Role of posteromedial plating in condylar fractures of Tibia in adults

Background: The purpose of this study was to evaluate role of Posteromedial Plating in condylar fractures of Tibia, especially patients with posterior tibial shear fractures. Materials and methods: This prospective study included 12 patients with mean age 40 years (range 30 to 50 years) who sustained high velocity posterior tibial plateau fracture-subluxations with/ without associated Bicondylar fractures (Moore I & II Types, Schatzker’s Groups – IV, V and VI). Surgical management included stabilisation plating through a posteromedial/ posterior approach and additional postero lateral or antero lateral approach as needed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Oxford Knee Score and Lyshom Score. Results: The mean OKS score was 40 (range 36 to 44) at the end of one year. The main clinical measures were early post-operative non weight bearing ROM, post-operative complication and functional outcome. The time to full weight bearing, the rate of post-operative complications and functional outcome was significantly better as evident by over 94 % showing good to excellent OKS and Lyshom scores. Conclusion: A posterior/ postero medial approach for posterior tibial plateau shear fractures (which are otherwise irreducible by conventional approaches) and buttress/ antiglide plate are usually needed to reduce the fractures anatomically, achieving absolute stability and mobilize early NWB, ROM of the knee joint to optimize the functional outcomes and minimize the complications, without the need for revision surgery.

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.

Biomechanical study on three types of internal fixation methods for posterolateral fracture of the tibial plateau / 医用生物力学

Objective To investigate a reasonable and effective internal fixation method for posterolateral fracture of the tibial plateau. Methods Specimens of the tibial plateau with posterolateral fracture made from 12 adult male cadavers were randomly and evenly divided into 3 groups, and fixed by anterior 6.5 mm lag screw, lateral 4.5 mm L-shape plate, posterior 3.5 mm T-shape plate, respectively. All the specimens were loaded in turn by stress of 250, 500, 750, 1 000 N, and the corresponding axial displacement and stress were measured. Results Under the same stress, the Y-axial displacement of the anterior lag screw group was the smallest, showing a significant difference with the lateral plate group and the posterior plate group, while there was no significant difference between the lateral plate group and the posterior plate group in the Y-axial displacement. The stresses on marked points in the anterior lag screw group were evenly distributed. Conclusions For fixation of isolated posterolateral fractures of the tibial plateau, the anterior 6.5 mm lag screw can effectively increase the axial stability and balance the stress distribution around the fracture block, indicating it is an effective method for mechanical fixation. The lateral plate has certain advantage in lateral stability control, while the posterior plate has certain value to reduction of the posterior tibia plateau fracture.

Surgical oPtion to treat tibia Plateau fracture / 中国综合临床

Objective To summarize the clinical results of treatment of tibia plateau fracture. Methods Forty-six cases of tibial plateau fractures were treated with operation from Oct. 2007 to Oct. 20l2 in General Hospital of PinGdinGshan Coal Industry Groud. AccordinG to Schatzker classification,6 cases were typeⅠ,8 were type Ⅱ,6 were type Ⅲ,4 were type Ⅳ,l2 were type Ⅴ,and l0 were type Ⅵ. Patients in type Ⅰwere treated with open reduction and fixation with screws,other types were treated with open reduction and internal fixation combined with anatomy or lockinG plates and screws. And bone Grafts were used when severe bone defect after reduction. Results Forty-six cases were followed up from 6 months to l8 months( averaGe 8. 5 months ) . AccordinG to the Rasmussen knee score standard,the satisfactory rate was 89. l%( 4l/46 ). Conclusion Different methods of operative treatment of tibia plateau fracture is recommended accordinG to the type of fractures,quality of the bone and the combination of injury. Soft tissue protection should always be kept in mind durinG operation. Delayed operation,Good restitution and fixation,early exercise of joint and late weiGht loadinG are the key factors in the treatment of tibial plateau fracture.

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.

The effect of hyaluric acid sodium injection and functional exercises on patients with comminuted fracture of tibia plateau after reposition / 中国实用护理杂志

Objective To investigate the clinical effect of hyaluric acid sodium injection and functional exercises on patients with comminuted fracture of tibia plateau after reposition. Methods 134 patients with comminuted fracture of tibia plateau after reposition were randomized into the observation group and the control group with 67 cases in each group. The observation group received 2ml of hyaluric acidsodium injection into the knee joint cavity with 1％ lidocaine once a week and 3 times totally. At the same time active and passive functional exercises were applied. The control group was only given routine nursing. The knee function was evaluated by Lysholm Scale 4 months after operation and the results were compared. Results The score of the observation group was higher than that of the control group(P＜0.01).Conclusion The hyaluric acid sodium injection and functional exercises could improve the healing of joint cartilage and contribute to the rehabilitation of joint function in patients with comminuted fracture of tibia plateau after reposition.

