Abstract
Introduction: Single buttress plating laterally was sometimes performed by a few orthopedists to treat complex tibial plateau fractures with medial compartment involvement. However, we might encounter cases with medial compartment collapse due to such treatment. The causes of failure, the technique of the revision surgery, and the methods of prevention were investigated retrospectively. The purpose of this study was to report our clinical results of a retrospectively followed series of patients treated with blade plate fixation for proximal tibial metaphyseal nonunions and malunions which were treated with unilateral plating. Materials and methods: Twenty-eight patients with failed treatment of complex tibial plateau fractures due to single buttress plating laterally underwent the revision surgeries. Removal of the buttress plate, proximal tibial corrective osteotomy, and insertion of an angled blade plate medially were performed. Postoperatively, exercise of the range of motion of the knee was encouraged as early as possible. Results: Twenty-five patients were followed-up for a median of 4.8 years (range, 1.2–6.8), and all fractures healed at a median of 4.0 months (range, 3.0–6.0). The proximal medial tibial angle (PMTA) was corrected to the acceptable range (80–99°) in all 25 patients (P<0.001) and knee function improved in 22 out of 25 patients (P<0.001). Conclusion: For clinical and biomechanical considerations, single buttress plating laterally was unsuitable for complex tibial plateau fractures with medial compartment involvement due to relatively huge compressive loads on the medial compartment. The stability provided by a few screws of the buttress plate laterally was normally insufficient. An angled blade plate could be a useful armament in the management of metaphyseal nonunion and malunions of the proximal tibia. Its better stabilization could normally provide a high success rate.
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References
Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK (2004) Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 18:649–657
Carpenter CA, Jupiter JB (1996) Blade plate reconstruction of metaphyseal nonunion of the tibia. Clin Orthop 332:23–28
Cole PA, Zlowodzki M, Kregor PJ (2004) Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma 18:528–535
Coventry MB (1988) Proximal tibial osteotomy. Orthop Rev 17:456–458
DeLee JC, Heckman JD, Lewis AG (1981) Partial fibulectomy for ununited fractures of the tibia. J Bone Joint Surg Am 63:1390–1395
Egol KA, Su E, Tejwani NC, Sims SH, Kummer FJ, Koval KJ (2004) Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating. J Trauma 57:340–346
Freeman EL, Johnson EE (1995) Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop 315:25–33
Hsu RW, Himeno S, Coventry MB, Chao EY (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop 255:215–227
Mize RD, Bucholz RW, Grogan DP (1982) Surgical treatment of displaced, comminuted fractures of the distal end of the femur: an extensile approach. J Bone Joint Surg Am 64:871–879
Mow VC, Proctor CS, Kelly MA (1989) Biomechanics of articular cartilage. In: Nordin M, Frankel (eds) Basic biomechanics of the musculoskeletal system. Lea & Febiger, Philadelphia, pp 31–58
Mueller KL, Karunakar MA, Frankenburg EP, Scott DS (2003) Bicondylar tibial plateau fractures: a biomechanical study. Clin Orthop 412:189–195
Paley D, Maar DC, Herzenberg JE (1994) New concepts in high tibial osteotomy for medial compartment osteoarthritis. Orthop Clin North Am 25:483–498
Ricci WM, Rudzki JR, Borrelli J Jr (2004) Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J Orthop Trauma 18:521–527
Schatzker J, McBroom R, Bruce D (1979) Tibial plateau fractures: the Toronto experience 1968–1975. Clin Orthop 138:94–104
Stannard JP, Wilson TC, Volgas DA, Alonso JE (2004) The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma 18:552–558
Tew M, Waugh W (1985) Tibiofemoral alignment and the results of knee replacement. J Bone Joint Surg Br 67:551–556
Tscherene H, Lobenhoffer P (1993) Tibial plateau fractures: management and expected results. Clin Orthop 292:87–100
Whittle AP, Wood GW II (2003) Fractures of lower extremity. In: Canale ST (ed) Campbell’s operative orthopedics. CV Mosby, Philadelphia, pp 2725–2872
Wood GW II (2003) General principles of fracture treatment. In: Canale ST (ed) Campbell’s operative orthopedics. CV Mosby, Philadelphia, pp 2669–2723
Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23:149–154
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Wu, CC. Salvage of proximal tibial malunion or nonunion with the use of angled blade plate. Arch Orthop Trauma Surg 126, 82–87 (2006). https://doi.org/10.1007/s00402-006-0106-9
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DOI: https://doi.org/10.1007/s00402-006-0106-9