Influence of axial rotation on measurement of medial proximal tibial angle / 中国骨伤

OBJECTIVE@#To measure and compare medial proximal tibial angle (MPTA) of lower limbs under different axial rotation angles(neutral position, 30° internal rotation, 30° external rotation) on the load position radiographs, and explore changes and significance of MPTA measured within and between groups of tibia at different axial rotation positions.@*METHODS@#From January 2018 to December 2018, 40 patients with knee osteoarthritis (KOA) were selected, with a total of 80 limbs, including 12 males and 28 females, aged from 29 to 73 years old with an average of (59.6±12.7) years old. Full length radiographs of the lower limbs were taken on neutral tibia position, 30° internal rotation and 30° external rotation, respectively. MPTA was measured and the results were compared between groups and within groups.@*RESULTS@#MPTA measured on the left lower extremity of neutral tibia, 30° internal rotation and 30° external rotation were (86.08±2.48) °, (88.62±2.94) ° and (83.47±3.10) °, respectively. MPTA measured on the right lower limb were (86.87±1.97) °, (89.02±2.39) ° and (83.80±2.77) °, respectively, and there were no significant difference in MPTA measured between rotation angle group (P>0.05). While there were statistical difference in MPTA on the same limb between groups (P<0.05). On 30° internal rotation, MPTA of left and right lower limbs increased by (2.54±1.74) ° and (2.15±1.78) ° compared with tibia neutral position. On 30° external rotation, MPTA of left and right lower limbs decreased (2.61±2.03) ° and (3.07±1.75) ° compared with tibial neutral position.@*CONCLUSION@#When a full-length X-ray film is taken on the weight-bearing position of both lower limbs, if there is axial rotation or external rotation of tibia, MPTA will increase or decrease compared with neutral position, which may cause a certain degree of deviation in clinical operation based on the accurate measurement of MPTA. However, the extent to which this bias affects the clinical operation effect remains to be verified. In addition, limited by the total number of samples and the number of measurement groups, whether there is a linear relationship between MPTA deviation and tibial axial rotation needs to be further studied.

A new minimally invasive spreader combined with less invasive stabilization system for proximal tibial fractures / 中国组织工程研究

BACKGROUND: The traditional surgical treatment of proximal tibial fractures has extensive dissection of the fracture site, and affects local blood circulation, increases the incidence of delayed union and nonunion. In recent years, the rising minimally invasive internal fixation system can protect the local soft tissue and blood circulation to the maximum extent, and provide better conditions for fracture healing. The application of new spreader also solves the problems of stability and durability of traditional manual traction reduction, and the combination of the two is gradually concerned. OBJECTIVE: To explore the effect of a new minimally invasive spreader assisted reduction and less invasive stabilization system for the treatment of proximal tibial fractures. METHODS: Twenty-two patients with proximal tibial fractures treated from May 2016 to October 2019 were studied and randomly assigned to control group and observation group (n=11 per group). Patients in the control group were treated with conventional manipulative reduction and conventional incision plate internal fixation. Patients in the observation group were treated with a new minimally invasive spreader assisted reduction and less invasive stabilization system. This study was approved by the Ethics Committee of Fifth Hospital, Guangzhou Medical University. RESULTS AND CONCLUSION: Compared with the control group, Rasmussen knee function score was better in the observation group at the last follow-up. Intraoperative blood loss, operation time, length of hospital stay, and weight-bearing time in the observation group were better than those in the control group. Postoperative complications such as joint limitation and delayed fracture healing were less in the observation group than in the control group. However, the healing time was not statistically significant between the two groups. Moreover, infection of the incision and loosening and fracture of the internal fixator were not statistically significant between the two groups. These indicated that the application of a new minimally invasive spreader combined with less invasive stabilization system for proximal tibial fractures can reduce surgical reduction time and local soft tissue damage, which is beneficial to early functional exercise and can reduce postoperative complications.