Discussion of influencing factors therapeutic effect in the operative treatment of the fracture of tibial plateau / 中国矫形外科杂志

[Objective]To evaluate the result of operative treatment of tibial plateau fracture and analyze its related factors of influencing the therapeutic effect and provide effective prevntional measures.[Method]Totally 107 cases(male 62 cases;female 45 cases) of tibia plateau fractures were operated with internal fixation from Feb.2000 to Apr.2005 in our hospital.According to Schatzker classification,there were typeⅠfracture 2 cases,typeⅡ 37 cases,typeⅢ 29 cases,type Ⅳ 22 cases,type Ⅴ 10 cases,type Ⅵ 7cases.TypeⅠfractures were treated with cannulated screws,other type fractures were performed with open reduction and internal fixation with buttress plates and autologous and/or allograft bone grafts.Therapeutic effect and its related factors were analyzed concomitantly.[Result]The 107 patients were followed up for 9~64 months(averaged 27 months).The clinical results were assessed according to Hohl scale for knee joint.The excellent and good results was 85.98%.There were obvious complications articular stiffness 1 cases and traumatic arthritis 8 cases including tibia plateau articular depression 4 cases.[Conclusion]Surgical operation is effective methods of treating tibia plateau fracture,The complete fracture reduction suitable internal fixation a good protection and recovery of the soft tissue of the knee joint structure,and correct and effective function rehabilitation are the significant measures for good therapeutic effect in the treatment of tibia plateau fracture.

Clinical analysis of surgical treatment in 64 cases with tibial plateau fracture / 中国矫形外科杂志

[Objective]To investigate the clinical results of open reduction and internal fixation in the treatment of tibial plateau fractures.[Method]Sixty-four cases of tibial plateau fractures were treated from January 1994 to December 2000 in our hospital.According to Schatzker classification,8 cases were type Ⅰ,40 cases were type Ⅱ,6 cases type Ⅲ,4 type Ⅳ,3 type Ⅴ and 3 cases were type Ⅵ.They were treated with open reduction and internal fixation and allograft implantation for defective fractures.[Result]Fifty-eight cases were followed up from 1 to 7 years,with an average of 2.8 years.All the fractures united.The satisfactory rate was 84.48% based on Hohl scale.[Conclusion]Internal fixation is an effective method to treat tibial plateau fracture,and the operation procedures should be varied with the fracture types.Complications after operation are closely associated with the fracture complexity.Anatomical reduction,bone transplantation,stable internal fixation,and early functional exercises are effective measures of preventing complications.Early treatment of soft tissue injury must be emphasized especially.

Treatment of tibial plateau fracture-report of 126 cases / 中国矫形外科杂志

[Objective]To increase the cure rate and decrease the disabilities rate of tibial plateau fracture.[Method]The clinical classification,management,and prognosis of tibial plateau fracture were studied by following 126 cases in 20 months.[Result](1)126 cases were followed and the result was: excellent: 86 cases,good: 21 cases,acceptable: 14 cases,bad: 5 cases.The cure rate was 84.9 %.(2) The cure rates of type Ⅰ,Ⅱ and Ⅲ were 95.45%,83.3%,62.5%(P0.05).[Conclusion](1)Displaced fracture with vertical split

Arthroscopically assisted treatment of tibial plateau fractures in 38 cases / 中国微创外科杂志

Objective To explore clinical results of arthroscopically assisted treatment for tibial plateau fractures.Methods Thirty-eight cases of tibial plateau fractures were treated under arthoscope.According to the Schatzker classification,there were 8 cases of type Ⅰ, 10 cases of type Ⅱ,11 cases of type Ⅲ,4 cases of type Ⅳ,3 cases of type Ⅴ,and 2 cases of type Ⅵ,respectively.Routine arthoscopic examination of the knee found 15 cases of meniscus injury,12 cases of partial or complete rupture of anterior cruciate ligament(ACL),and 7 cases of medial collateral ligament (MCL) injury.Fracture reduction and fixation was performed under arthroscopic surveillance.The tibia plateau fracture was fixed with the cancellous bone screws(Schatzker Ⅰ~Ⅲ) or minimally invasive plate osteosynthesis(Schatzker Ⅳ~Ⅵ).Results The operation time was 30~72 min(mean,40 min) and the intraoperative blood loss was less than 20 ml.A follow-up was carried out in 36 cases for 4~36 months(mean,15 months).The X-ray findings at the 3 postoperative month showed bone union in all the 36 cases.There were no wound or joint infection,skin necrosis,or delayed union.The Hospital for Special Surgery(HSS) knee scores 3 months after operation revealed excellent results in 28 cases,good in 6 cases,and fair in 2.The main untoward manifestations at this period were lacking of muscle force and limited extension and incurvation of the knee joint.The HSS scores 6 months after operation showed excellent result in 33 cases and good in 3 cases. Conclusions Arthroscopically assisted treatment of tibial plateau fractures has advantages of accurate reduction and fixation and early detection and management of associated intraarticular injuries.Different methods of internal fixation should be chosen according to different types of facture.

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.