker IV tibial plateau fractures.</p><p><b>METHODS</b>From January 2012 to January 2016, 19 patients with Schatzker type IV tibial plateau fractures were treated with arthroscopy combined with minimally invasive technique including 12 males and 7 females with an average age of 46.5 years old ranging from 19 to 78 years old. Patients were suffering knee pain, swelling, flexion and extension limited, and other symptoms preoperative. Patients were followed up and assessed by Rasmussen knee function score.</p><p><b>RESULTS</b>No infection, traumatic arthritis, and knee joint valgus occurred after operation. Nineteen cases were followed up for 12 to 24 months with an average of 18.6 months. Fracture healing time was 3 to 5 months with an average of 3.8 months. The knee pain and limited mobility improved significantly. The range of autonomic movement of joints was from 90 to 136 degrees. According to Rasmussen functional score criteria, the total score was 27.00±2.49, the result was excellent in 16 cases, good in 2 cases, fair in 1 case.</p><p><b>CONCLUSIONS</b>Arthroscopic treatment for Schatzker type IV tibial plateau fractures combined with MIPPO can simultaneously treat internal structural injuries such as meniscus and other knee joints, with less trauma, fewer complications, and faster joint function recovery, but we must strictly grasp surgical indications and avoid expanding injuries.</p>
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Objective: To summarize the progress in the treatment of hyperextension tibial plateau fractures.
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<p><b>PURPOSE</b>Tibia plateau fracture (TPF) treatment aims at achieving a stable, aligned, mobile, painless knee and preventing post-traumatic osteoarthritis. To achieve this goal, surgeons consider criteria such as patients' characteristics, severity, risk of complications, fracture displacement/depression, degree of soft tissue injury. However, body mass index (BMI) is not considered as a risk factor in literature. Our study was conducted to find out any possible correlation between BMI and functional scores or radiological score separately.</p><p><b>METHODS</b>Retrospective analysis of case series between 2011 and 2014 was done on the database of a tertiary hospital in Istanbul. There were 67 TPF patients (54 males, 13 females) in the study. Relationship between BMI and functional knee scores or radiological score was compared statistically. Closed fractures with both high-energy and low-energy injury were included in the study. Patients with open fracture, multi-trauma presence, meniscus and/or ligamentous injury, increased co-morbidity, inadequate records (25 cases in all) were excluded. Surgery type, Schatzker classification, injury side, trauma energy, and gender were considered as possible risk factors. Binary regression analysis was done for possible factors affecting functional knee scores and radiologic score.</p><p><b>RESULTS</b>Model summary calculations were done as Nagelkerke R test for Knee Society score, Lysholm knee score, and Ahlback and Rydberg radiologic scores, which were 0.648, 0.831, and 0.327 respectively. Homer-Lemeshow test values were 0.976, 0.998, and 0.362, respectively. There is negative correlation between BMI and both knee function scores. There is no correlation between BMI and radiologic score.</p><p><b>CONCLUSION</b>An increase in BMI has a negative effect on functional knee scores after surgical treatment of TPFs. Therefore, BMI should be considered as a risk factor for surgical treatment of TPFs.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Body Mass Index , Knee Joint , Retrospective Studies , Tibial Fractures , General SurgeryABSTRACT
The most commonly accepted system of classification for tibia plateau fractures is that of Schatzker. Increasingly, both high energy injuries and atypical osteoporotic fragility failures have led to more complex, unusual and previously undescribed fracture patterns being recognized. We present a case of a patient with a previously unreported pattern of tibia plateau fracture and knee dislocation. We highlight the challenges confronted and present the management and the outcomes of his injury. A 28-year old male motorcyclist was involved in a head on collision with a truck and was transferred by helicopter to our level 1 major trauma centre emergency department. His injuries were a circumferential degloving injury to his left leg and a right lateral tibial plateau fracture/knee dislocation. The pattern of the lateral tibial plateau fracture was unique and did not fit any recognised classification system. The patient received a spanning external fixator initially and after latency of 12 days for soft tissue resuscitation he underwent definite fixation through an antero-lateral approach to the proximal tibia with two cannulated 6.5 mm partially threaded screws and an additional lateral proximal tibia plate in buttress mode. A hinged knee brace was applied with unrestricted range of motion post-operatively and free weight bearing were permitted post operatively. At the 6 months follow up, the patient walks without aids and with no limp. Examination revealed a stable joint and full range of motion. Plain radiographs revealed that the fracture healed with good alignment and the fixation remained stable. High energy injuries can lead to more complicated fracture patterns, which challenge the orthopaedic surgeons in their management. It is crucial to understand the individual fracture pattern and the possible challenges that may occur. This study reports a lateral tibia plateau fracture/dislocation which perhaps is best described as a reverse Schatzker IV type fracture.
