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Journal of Orthopaedic Surgery and... Dec 2023There has been controversial for the treatment of the posterolateral tibial plateau fractures (PTPF). This study aimed to evaluate clinic outcomes of the lateral locking...
BACKGROUND
There has been controversial for the treatment of the posterolateral tibial plateau fractures (PTPF). This study aimed to evaluate clinic outcomes of the lateral locking compression plate (LCP) postposition, analyze the feasibility of LCP postposition through anatomical measurement, and address the potential problems of LCP postposition through the biomechanical assessment.
METHODS
39 patients with PTPF undergoing LCP fixation between June 2019 and June 2022 were retrospectively evaluated. All cases were divided into two group: Group A (15 cases) employed plate transverse arm postpositioning with posterolateral (PL) fracture fixation using two raft screws, while Group B (24 cases) utilized non-postpositioning with fixation by a single raft screw. Surgical duration, intraoperative blood loss, the change of lateral tibial plateau angle (LTPA), lateral tibial plateau posterior slope angle (LPSA) and fracture collapse between immediate postoperative and last follow up, range of motion (ROM), HSS knee score, and Lysholm knee score were recorded. CT measurements of the fibular head superior space and LCP transverse arm were taken in 50 healthy adult knees to assess postposition feasibility. Finally, three fracture models were established using finite element analysis: Model A with plate postposition and PL split fracture fixed by two raft screws of transverse arm, Model B with plate non-postposition and PL split fracture fixed by one raft screw, and Model C with plate non-postposition and PL split fracture fixed by one raft screw and anterior-posterior tension screws. Loadings of 250N, 500N, and 750N were applied for the analysis of the displacement degree, von Mises stress distribution.
RESULTS
Results indicate comparable operative duration and intraoperative hemorrhage between groups. Complications were minimal in both groups. Group A demonstrated superior outcomes in terms of radiographic parameters, functional scores, and fracture collapse prevention. CT measurements revealed compatibility in 72% of healthy knees with the postpositioning technique. Finite element analysis indicated favorable biomechanical stability.
CONCLUSION
Not all patients with PTPF were applicable to the management of the plate postposition and two raft screws fixation, even though this technique exerted good biomechanical stability and achieved satisfactory clinic outcomes. When the PL fracture was fixed by only raft screw through LCP owing to various reasons, two anterior-posterior tension screws might be necessitated to maintain the fracture stability.
Topics: Adult; Humans; Retrospective Studies; Tibial Plateau Fractures; Fracture Fixation, Internal; Tibial Fractures; Tibia; Bone Plates
PubMed: 38129885
DOI: 10.1186/s13018-023-04397-x -
Medicine Oct 2019Unicompartmental knee arthroplasty (UKA) is an effective method to treat single compartment disease of the knee joint. Report about the complications of UKA, especially... (Review)
Review
RATIONALE
Unicompartmental knee arthroplasty (UKA) is an effective method to treat single compartment disease of the knee joint. Report about the complications of UKA, especially tibial plateau fractures, is rare. Given its rarity, its pathogenesis is not well described, and a standard of treatment is still not established. Therefore, relevant studies and analysis of this complication have a significant effect on helping physicians avoid risks and guide clinical diagnosis and treatment.
PATIENT CONCERNS
The 1st case corresponds to a 70-year-old male patient who complained of knee pain, difficulty walking, nocturnal rest pain, and elevated skin temperature at 3 weeks after the left knee arthroplasty. The second case is a 72-year-old female patient who complained of left knee pain and swelling during movement at 2 weeks after the left knee arthroplasty.
DIAGNOSIS
The 1st case showed a fracture of the medial malleolus of the left knee and a secondary depression of the medial tibial plateau in X-rays and the second case showed a fracture of the medial malleolus of the left knee in computed tomography (CT) and X-rays.
INTERVENTIONS
The 1st case was treated with plate and screw fixation and the second case was treated conservatively and immobilized using brace and remained nonweight bearing for 6 weeks.