Application of proximal tibial hemiprosthesis replacement and second-stage revision for proximal tibial osteosarcoma in three children / 中国修复重建外科杂志

Objective: To investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma. Methods: Between 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively. Results: All patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively. Conclusion: The proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.

Avulsión de la tuberosidad tibial: reporte de un caso y revisión de la literatura / Tibial tubercle avulsion: a case report and literature review

Resumen La fractura por avulsión de la tuberosidad tibial es una patología poco común. Es una lesión característica de la infancia, con afección directa a la fisis, que amerita un diagnóstico oportuno y un tratamiento óptimo a fin de evitar complicaciones en el crecimiento, la mayoría de ellas graves. La reducción abierta y fijación interna ha probado ser un tratamiento adecuado en la mayoría de este tipo de lesiones; sin embargo, el procedimiento quirúrgico es un riesgo agregado al daño de la lesión per se. Con un adecuado tratamiento y rehabilitación la lesión tiende a una evolución por lo general satisfactoria. Tomando en cuenta la baja incidencia de esta patología, en el siguiente artículo reportamos el caso de un paciente de 13 años con avulsión de tuberosidad tibial tipo III de Watson-Jones, el abordaje diagnóstico-terapéutico y el éxito obtenido a 2 años de seguimiento; asimismo, realizamos una revisión de la literatura.

Abstract Tibial tubercle avulsion is an uncommon disease, usually found during childhood, with direct physis affection, that needs an accurate diagnosis and an optimum treatment in order to avoid growth complications which could have disastrous consequences for the child. Open reduction and internal fixation has been reported as an adequate treatment in most of these injuries; nevertheless, surgery increases the risk upon the injury itself. With an appropriate treatment and rehabilitation this injury tends to have a satisfactory evolution. Considering the low incidence of this pathology, a case report of a 13-year-old boy with a Watson-Jones type III avulsion, a diagnostic-therapeutic approach and the successful evolution for a two-years follow up is described, as well as a literature review.

Management of fracture of the proximal tibial epiphysis in children(19 cases) / 重庆医学

Objective To inoertyate the results of the management of fracture of the proximal tibial epiphysis ,with a particu‐lar reference to the prognosis and complications in children .Methods From January 2002 to June 2012 ,a total of 19 children with fracture of the proximal tibial epiphysis were reviewed ,10 cases were treated with closed reduction and immobilization with plaster cast ,9 patients were operated upon with open reduction and internal fixation .Results All the patients were available at the final follow up with a mean of 2 .8 years (range ,2‐4 .8 years) ,The mean healing time of the fracture was 11 .8 weeks (range ,8 .5‐20 weeks) .According to the assessment system described by Lysholm ,the knee joint function of patients was 13 excellent ,4 good ,1 better and 1 poor .1 case occurred traumatic arthritis ,leading to the pain of keen ,One patient had epiphyseal plate closed early ,and one patient had genu valgum .Conclusion Open reduction and internal fixation should be recommended for the management of the facture with remarkable displacement of type Ⅰ and type Ⅱ ,or the facture involving the articular surface collapses more than 5 mm or separates more than 2 mm of type Ⅲ and type Ⅳ .The treatment with Kirschenel wires or hollow lag screw fixation could achieve good results .

Biomechanical Analysis of Operative Methods in the Treatment of Extra-Articular Fracture of the Proximal Tibia

BACKGROUND: To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures. METHODS: Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure. RESULTS: Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8; p < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group. CONCLUSIONS: During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate.

