Arthroscopic management of tibial plateau fractures

doi:10.1016/S0020-1383(05)80012-9

Injury

Volume 23, Issue 4, 1992, Pages 261-264

https://doi.org/10.1016/S0020-1383(05)80012-9 Get rights and content

Ten tibial plateau fractures treated arthroscopically are reported. In eight cases, closed internal fixation was performed under arthroscopic control while in another two patients, arthroscopic washout alone was undertaken. Only one case required external splintage (a cast brace), the remainder being mobilized non-weight-bearing without plaster immediately after the operation. The results were good. We suggest that the arthroscope is a useful tool in the treatment of these fractures and provides information not otherwise available. There is a low morbidity, inpatient stay is short and early joint movement can be encouraged.

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Cited by (27)

Tibial plateau fractures: Internal fixation with locking plates and the MIPO technique
2010, Injury
Citation Excerpt :
Arthroscopic assisted reduction and internal fixation is recommended by some authors for selected cases (pure depression fractures). The considerable risk of development of compartment syndrome due to the drainage of irrigation fluids into the tibial compartments, as well as the prolongation of the surgical time and the logistics of the operation room restrict the expansion of this module.3,28,29 The use of circular ring fixators offer a reliable alternative method of treatment for high-energy fractures with gross intra-articular comminution (AO/OTA type C3) associated with severe soft-tissue damage.15,21
Proximal tibial fractures are difficult lesions to treat because of the involvement of the articular surface, the often occurring comminution, and the precarious condition of the soft tissues, especially following high-energy trauma. Aim of the treatment is to restore the congruence of the articular surface supporting the tibial plateau cartilage which is usually depressed; to fix the fracture with a stable device; to allow early rehabilitation.
We present our treatment strategy, utilising closed or open reduction and internal fixation, angle-stable polyaxial plates, immediate osteointegration, when necessary, with autologous bone graft or other osteoconductive material augmented with autologous platelet gel. Surgery is soft-tissue dependent in terms of timing, and it is usually performed directly or under supervision of an experienced surgeon utilising, whenever possible, a tissue sparing technique.
A cohort of 58 proximal tibial fractures, surgically treated, from January 2004 to June 2007, was retrospectively reviewed. Fractures were classified according the OTA/AO classification. The assessment of the functional outcome with the use of the Rasmussen score identified good to excellent results in 78% of the cohort 12 months post-surgery.
Internal fixation with locking plates, following the principles of MIPO (Minimally Invasive Percutaneous Osteosynthesis), provides satisfactory fracture reduction with good results regarding the mid-term clinical outcome.
Complications after tibia plateau fracture surgery
2006, Injury
High-energy tibial plateau fractures are often the result of blunt trauma and are associated with severe soft-tissue injury. Fixation techniques demand considerable surgical skill and mature judgment. The available surgical options do not always guarantee a favourable outcome. Operative treatment includes internal and external fixation, hybrid fixation and arthroscopically assisted techniques. Operative management of high-energy fractures remains difficult and challenging and may be associated with serious complications, such as knee stiffness, ankylosis, deep infection, post-traumatic arthritis, malunion and nonunion. Prevention of the complications can optimise the clinical outcome in these patients.
Part I: Arthroscopic management of tibial plateau fractures
2004, Arthroscopy - Journal of Arthroscopic and Related Surgery
Arthroscopy is a valuable tool for the assessment of tibial plateau fractures and is the treatment of choice for associated intra-articular pathology. In addition, (all)-arthroscopic reduction and internal fixation (ARIF) is recommended for type III fractures and is a consideration for types I, II, and IV. Published outcome studies of ARIF of tibial plateau fractures describe results that appear to equal outcomes of open reduction and internal fixation, but these studies suffer from susceptibility bias.
Open reduction and internal fixation of high-energy tibial plateau fractures
2002, Orthopedic Clinics of North America
Compartment syndrome of the leg after arthroscopic examination of a tibial plateau fracture. Case report and review of the literature
1997, Arthroscopy
Arthroscopic assistance for unselected tibial plateau fractures
1996, Arthroscopy
Nine closed tibial plateau fractures in nine patients were treated with arthroscopic-assisted reduction and percutaneous fixation or buttress plate. These procedures were performed between 1993 and 1994 and represent an exclusive and nonselected, consecutive series. The mean follow-up period from time of operation was 10.6 months (range, 6 months to 1.5 years). The results were satisfactory. All the reductions remained roentgenographically anatomic with good to excellent clinical function. Concomitant knee pathology included three cases of partial tear of the anterior cruciate ligament that required special postoperative treatment, and two cases of partial tear of the lateral meniscus that were treated arthroscopically. There were no intraoperative complications. There was one case of postoperative peroneal nerve neuropraxia that resolved spontaneously. Our conclusion is that this technique should be considered as a treatment alternative in the treatment of tibial plateau fractures.

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PaperArthroscopic management of tibial plateau fractures

Orthop. Clin. North Am.

Arthroscopy

Arthroscopy

Fractures of the lateral tibial condyle treated by skeletal traction and early mobilisation

J. Bone Joint Surg.

Fractures of the tibial plateau

Clin. Orthop.

Konservative oder Operative Behandlung von Schienbeinkopfbruchen

Z. Orthop.

Fatal air embolism during arthroscopy

J. Bone Joint Surg.

Paper
Arthroscopic management of tibial plateau fractures