OUTCOMES
After 1 year, both patients have good joint activity, and there was no pain or loosening of the prosthesis and fragment displacement.
LESSONS
The incidence of tibial plateau fractures (TPF) related to UKA might be low, but fatal and difficult to treat. Its pathogenesis determines procedure-related factors; when fracture develops, treatment should be based on the degree of displacement, stability of implant fixation, etc.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Braces; Conservative Treatment; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Postoperative Complications; Tibial Fractures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31626090
DOI: 10.1097/MD.0000000000017338 -
Nigerian Journal of Clinical Practice Oct 2022The optimal treatment for distal tibial fractures remains a matter of debate. Nonetheless, plate osteosynthesis produces favorable results to intramedullary...
Clinical and radiological outcome of the locked plate osteosynthesis in distal metadiaphyseal tibial fracture according to the severity of comminution: Varus reduction would not be preferable with lower clinical outcomes.
BACKGROUND
The optimal treatment for distal tibial fractures remains a matter of debate. Nonetheless, plate osteosynthesis produces favorable results to intramedullary stabilization in aspects of alignment restoration.
AIM
The aim of the study was to compare the radiologic and clinical outcomes of distal metadiaphyseal tibial fracture between a simple/wedge fracture (SWF) and a comminuted fracture (CF) using minimally invasive plate osteosynthesis (MIPO).
PATIENTS AND METHODS
This retrospective study analyzed patients with SWF or CF of the distal tibial metadiaphysis that was surgically treated with a locking compression plate. Postoperative radiographic assessments and the time to radiologic union were noted. Clinical assessments were evaluated using both the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the foot function index (FFI). Postoperative complications were documented.
RESULTS
Seventy-one cases were analyzed over a mean follow-up period of 20.9 months. Thirty-six patients had SWF and 35 patients presented with CF. The mean time to radiologic union, amounts of postoperative coronal angulation, and incidence of malunion showed no statistical differences. Fibular fixation was more applied in the CF group (P < 0.001). Moreover, the clinical scores revealed no differences. Nonetheless, in the valgus union group, the AOFAS ankle-hindfoot score was 90.9 compared to 84.1 in the varus union group (P = 0.042) and the FFI was 9.2% compared to 20.2% in the varus union group (P = 0.017).
CONCLUSION
Plate osteosynthesis for SWF or CF of the distal tibial metadiaphysis led to high union rates and good clinical outcomes. There was no significant difference in the radiologic and clinical results according to the presence of fracture comminution. Nonetheless, the valgus union group showed better clinical outcomes than the varus union group. Clinically, it would be preferred to avoid intraoperative varus reduction.
Topics: Humans; Tibial Fractures; Fractures, Comminuted; Retrospective Studies; Minimally Invasive Surgical Procedures; Treatment Outcome
PubMed: 36308241
DOI: 10.4103/njcp.njcp_173_22 -
BMC Musculoskeletal Disorders Jun 2022Tibial plateau fractures and tibial implant- loosening are severe complications in cementless unicompartmental knee replacement (UKR). The tibial keel preparation is...
BACKGROUND
Tibial plateau fractures and tibial implant- loosening are severe complications in cementless unicompartmental knee replacement (UKR). The tibial keel preparation is particularly demanding and different saw blades can be used. It was hypothesized that different blade designs and thickness have an influence on the frequency of tibial plateau fractures and implant-loosening in cementless medial UKR.
METHODS
1258 patients with cementless medial UKR were included in this retrospective study between 2013 and 2020. The tibial keel cut was performed either with a double keel saw blade (DKS; 2.8 mm) and added hand guided pick or a mono reciprocating saw blade (RKB) of different thickness (2.5 mm; 2.65 mm; 2.75 mm). Tibial plateau fracture and loosening were demonstrated by standard two-plane radiographs. Tibial implant-loosening was defined as complete radiolucency and implant migration. Fracture and loosening were combined with pain and loss of function.