Locking Plate in Proximal Tibial Fracture: A Correlation between the Coronal Alignment of Tibia and Joint Screw Angle

PURPOSE: The purpose of this study is to evaluate the relationship between the angle formed between the proximal most screw through the locking compression plate-proximal lateral tibia (LCP PLT) and the joint line, and to evaluate if this angle can be used intraoperatively as an assessment tool to determine normal alignment of the tibia in the coronal plane. MATERIALS AND METHODS: There are two parts to this study: in the first part, LCP PLT was applied to 30 cadaveric adult tibia. The angle between the joint line and the proximal most screw was measured and termed as the 'joint screw angle' (JSA). In the second part, 56 proximal tibial fractures treated with LCP PLT were retrospectively studied. Two angles were measured on the radiographs, the medial proximal tibial angle (MPTA) and the JSA. Their relationship was analyzed statistically. RESULTS: The average JSA was 1.16 degrees in the anatomical study. Statistical analysis of the clinical study showed that the normal MPTA had a direct correlation with an acceptable JSA. CONCLUSION: We therefore conclude that the JSA can be used intraoperatively to assess the achievement of a normal coronal axis.

Anatomical measurements of proximal tibia of anterior and posterior cruciate ligament-retaining knee prosthesis / 中国组织工程研究

10.3969/j.issn.2095-4344.2013.26.004

Comparación entre resultados obtenidos en la corrección de valgo tibial proximal en pacientes pediátricos con sistema de grapas y sistema de placas en el Hospital Ortopédico Infantil Caracas Venezuela 2000-2007 / Comparison of results obtained in the proximal tibial valgus correction in pediatric patients with staple system and system of plaques in the Hospital Ortopédico Infantil 2000-2007 Caracas Venezuela

Las deformidades axiales de los miembros inferiores, motivo de consulta habitual, no corregen espontáneamente si son persitentes y sginificativas. La epifisiodesis produce la corrección grudual de la deformidad en un procedimiento mínimamente invasivo, en pacientes esqueléticamente inmaduros, en genu valgum y varum, con grapas o placas y tornillos. Según las observaciones clínicas, las placas permiten un mejor resultado en tiempo más corto, menor daño a la fisis y menos riesgo de complicaciones o falla de material en comparación con las grapas. La comparación de las técnicas en engrapado y placa en la resolución de deformidades en valgo de tibia proximal en los pacientes pediátricos en el Hospital Ortopédico Infantil, durante el periodo 2000 al 2007. Estudio retrospectivo simple y comparativo, se evaluaron 36 pacientes de ambos sexos con el diagnostico de Valgo Proximal Tibial, idiopáticos o asociados a otras patologías, que fueron tratados en el Hospital Ortopédico Infantil durante 2000 al 2007 con las técnicas de grapa y placa, mediante revisión de controles pre y postoperatorios de la historia clínica, y por medición radiológica de los ángulos FDLm, TPMm y MAD en radiogrfías panorámicas pre y postoperatorias. Se estudiaron 36 pacientes de ambos sexos, (16 varones y 20 niñas), promedio de edad de 10 años +/- 3,3 años. Existen similitudes en los primeros 12 meses en esta muestra, pero a partir de ese momento la Placa alcanza los valores de corrección antes que las grapas. Según la pendiente Y, la placa se proyecta para correcciones de 6,62 mm cada 6 meses, en cambio la grapa se proyecta para correciones de 5,72 mm cada 6 meses. Los valores del ángulo se estabilizan con la placa, y en cuanto a la grapa, se continúa la corrección en sentido contrario. La pendiente Y indica que la placa corrige -1,95º cada 6 meses, y la grapa corrige -2,95º cada 6 meses hacia el varo. Según la prueba ANOVA, combinando las variables Tiempo-Material, la placa alcanza....

