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Erschienen in: HSS Journal ® 1/2017

08.11.2016 | Surgical Technique

Early Revision Surgery for Tibial Plateau Non-union and Mal-union

verfasst von: Dominic L. Van Nielen, MD, Christopher S. Smith, MD, David L. Helfet, MD, Peter Kloen, MD, PhD

Erschienen in: HSS Journal ® | Ausgabe 1/2017

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Abstract

Background

Although relatively rare, non-unions and mal-unions of tibial plateau fractures present significant challenges for the orthopedic surgeon. With careful pre-operative planning, tibial plateau mal-union or non-union revision surgery with intra-articular and varus opening osteotomies can provides good functional results when performed early (within 1 year) after primary surgical procedure.

Questions/Purposes

We present our treatment algorithm for approaching and treating non-union or mal-union of tibial plateau fractures. Our aim is to give surgeons treating these difficult injuries an overview of the pertinent literature as well as describe the challenges and pitfalls we have experienced when treating non-union or mal-union of tibial plateau fractures.

Methods

Using two case examples from our institution, one for mal-union and one for mal-reduction, we describe our treatment algorithm and surgical technique for managing these difficult injuries. We also provide a brief literature review outlining relevant studies and summarizing outcomes for similar injuries. A systematic literature review was conducted with the aim of determining the methods and outcomes commonly reported in the literature regarding revision surgery following tibial plateau non-union or mal-union. Due to the nature of revision surgery, there are no long-term randomized trials dealing with outcomes, but rather several smaller case series exist from which larger conclusions have to be drawn.

Results

To date, we have successfully treated approximately 35 patients with this technique, and clinical follow-up continues to show good functional outcomes with reduced pain and little radiographic evidence of arthritic changes. Restoring long leg alignment, anatomic reduction of the articular surface, and achieving stable internal fixation are paramount in achieving the best long-term outcome. Due to the shallow soft tissue envelope around the proximal tibia, and the tendency for these fractures to fall into progressive valgus collapse, these problems can seem intimidating and complex. However, with well-planned surgery and meticulous surgical technique, reliable healing can be achieved.

Conclusion

By outlining our method, we hope to provide other surgeons with an algorithm to guide clinical and operative decision making. These difficult injuries can be daunting to treat, but if performed before the onset of severe degenerative arthritis, early revision surgery, as we describe, can be a viable alternative to total knee arthroplasty, particularly in younger, more active patients.
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Literatur
1.
Zurück zum Zitat Borelli J Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma. 2002; 16: 691-695.CrossRef Borelli J Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma. 2002; 16: 691-695.CrossRef
2.
Zurück zum Zitat Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. International Orthopaedics. 2010; 34: 271-281.CrossRefPubMed Chan DB, Jeffcoat DM, Lorich DG, Helfet DL. Nonunions around the knee joint. International Orthopaedics. 2010; 34: 271-281.CrossRefPubMed
3.
Zurück zum Zitat Court-Brown CM, Caesar B. The epidemiology of fractures. In: Heckman JD, Buchholz RW, Court-Brown CM, eds. Rockwood and Greens Fractures in Adults. 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2006: 95-113. Court-Brown CM, Caesar B. The epidemiology of fractures. In: Heckman JD, Buchholz RW, Court-Brown CM, eds. Rockwood and Greens Fractures in Adults. 6th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2006: 95-113.
4.
Zurück zum Zitat Kerkhoffs G, Rademakers M, Altena M, Marti R. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia: surgical technique. J Bone Joint Surg Am. 2009; 91: 101-115.CrossRefPubMed Kerkhoffs G, Rademakers M, Altena M, Marti R. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia: surgical technique. J Bone Joint Surg Am. 2009; 91: 101-115.CrossRefPubMed
5.
Zurück zum Zitat Kerkhoffs G, Rademakers M, Altena M, Marti R. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. J Bond Joint Surg Am. 2008; 90: 1252-1257.CrossRef Kerkhoffs G, Rademakers M, Altena M, Marti R. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. J Bond Joint Surg Am. 2008; 90: 1252-1257.CrossRef
6.
Zurück zum Zitat Krettek C, Hawi N, Jagodzinski M. Intracondylar segment osteotomy: correction of intra-articular malalignment after fracture of the tibial plateau. Unfallchirurg. 2013; 116(5): 413-426. German.CrossRefPubMed Krettek C, Hawi N, Jagodzinski M. Intracondylar segment osteotomy: correction of intra-articular malalignment after fracture of the tibial plateau. Unfallchirurg. 2013; 116(5): 413-426. German.CrossRefPubMed
7.
Zurück zum Zitat Marti RK, Verhage RA, Kerkhoffs GM, Moojen TM. Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results. J Bone Joint Surg Am. 2001; 83: 164-170.CrossRefPubMed Marti RK, Verhage RA, Kerkhoffs GM, Moojen TM. Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results. J Bone Joint Surg Am. 2001; 83: 164-170.CrossRefPubMed
8.
Zurück zum Zitat Martinez A, Sarmiento A, Latta LL. Closed fractures of the proximal tibia treated with a functional brace. Clin Orthop. 2003; 417: 293-302. Martinez A, Sarmiento A, Latta LL. Closed fractures of the proximal tibia treated with a functional brace. Clin Orthop. 2003; 417: 293-302.
9.
Zurück zum Zitat Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures, definition, demographics, treatment rationale, and long term results of closed traction management or operative reduction. J Orthop Trauma. 1987; 1(2): 97-119.CrossRefPubMed Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures, definition, demographics, treatment rationale, and long term results of closed traction management or operative reduction. J Orthop Trauma. 1987; 1(2): 97-119.CrossRefPubMed
10.
Zurück zum Zitat Stevens DG, Beharry R, McKee MD, et al. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma. 2001; 15: 312-320.CrossRefPubMed Stevens DG, Beharry R, McKee MD, et al. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma. 2001; 15: 312-320.CrossRefPubMed
11.
Zurück zum Zitat Toro-Arbelaez JB, Gardner MJ, Shindle MK, Cabas JM, Lorich DG, Helfet DL. Open reduction and internal fixation of intraarticular tibial plateau nonunions. Injury, Int. 2007; 38: 378-383.CrossRef Toro-Arbelaez JB, Gardner MJ, Shindle MK, Cabas JM, Lorich DG, Helfet DL. Open reduction and internal fixation of intraarticular tibial plateau nonunions. Injury, Int. 2007; 38: 378-383.CrossRef
12.
Zurück zum Zitat Watson JT, Schatzker J. Tibial plateau fractures. In: Browner BD, ed. Skeletal trauma: basic science, management, and reconstruction. 3rd ed. Philadelphia, Pa: Saunders; 2003: 2047-2130. Watson JT, Schatzker J. Tibial plateau fractures. In: Browner BD, ed. Skeletal trauma: basic science, management, and reconstruction. 3rd ed. Philadelphia, Pa: Saunders; 2003: 2047-2130.
Metadaten
Titel
Early Revision Surgery for Tibial Plateau Non-union and Mal-union
verfasst von
Dominic L. Van Nielen, MD
Christopher S. Smith, MD
David L. Helfet, MD
Peter Kloen, MD, PhD
Publikationsdatum
08.11.2016
Verlag
Springer US
Erschienen in
HSS Journal ® / Ausgabe 1/2017
Print ISSN: 1556-3316
Elektronische ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-016-9529-1

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