RESULTS
In 126 patients (10%) the tibial keel was prepared with DKS, in 407 patients (32.4%) with RKB 2.5 mm, in 330 patients (26.2%) with RKB 2.65 mm and in 395 patients (31.4%) with 2.75 mm. In 4 patients (3.17%) with DKS tibial plateau fracture occurred, in 4 patients (0.99%) with 2.5 mm RKB, in 3 patients (0.92%) with 2.65 mm RKB and in 1 patient (0.25%) with 2.75 mm RKB. Significantly fewer fractures occurred with a RKB design (p = 0.007). A negative correlation between fracture incidence and RKB saw blade thickness was found (Spearman-r = - 0.93). No difference for tibial implant-loosening was shown (p = 0.51).
CONCLUSION
Different blade designs and thickness have a significant influence on the incidence of tibial plateau fractures and aseptic tibial implant-loosening. The incidence of tibial plateau fractures in cementless medial UKR can be reduced by changing the design and thickness of the tibial keel saw blade. Greater thickness of RKB leads to significantly fewer tibial plateau fractures while the incidence of implant-loosening is not increasing.
TRIAL REGISTRATION
This study was retrospectively registered and ethical approval was waived by the local ethical committee (No. 2020-1174).
Topics: Arthroplasty, Replacement, Knee; Humans; Incidence; Knee Prosthesis; Prosthesis Design; Retrospective Studies; Tibial Fractures
PubMed: 35729631
DOI: 10.1186/s12891-022-05500-9 -
Asian Journal of Surgery Jul 2022To evaluate the incidence and risk factors for posterior malleolar fractures (PMFs) in patients with spiral distal tibial fractures (SDTFs).
OBJECTIVE
To evaluate the incidence and risk factors for posterior malleolar fractures (PMFs) in patients with spiral distal tibial fractures (SDTFs).
METHODS
In a retrospective study, 248 adults with SDTFs who underwent treatment were enrolled between November 2017 and May 2020. In a prospective study, we recruited 113 consecutive, skeletally mature patients with SDTFs who were identified from the trauma clinic of our hospital between June 2020 and May 2021. Radiographs and CT scans of the ankle region on the affected side were obtained to determine the presence of PMFs. If the CT scan was negative, additional MRI examination of the ankle was performed as a supplementary protocol in the prospective study. Univariate analysis and multivariate analysis were conducted to analyze the risk factors.
RESULTS
In the retrospective study, the incidence of PMFs associated with simple SDTFs was 74.0% (105/142), which was significantly lower than 90.8% (69/76) in the prospective study. Independent predictors of PMFs in patients with simple SDTFs identified by multivariate analysis in the retrospective study were age (OR = 1.07; P = 0.001) and external rotation of the proximal tibia (OR = 3.36; P = 0.027) and those in the prospective study were osteoporosis (OR = 0.04; P = 0.007) and spiral fibula fractures (OR = 16.05; P = 0.046).
CONCLUSION
This study reexamined the high incidence of concurrent PMFs. Additionally, ankle radiographs and CT scans were recommended for all simple SDTF patients. For simple SDTF patients with negative CT scans, especially those caused by external rotation of the proximal tibia, combined with nonosteoporotic or spiral fibula fractures, additional MRI examinations are recommended.
Topics: Adult; Ankle Fractures; Fracture Fixation, Internal; Humans; Incidence; Prospective Studies; Retrospective Studies; Risk Factors; Tibia; Tibial Fractures
PubMed: 34635409
DOI: 10.1016/j.asjsur.2021.09.042 -
Acta Bio-medica : Atenei Parmensis May 2021Purpose The purpose of this study was to describe the authors' arthroscopic-assisted reduction and fixation (ARIF) technique in the treatment of type Schatzker I-III...