The axial deformities of the lower limbs, common reason for consulation, will not correct spontaneously if they are persistent and significant. Epiphysiodesis produce gradual correction of deformity in a minimally invasive procedure in skeletally immature patients in valgum and genu varum with staples or plates and screws. According to clinical observations, the plates allow a better result in shorter time, less damage to the physis and less risk of complications or failure of material compared with the staples. Comparison of stapling techniques and plaque in the resolution of valgus deformity of proximal tibian in pediatric patients at Children's Orthopedic Hospital during the period 2000 to 2007. A retrospective and comparative simple, we evaluated 36 patients of both sexes with a diagnosis of Proximal Tibial Valgus, idiopathic or associated with other diseases, which were treated at the Children's Orthopedic Hospital during the period 2000 to 2007 with the techniques staple and plate by reviewing pre-and postoperative checks of medical record, and radiological measurements of the angeles FDLm, TPMm, and MAD in pre-and postoperative panoramic radiographs. We studied 36 patients of both sexes (16 boys and 20 girls), mean age 10 +/- 3,3 years. There are similarities in the first 12 months in this sample, but from that moment on the plate reaches the values of correction rather than staples. According to the slope and The plate is projected to corrections from 6,62 mm every 6 months, however the clip is projected to corrections of 5,72 mm every 6 months. The angle values are e¡stabilized with the plate, and as for the clip, continue the correction in the opposite direction. The slope indicates that the board and fixes -1,95º every six months, and the clip fixes -2,95º every six months into varus. According to the ANOVA test, combining the time-material variables, the plate reaches the expected correction before on the staple, the period aroun 12 months would.....

Comparison of the Limb Alignment and the Component Positioning between Conventional and Navigated Total Knee Arthroplasties for the Osteoarthritic Knees That Have Anatomic Variation

PURPOSE: The authors sought to assess the usefulness of navigation as opposed to the conventional method by analyzing the radiographic results obtained from subjects who underwent total knee arthroplasty for knees that were accompanied with anatomic variations. MATERIALS AND METHODS: The study subjects were selected from 53 patients (a total 72 cases: 43 were treated by the conventional method and 29 were treated by the navigational method) who exhibited radiographic evidence of distal femoral varus (2degrees). The coronal femoral component angle (alpha) and the coronal tibial component angle (beta) were measured, and the femoral component position in relation to the mechanical axis (theta) and the post-operative weight-bearing mechanical axis difference (MAD) were compared and analyzed. RESULTS: The navigation method showed significant better results in terms of the alpha, theta and MAD (p<0.05). Among the outliers greater than 3degrees, a statistically significant difference was shown only for the MAD (p=0.030). CONCLUSION: Navigation surgery is useful in terms of the femoral component's position in the coronal plane and limb alignment in the osteoarthritic knee that is accompanied by distal femoral varus or proximal tibial varus.

Staged Minimally Invasive Plate Osteosynthesis of Proximal Tibial Fracture

PURPOSE: To assess the results of staged MIPO (Minimally Invasive Plate Osteosynthesis) for proximal tibial fractures with compromised soft tissue. MATERIALS AND METHODS: Eighteen proximal tibial fractures (AO 41:9 cases, AO 42:9 cases) included this study. Ten were open fractures. After temporary external fixation until soft tissue healed (mean 27.3 days), MIPO was performed secondarily without bone graft. We assessed the bony union and knee function, and affecting factors of the results were investigated. RESULTS: All fractures united at 20 weeks (range, 11~32) except 1 case. Mean range of knee flexion was 134.4degrees and mean IOWA knee score was 89.1. There were 2 superficial and 2 delayed deep infections from open fractures (grade II:1 case, grade III:3 cases), although they healed after implant removal. Open fractures seem to influence the infection rate. Otherwise, there was no related factor affecting the results. CONCLUSION: MIPO after temporary external fixation can provide favorable results in proximal tibial fractures with soft tissue injuries, but attention of delayed infection should be paid in open fractures.