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Adult , Humans , Male , External Fixators , Fracture Fixation, Internal , Tibial Fractures , Classification , Diagnostic Imaging , General Surgery , Tomography, X-Ray ComputedABSTRACT
ResumenLas fracturas de plato tibial representan el 1,2% de las fracturas, se observan predominantemente en dos grupos: en pacientes jóvenes que sufren lesiones de alta energía y en adultos mayores con osteopenia debido a traumas de baja energía. 1,2En el paciente joven es más frecuente la lesión de tejidos blandos debido a la resistencia ósea, mientras en el paciente anciano suele asociarse mayor frecuencia de depresión de la superficie articular.2Las causas asociadas son la compresión axial asociada a varo o valgo, precipitaciones, accidentes de tránsito y actividades deportivas. Las fracturas del plato tibial lateral son más frecuentes que las mediales, debido al valgo fisiológico.1,2 .Se dividen en VI tipos. Los tipos de fracturas V y VI involucran los dos platos tibiales, medial y lateral, por lo que en este tipo de fracturas se observan peores resultados postquirúrgicos. Las consecuencias se deben al tiempo requerido para la recuperación y las secuelas residuales.El presente estudio pretende documentar cuáles son los tratamientos de elección en el Hospital San Juan de Dios y sentar un precedente epidemiológico con datos costarricenses que sirva de base para futuras investigaciones y/o protocolos de tratamiento.Los resultados quirúrgicos se miden de acuerdo a la satisfacción de los pacientes con el proceso quirúrgico y la funcionalidad postquirúrgica, esto debido a que dichas medidas han demostrado poseer mayor utilidad para monitorizar las intervenciones terapéuticas.6,7
AbstractTibialplateau fractures represent 1,2% of all fractures, they are predominant in two groups: young patients who suffer of high-energy trauma and in elderly with osteopenia due to low energy trauma. In young patients, soft tissue trauma is more frequent due to bone resistance, in the elderly it is associated with articular surface depression. Fractures causes are associated with valgus or varus axial compression, precipitation, car accidents and sports. Lateral tibialplateau fractures are more frequent than medial fractures due to physiological valgus.These fractures are divided in VI types, V and VI include both tibialplateau, medial and lateral, having worst post surgical results due to recovery time and residual sequels.This study will evaluate treatment election in Hospital San Juan de Dios and present epidemiological background with costarrican data that will be useful for future investigations and/or treatment protocols.Surgical results are assessed with patient satisfaction with the surgical process and post surgical functionality, because these variables have proven best effect in therapeutical intervention evaluation.