Purpose The purpose of this study was to describe the authors' arthroscopic-assisted reduction and fixation (ARIF) technique in the treatment of type Schatzker I-III tibial plateau fractures, with the use of instruments commonly used in anterior cruciate ligament reconstruction, evaluating clinical and radiological outcomes on four patients at short-term follow-up. Methods A retrospective analysis was performed in our Institution considering 4 patients who underwent ARIF procedure between 2018 and 2020 at minimum 3 months of follow-up. All patients were evaluated clinically (Rasmussen Score, VAS and Crosby-Insall Grading) and radiographically (after surgery and at 6 weeks). Results Mean follow-up was 9 months (range 6-12 months). Rasmussen score and VAS were respectively 26 (Excellent) and 1 at the last follow-up. According to the Crosby-Insall Grading System, all patients reported excellent results. At final control the mean ROM in the injured knee was 125°(range 100°-140°). Mean hospitalization was 2 days (range 1-4 days). No adverse events were reported. Conclusions ARIF is a reliable technique for tibial plateau fracture (Schatzker I-III). The technique described is very cheap and reproducible in any hospital . This procedure allows to well understand the pattern of fracture and to obtain an anatomical reduction with a great tissue sparing and a faster recovery of knee function. Level of Evidence: Level IV Keywords: tibial plateau fractures, treatment, arthroscopy, surgery, artrhoscopic-assisted.
Topics: Arthroscopy; Fracture Fixation, Internal; Humans; Open Fracture Reduction; Retrospective Studies; Tibial Fractures; Treatment Outcome
PubMed: 33988160
DOI: 10.23750/abm.v92i2.10711 -
Orthopaedic Surgery Mar 2022To evaluate clinical and radiological outcomes including hindfoot alignment after plate vs intramedullary nailing (IMN) for distal tibia fracture and to define...
OBJECTIVE
To evaluate clinical and radiological outcomes including hindfoot alignment after plate vs intramedullary nailing (IMN) for distal tibia fracture and to define radiologic parameters that influence changes in hindfoot alignment.
METHODS
Among 92 patients with distal tibia metaphyseal fractures treated from 2002 to 2015, 39 cases of intramedullary nailing and 53 cases of standard plate osteosynthesis were performed. Union rate and complication rate were compared in both groups. Radiographic measurements including hindfoot angulation, moment arm, calcaneal pitch angle, and Meary angle were evaluated at a minimum of 1-year follow-up. Hindfoot alignment changes after surgery were compared between both groups using student t-test. Correlation and regression were analyzed between fracture alignment parameters and hindfoot alignment.
RESULTS
All patients ultimately healed, with an average union period of 26 weeks in both groups. The AOFAS and VAS scores were not significantly different between the two groups. Complications were similar between the two groups. Hindfoot alignment angle, calcaneal pitch, and Meary angle showed no significant differences between the groups. The hindfoot moment arm increased with valgus in the IMN group. A low correlation was detected between angulation at the fracture site in the coronal view and hindfoot alignment (angulation and moment arm) changes (R = 0.38). A significantly high correlation was noted only between transverse rotation and hindfoot alignment changes (R = 0.79).
CONCLUSIONS
Rotation in the transverse plane notably influenced changes in hindfoot alignment. And this suggests that patients with distal tibia fracture should be closely monitored for hindfoot alignment changes caused by intraoperative transverse rotation regardless of the fixation method.
Topics: Bone Nails; Bone Plates; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Fracture Healing; Humans; Tibial Fractures; Treatment Outcome
PubMed: 35106932
DOI: 10.1111/os.13210 -
International Orthopaedics Aug 2021To evaluate the available tibial fracture non-union prediction scores and to analyse their strengths, weaknesses, and limitations.
PURPOSE
To evaluate the available tibial fracture non-union prediction scores and to analyse their strengths, weaknesses, and limitations.
METHODS
The first part consisted of a systematic method of locating the currently available clinico-radiological non-union prediction scores. The second part of the investigation consisted of comparing the validity of the non-union prediction scores in 15 patients with tibial shaft fractures randomly selected from a Level I trauma centre prospectively collected database who were treated with intramedullary nailing.