Survivorship Analysis of Closing Wedge Proximal Tibial Osteotomy Using Miniplate Staple

PURPOSE: To evaluate the clinical and radiological results and to analyze the survivorship after closing wedge proximal tibial osteotomy(PTO) using miniplate staple. MATERIALS AND METHODS: From November 1993 to August 2003, sixty closing wedge PTO using miniplate staple were performed in forty patients. The average follow-up period was 7.2 years(range, 2.8~12.5 years). According to the post- operative femorotibial angle(FTA), group I was defined as the cases whose FTA was less than 7 degrees of valgus(25 cases) and group II was defined as the cases whose FTA was more than 7 degrees of valgus(35 cases). The HSS score, FTA and survivorship were compared between group I and II. RESULTS: Average HSS score at the last follow up were 75.3 in group I and 85.9 in group II(p=0.006). Average FTA at the last follow up were 0.8 degrees in group I and 7.7 degrees in group II(p=0.006). The overall 7-year survivorship was 92.6% and 12-year survivorship was 75.5%. The 7-year survivorship and 12-year survivorship of group I were 86.7% and 54.2%, respectively. Group II have no failure at last follow up(p=0.0489). CONCLUSION: Our results suggest that the desirable postoperative FTA was more than 7 degrees of valgus, considering the long term satisfactory result and survivorship of the closing wedge PTO using miniplate staple for the osteoarthritic knees.

Three dimensional linear measurement of proximal tibia in medial and lateral approach for bone harvesting

PURPOSE : The aim of this study was simply assessing linear measurements in the lateral and medial approach, respectively, for bone harvesting using anatomic and three-dimensional (3D) computed tomographic (CT) analyses on a dried cadaveric proximal tibia. In addition, the availability of the three-dimensional computed tomographic (3D-CT) analysis was also estimated. MATERIALS AND METHODS : Ten dried proximal tibia were obtained from five Korean cadavers. Four the reference points, the SM (superior-medial), IM (inferior-medial), SL (superior-lateral), and IL (inferior-lateral) were marked around the tibial tuberosity. The PM (posterior-medial) and PL (posterior-lateral) points were randomly marked at points farthest from the lateral and medial reference points, respectively, in the posterior border of the superior articular surface of both condyles. All measurements were obtained on the dried proximal tibia. After computed tomography had been performed, the three dimensional images were reconstructed using V works 4.0(TM) (Cybermed Inc., Seoul, Korea), and the length between the reference points were measured three dimensionally using the method described above. The error between the mean actual and mean 3D-CT measurements was calculated in order to determine the availability of the three dimensional computed tomographic analysis. RESULTS : The length between the reference points was greatest at the IL-PM, which averaged 65.39 mm+/-10.35. This was followed by the SL-PM with 63.24 mm+/-8.10, the IM-PL with 58.09 mm+/-10.02, and the SM-PL with 51.99 mm+/-9.06. The differences between the IL-PM and SM-PL were 13.4 mm. The mean values were 55.04 mm in the medial approach and 64.32 mm in the lateral approach, and the differences between medial and lateral were 9.28 mm. The error between the mean actual and mean 3D-CT measurements was 0.31% and the standard deviation was 0.28%. CONCLUSION : The anatomical and three dimensional computed tomographic analysis indicates that there was only a 9.28 mm linear difference between the lateral and medial approach. This is consistent with previous studies, which showed that there was little difference between the two approaches in terms of the bone volume. In addition, the error (0.31%) and the standard deviation (0.28%) were considered low, demonstrating high accuracy of 3D-CT. Therefore it can be used in preoperative treatment planning.

A Comparison according to Insertion Method for Intramedullary Nailing in Proximal Tibial Fractures