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Humans , Male , Female , Tibial Fractures , Tibial Fractures/classification , Costa Rica , Fractures, Bone , Fracture Fixation, InternalABSTRACT
Objective To explore the clinical effect of conventional surgical treatment of tibial plateau fractures and traditional Chinese medicine intervention. Methods Sixty-eight patients with tibial plateau fractures who had received medical treatment from Hangzhou Cancer Hospital (May 23, 2015 to May 23, 2016) were randomized to the surgical group and the combined group as the subjects of this study. 34 patients in the operation group were treated with surgical treatment. 34 patients in the combined group were treated with traditional Chinese medicine on the basis of operation. The clinical efficacy and knee function scores of the patients with tibial plateau fractures were compared. Results The total effective rate was 91.18% in the combined group, which was significantly higher than that in the operation group (73.53%) (P<0.05). The knee function score of the combined group was (25.36±3.85) The operation group (21.24 ± 3.89) was significantly higher (P<0.05). Conclusion The intervention of traditional Chinese medicine combined with traditional Chinese medicine can significantly improve the function of knee joint in patients with tibial plateau fractures.
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Objective To analyze the indications and evaluate the efficacy of the needle to 'double reverse' traction reset,inside and outside double column locking plate internal fixation with MiPPO for tibial plateau fractures.Methods From August 2015 to March 2017,a total of 31 patients with tibial plateau fractures in our hospital were divided into treatment group and control group.The treatment group with 12 cases were treated with the needle to be 'double reverse' traction reset,inside and outside double column locking plate MiPPO fixation.The control group with 19 cases received open reduction and internal fixation with locking plate.Results In treatment group,the operation time was (51.3±6.5)minutes,the intraoperative bleeding was (60±8.7)mL.In the control group,the operation time was (68.5±6.6)minutes,the intraoperative bleeding was (230±7.8)mL.The operation time and blood loss of treatment group were less than those of control group,the differences were statistically significant(P<0.05).The postoperative X ray film of fracture showed that the bone plate and screw position were ideal compared with those before operation,no complication occurred.Conclusion The needle 'double inverse' traction and locking plate MiPPO fixation treatment have good clinical effect for patients of Schatzker Ⅴ,Ⅵ tibia platform fracture,with less complication.
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Objective To study and observe the clinical efficacy of using non skid plate by posteromedial approach for fixing splitting or compression tibial plateau fracture.Methods Twenty eight cases of patients who were treated for fixing splitting or compression tibial plateau fracture from January 2014 to January 2016 in people's hospital of Xinyu were retrospectively reviewed.All patients were treated byposterior medial approach with non skid plate for fixation,all patients were followed up by postopera tive imaging and clinical follow-up to observe its clinical curative efficacy.Results Twenty-eight patients were followed up,the mean follow-up time was 12 months.All patients had no internal fixation loosening fracture,send,vascular and nerve damage and other adverse reactions.All the patients were healed within 4 to 7 months,the average healing time was 18.5 weeks.After healing,knee joint function was evaluated,18 cases were excellent,5 cases were good,the excellent and good rate was 82.1 ％.Conclusion The efficacy of using non skid plate by posteromedial approach for fixing splitting or compression tibial plateau fracture is good,it is worthy of clinical application.
