RESUMO
Tibial plateau fractures are complex lesions capable of causing severe consequences if not appropriately treated. They are often the result of a high-energy trauma and, not rarely, are associated with significant soft-tissue and intra-articular injuries. Different therapeutic options can be managed in the treatment of these lesions. Minimally invasive surgery offers several advantages compared to other surgical techniques and allows, with less additional soft tissue damages, good reduction and stable fixation of the fracture. The use of arthroscopic and radiologic assistance for treatment of tibial plateau fractures seems reasonable because the fracture and its subsequent reduction can be directly visualized without arthrotomy or meniscal detachment, thereby lessening postoperative morbidity, pain, and stiffness. Associated ligamentous and meniscal injuries may also be better addressed arthroscopically. The purpose of this study is to evaluate the functional and radiographic results and the value of the combined arthroscopic and radiologic treatment of tibial plateau fractures as a minimally invasive method to achieve good congruity. Between January 2005 and December 2008 this study was performed with the combined arthroscopic and radiologic assisted treatment in 19 patients with tibial plateau fractures. We reviewed clinical records and radiographic findings of 18 out of the 19 patients with a minimal follow-up of at least 12 months [range 12 months-3 years]. There were 13 men and 5 women, mean age at injury 36 years old [range 15-61]. One patient refused to participate in the study. In this study we assessed the results of the combined arthroscopic and radiologic assisted reduction and internal fixation of tibial plateau fractures percutaneous with osteosynthesis in 18 patients affected by Schatzker type I, II and III fractures except in two cases plate and screws were applied also arthroscopically without arthrotomy. The indications for operative fixation included any lateral plateau fractures with a varus or valgus instability > 10 degrees, and an articular step off > 3 mm ora condylar widening > 5 mm. Initially, post-operative treatment started with 4 weeks of immobilization in plaster, followed by four weeks of physiotherapy without weight bearing using continuous passive and active motion. In the last cases this period of immobilization was shorter. Weight bearing was allowed after a mean time of 2 months. According to Kohl's and Rasmussen's grading system, 16 out of 18 patients scored as satisfactory result. We experienced no complications due to arthroscopy. All the fractures healed in 3 to 4 months There were no failure of fixation,infection, deep venous thrombosis, compartment syndrome, or arthrofibrosis and osteoarthritis According to the Rasmussen clinical scoring system [Table 1], 8 patients were assessed as excellent, 7 good, 2 fair and 1 poor. Combined arthroscopic and radiologic reduction and internal fixation provides an accurate assessment of, and allows definitive treatment for, intraarticular injuries associated with tibial plateau fractures. The technique allows less soft tissue stripping than with traditional arthrotomy, better visualization of the articular surface, early return to physical activities, and obviates the need for meniscal tear and partial menisectomy did. However, not all types of tibial plateau fractures are amenable to arthroscopic reduction and internal fixation. The split, split depression, and joint depression fracture types in young, active patients with good bone stock are ideally suited for arthroscopic reduction and internal fixation. Randomized, prospective trialsmay be needed to confirm the advantages of arthroscopic reduction and internal fixation in the treatment of tibial plateau fractures compared with conventional open reduction techniques