PURPOSE: To compare clinical and radiological results between standard insertion method and semiextended method which was designed to improve proximal fixation and alignment in proximal tibia fracture. MATERIALS AND METHODS: A retrospective review from May 2000 to February 2004, identified 24 extraarticular fractures in proximal tibia, initially treated with locked intramedullary nails at least 1 year follow up. There were 12 open injuries, 4 segmental, 3 butterfly fragments and 17 comminuted. Semiextended method was used in 10 fratures and standard insertion method which is cephalad to tibial tubercle in 14. Follow up clinical assessment consisted of review of associated injuries and complications and these two methods were compared by postoperative angulation and displacement in anteroposterior and lateral radiographs. Data were analysed by t-tests. RESULTS: In semiextended group, average angulation was 2.3 degrees in coronal and 2.8 degrees in sagittal plane and average displacement was 4.5 mm in coronal and 5.3 mm in sagittal. In ordinary group, average angulation was 5.1 degrees in coronal and 7.4 degrees in sagittal plane and average displacement was 6.1 mm in coronal and 5.3 mm in sagittal. In semiextended group, there were significant reduction in coronal angulation (p=0.006) and sagittal angulation (p=0.001), but there was no significant difference in coronal (p=0.344) and sagittal (p=0.99) displacement. Both groups showed anterior, valgus angulation and posterolateral displacement in most cases. There were 14 associated injuries and one patient developed nonunion and was treated by nail exchange with autogenous bone graft. CONCLUSION: Our retrospective analysis demonstrated that semiextended method is effective for reducing coronal and sagittal angulation, but is not helpful for reducing displacement in both planes.

Rigid Stepped Plate (RSP) for the Internal Fixation of the High Tibial Osteotomy / 대한정형외과연구학회지

PURPOSE: To compare the fixation power of the newly devised RSP (rigid stepped plate) with the L-plate by mechanical study and to prove the efficacy of the RSP. MATERIALS AND METHODS: Lateral closing wedge proximal tibial osteotomy was performed on the 10-monthsold porcine tibiae, which were fixed by 15 L-plates and 15 RSP's. Each group of 5 pairs of the specimen were applied to the Instron apparatus and loaded by compression, valgus, and varus bending. The fixation power was compared by the stiffness of each construct. RESULTS: Specimen fixed by the RSP's showed larger stiffness than those fixed by the L-plate. Even though the difference was not statistically significant in compression (p=0.465), it was statistically significant in valgus (p=0.047) and varus (p=0.009) bending. CONCLUSION: The RSP can be applied with minimal skin incision, will provide firm initial fixation to the osteotomy site, and seems to enable early range of motion exercise. It will improve the outcome of proximal tibial osteotomy by preventing excessive soft tissue dissection and complications resulting from long-term immobilization of the knee joint.

Minimally Invasive Percutaneous Plate Stabilization of Proximal Tibial Fractures

PURPOSE: Despite of various treatment methods, proximal tibial fractures are common injuries that may be associated with poor outcomes and high rates of complications. To improve this, percutaneous plating technique was performed in the proximal tibial fractures. MATERIALS AND METHODS: Twenty-four proximal tibial fractures (AO 41A; 5, AO 41C; 12, AO 42; 7) were treated by percutaneous plating with either or both sides without bone graft. One was open fracture. RESULTS: All fractures were healed. The average time for fracture healing was 16.5 weeks (range, 8~24 weeks). Complications included a 1cm shortened case and two mal-alignments; a 6 degree valgus case and 5 degree varus case. There was one case of superficial infection, which healed after plate removal. But, there was no deep infection. Results were evaluated by modified Rasmussen score system, all patients had excellent or good result. CONCLUSION: Minimally invasive percutaneous plating technique can provide favorable results in the treatment of proximal tibial fractures.

Operative Treatment of Proximal Tibial Plateau Fractures through Lateral Submeniscal Approach

PURPOSE: The purpose of this study was conducted to evaluate the clinical results of proximal tibial plateau fractures treated with open reduction and internal fixation through the lateral submeniscal approach and allowed early motion of the knee and to evaluate the effectiveness of the approach. MATERIALS AND METHODS: From January 1998 to December 2002, fifty four patients who underwent open reduction through the lateral submeniscal approach for proximal tibia plateau fracture and had a follow-up more than one year were included in this study. Clinical results were evaluated by postoperative radiographs taken at the last follow-up and Porter's assessment method. RESULTS: Anatomical reduction was achieved under direct vision through the submeniscal approach in most of the cases in this study. The postoperative radiographs showed anatomical reduction in 32 cases (59%) and adequate reduction with displacement within 2 mm in 20 cases (37%). The clinical evaluation by Porter's assessment method revealed that 49 cases (91%) were acceptable results of excellent or good at the final follow-up CONCLUSION: This study indicates that open reduction and internal fixation through the lateral submeniscal approach can be a good option for proximal tibia plateau fractures because it allows accurate reduction of the articular fractures, which is confirmed directly during operation, identification and repair of associated soft tissue injuries are facilitated, sufficient bone graft and stable fixation of the articular fragments under direct vision allow early motion of the knee.