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<p><b>OBJECTIVE</b>To study the methods and therapeutic effects of posterolateral tibial plateau fractures with an extended anterolateral approach.</p><p><b>METHODS</b>From January 2011 to December 2013, 15 patients with posterolateral tibial plateau fractures were treated by extended anterolateral approach, including 9 males and 6 females, with an average age of (38.4±7.7) years old ranging from 23 to 70 years old. Seven patients were on the left knees and 8 patients were on the right knees. The injury causes included traffic accidents in 6 cases, falling from height in 7 cases, and falling down when walking in 2 cases. The time from injury to operation was 2 to 14 days (means 5.6 days).</p><p><b>RESULTS</b>All patients were followed up with an average of 19.7 months ranging from 12 to 30 months. All patients were followed with anteroposterior and lateral X ray and CT films, which showed anatomic reduction or near anatomic reduction. The follow up CT scan showed an anatomic reduction in 14 patients and step and gap measurement of 3 mm in 1 case. The average radiographic bony union time was 9.6 weeks (ranged from 8 to 14 weeks). There were no wound complications, nonunion, plate loosening or breakage, valgus knee deformity, or fracture redisplacement. No patients sustained neural or vascular injuries, with knee extension of (2.1±2.1)° and knee flexion of (120.6±18.9)° at the final follow up. The total Rasmussen score averaged (25.0±2.8) points, the result was excellent in 10 cases, good in 4 cases, fair in 1 case.</p><p><b>CONCLUSIONS</b>The extended anterolateral approach has the advantage of allowing visualization of the posterolateral tibial plateau fragments, therefore facilitating its reduction. The approach also ensures safe and adequate posterior placement of a lateral buttress plate because the plate can be placed more posteriorly than can occur through an anterolateral approach.</p>
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Objective To observe the clinical outcome of modified posterolateral approaches for the treatment of posterolateral tibial plateau fractures. Methods From January 2012 to January 2015,13 patients with posterolateral tibial plateau fractures were identified in the Second Hospital of Changzhou Affiliated to Nan?jing Medical University. All the posterolateral fractures were fixated with a plate. The knee function was evaluated at the last follow?up by the Hospital for Special Surgery( HSS) Score,and the occurrence of postoperative compli?cations were observed. Results Thirteen patients were followed up for an average of 14. 4 months,all patients obtained bony union. There were no significant differences regarding the mean HSS score among 3 months, 6 months and 1 year post?operation((71. 6±1. 5) points, (76. 4±1. 6) points, (83. 2±1. 1) points;P=0. 154) . There were no significant differences regarding the tibial plateau angle and posterior slope angle on radiograph?ies of inside and outsideamong immediate,6 and 12 months postoperation((83. 7±1. 7)°,(84. 3±1. 5)°,(85. 1 ±1. 4)°,(85. 4±1. 5)°;(7. 7±1. 5)°,(7. 7±1. 4)°,(7. 7±1. 3)°,(7. 6±1. 8)°;P=0. 223,0. 191). No com?plications associated with the approach were observed and there was no infection,no malunion or fixation failure either. Conclusion In the treatment of posterolateral tibial plateau fractures,the modified posterolateral approa?ches can result in excellent fracture reduction under direct visualization and allow for posterior buttress plating.
ABSTRACT
Objective To observe the clinical effect of minimally invasive with AO joint anatomic locking plate under arthroscope and traditional internal fixation on treatment of severe comminuted fracture of tibial plateau.Methods Thirty-six cases of patients with severe comminuted fracture of tibial plateau were treated in Zhongshan Hospital Affiliated to Dalian University from June 2013 to June 2015 were selected.All patients received minimally invasive treatment with AO joint anatomic locking plate under arthroscope.At the same time,35 cases of patients under traditional fixation were selected as the control group.General surgery information including operation time,intraoperative blood loss,length of incision,limb shortening,knee flexion degree and knee HSS score of patients in both two groups were observed.Results The operation time,intraoperative blood loss,length of incision of the research group were (95.1 ± 20.4) min,(385.4 ± 40.7) ml and (1.9±0.7) cm respectively,(77.6±14.3) min,(456.7±45.1) ml and (4.0±1.2) cm for the control group,the differences were significant (t =4.175,6.997,9.038;P ＜ 0.05).The limb shortening,knee flexion degree of the research group were (0.9±0.7) mm and (112.1 ± 14.8) ° respectively,(2.5± 1.8) mm and (90.1± 10.6) ° for the control group,the differences were significant (t =4.962,7.183;P＜ 0.05).After treatment,the knee joint HSS score of the research groups was (84.9±9.7),(69.1±7.3) for the control group,the difference was significant(t =7.738,P＜0.05).Conclusion The clinical effect of minimally invasive treatment of severe comminuted fracture of tibial plateau with AO joint anatomic locking plate under arthroscope is significant,with smaller invasion,better postoperative recovery than traditional fixation,and can promote the recovery of neural function.