RESULTS
Four scoring systems identified: The Leeds-Genoa Non-Union Index (LEG-NUI), the Non-Union Determination Score (NURD), the FRACTING score, and the Tibial Fracture Healing Score (TFHS). Patients demographics: Non-union group: five male patients, mean age 36.4 years (18-50); Union group: ten patients (8 males) with mean age 39.8 years (20-66). The following score thresholds were used to calculate positive and negative predictive values for non-union: FRACTING score ≥ 7 at the immediate post-operative period, LEG-NUI score ≥ 5 within 12 weeks, NURD score ≥ 9 at the immediate post-operative period, and TFHS < 3 at 12 weeks. For the FRACTING, LEG-NUI and NURD scores, the positive predictive values for the development of non-union were 80, 100, 40% respectively, whereas the negative predictive values were 60, 90 and 90%. The TFHS could not be retrospectively calculated for robust accuracy.
CONCLUSION
The LEG-NUI had the best combination of positive and negative predictive values for early identification of non-union. Based on this study, all currently available scores have inherent strengths and limitations. Several recommendations to improve future score designs are outlined herein to better tackle this devastating, and yet, unsolved problem.
Topics: Adult; Fracture Fixation, Intramedullary; Fracture Healing; Humans; Male; Retrospective Studies; Tibial Fractures; Treatment Outcome
PubMed: 34131766
DOI: 10.1007/s00264-021-05088-0 -
Medicine Sep 2015A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. This case... (Review)
Review
A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. This case report describes the successful management of such a fracture pattern in a 45-year old male using an open reduction and lag screw fixation of the tuberosity with a minimally invasive reduction and plate fixation of the proximal tibial diaphyseal fracture. A literature search was done to determine the expected clinical outcome of this fracture pattern. This is the first reported adult case of an avulsion fractures of the tibial tuberosity associated with an open proximal tibial diaphyseal fracture successfully treated by an anatomical reduction and fixation of the avulsion fracture of the tibial tuberosity combined with minimally invasive percutaneous plate osteosynthesis of the proximal tibial diaphyseal fractures.
Topics: Bone Plates; Bone Screws; Femoral Fractures; Fracture Fixation, Internal; Fractures, Open; Humans; Male; Middle Aged; Tibial Fractures
PubMed: 26426669
DOI: 10.1097/MD.0000000000001684 -
Knee Surgery, Sports Traumatology,... Dec 2015To carry out a systematic review of the literature on arthroscopic-assisted management (all types) of tibial plateau fractures to gain a more comprehensive understanding... (Review)
Review
PURPOSE
To carry out a systematic review of the literature on arthroscopic-assisted management (all types) of tibial plateau fractures to gain a more comprehensive understanding of clinical outcomes with this surgical technique, specifically to determine whether this may be a viable technique for the management of tibial plateau fractures.
METHODS
MEDLINE, Cochrane, and EMBASE databases were searched until July 2013 using combinations of the search terms: tibial plateau, fractures, and arthroscopically/arthroscopic/arthroscopy/percutaneous/minimally invasive. Inclusion criteria were observational study, patients with tibial plateau fractures, and clinical and radiological outcomes assessed using Rasmussen scoring system. The outcome measures of interest were clinical and radiological Rasmussen scores and the prevalence of secondary osteoarthritis.
RESULTS
A total of 12 studies, 5 prospective and 7 retrospective, involving 353 patients were included in the review. The majority of patients in most studies had Schatzker type I-III fractures. The graft material used varied between studies. The length of the follow-up was typically between 34 and 38 months. Mean clinical Rasmussen scores ranged from 25.5 to 28.4. In each study, the majority (≥80 %) of patients had excellent/good clinical Rasmussen scores. In each study, the majority (≥63 %) of patients had excellent/good radiological Rasmussen scores. The proportion of patients who experienced secondary osteoarthritis was variable, ranging from 0 to 47.6 %.
CONCLUSIONS
The results of this systematic review indicate that arthroscopic-assisted management of tibial plateau fractures can be effective. Surgeons should consider using this approach when treating patients with tibial plateau fractures.
LEVEL OF EVIDENCE
III.
Topics: Arthroscopy; Humans; Osteoarthritis; Radiography; Tibial Fractures; Treatment Outcome
PubMed: 25246171
DOI: 10.1007/s00167-014-3256-2