Surgical Treatment of the Irreducible Hohl and Moore Type 2 Proximal Tibia Fracture-Dislocation 3 Years Follow up Study: 1 Case Report

Intraarticular proximal tibia fracture and dislocation patterns, that were proposed by Hohl and Moore, are generally caused by high energy mechanism . These fracture and dislocation patterns are known to be combined with injuries of popliteal artery, peroneal nerve and cruciate ligament in many cases. We experienced a case irreducible Hohl and Moore fracture-dislocation patterns type 2, in which posterior dislocation with medially displaced entire lateral condyle that could not be reduced by closed mean for fibular head blocking the proper reduction. Additionally, popliteal artery was entrapted into the fracture site. We carried out open reduction and screw fixation via posterior approach and with fibular osteomy. We followed the patient for 3 years.

Measurement of Posterior Slope Angle of the Proximal Tibia by MRI and X-ray / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the anatomic proximal tibial posterior slope angle by measuring the true posterior slope angle of the proximal tibia and the meniscal slope angle by MRI. MATERIALS AND METHODS: We measures 102 meniscal and tibial plateau slope angles, including 39 medial and 63 lateral sides. The average age of the patients was 33.3 years (8-66). We measured the meniscal slope angle form MRIs of the patients, with confirmed no pathologic abnormality of the meniscus by arthroscopy. We traced the line between the upper margins of the anterior and posterior horn of the medial and lateral menisci, and the proximal tibial plateau line. The angle between the two lines was considered as the meniscal slope angle. RESULTS: The medial meniscal slope angle between the medial meniscal slope and the medial tibial bony slope averaged 6.2 degrees (2.5-9) and 5.3 degrees (1-15) in the lateral, side, an overall average angle of 5.8 degrees. CONCLUSION: This results suggests that the proximal tibial meniscal slope is less oblique than the usually measured bony slope at about 5.8 degrees. The authors suggest the proximal tibial cutting slope with 5.8 degrees less posterior tilt than bony slope angle.

Proximal Tibial Osteotomy fixed with Miniplate Staple / 대한정형외과학회잡지

The rationale for proximal tibial osteotomy is to correct the abnormal loading stresses on the knee that are caused by an abnormal tibiofemoral axis in the coronal plane. Aithough there are many methods of fixation including cast, staple and external fixation, Coventry staple has been used widely. But Coventry staple has some disadvantages such as inadequate fixation, long term cast immobilization and rehabilitation. The purpose of this study is to demonstrate the superior performance of Miniplate staple which was designed by authors(Johnson & Johnson Orthopaedics, New Milton, UK) over the conventional Coventry staple. We have analyzed the clinical results including postoperative rehabilitation course of 3I cases who had proximal tibial osteotomy fixed with Miniplate staple. Preoperative diagnosis was osteoarthritis(OA) in 24 cases(77.4%) and physiologic genu varum in 7 cases(22.6%). 1. Hospital for Special Surgery knee score was average 72.2 points preoperatively, 90.1 points postoperatively in osteoarthritis and average 94.1 points preoperatively, 99.7 points postoperativeiy in physiologic genu varum. 2. The average tibiofemoral angle was varus 5.8 degrees preoperatively and valgus 8.7 degrees postoperati vely. 3. The active ROM exercise started at 5.3 days, standing at 13.3 days, crutches ambulation at 20.2 days and ambulation without crutches at 46.3 days after operation. In conclusion, more rigid fixation and rapid mobilization was possible with newly designed Miniplate staple in proximal tibial osteotomy.