Arthroscopic-assisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures

doi:10.1016/j.arthro.2003.09.038

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 19, Issue 9, November 2003, Pages 974-984

https://doi.org/10.1016/j.arthro.2003.09.038 Get rights and content

Abstract

Purpose:

Our aim was to determine the outcome of arthroscopic-assisted reduction with bilateral buttress plate fixation for the treatment of closed complex tibial plateau fractures.

Type of Study:

Case series.

Methods:

18 consecutive patients (12 men, 6 women) with complex tibial plateau fractures were enrolled in this prospective study. All patients underwent arthroscopic-assisted bilateral buttress plate fixation of closed complex tibial plateau fractures. The average age at operation was 35 years (range, 23 to 45 years). The follow-up period ranged from 39 to 69 months, with an average of 48 months. Using the Schatzker classification, there were 11 type V and 7 type VI fractures. The clinical and radiological outcomes were determined according to Rasmussen’s system.

Results:

All of the 18 fractures united. Overall, 4 (22%) patients were rated as excellent, 12 (67%) good, and 2 (11%) fair. Secondary osteoarthritis appeared in 3 injured knees (16.7%). One patient had a wound dehiscence (3 cm long) of the medial incision. Condylar joint surface depression was noted in 3 patients without functional instability. Two patients had valgus alignment between 10° and 15°. Two patients had the paresthesia over the lateral calf. There were no complications directly associated with arthroscopy in any of the 18 patients. No deep vein thrombosis, infection, or knee stiffness was found at final follow-up.

Conclusions:

Arthroscopic-assisted reduction with bilateral buttress plate fixation for complex tibial plateau fractures allows accurate fracture reduction, diagnosis, and treatment of associated intra-articular lesions, and less dissection than open reduction internal fixation.

Section snippets

Patients and methods

Between March 1996 and September 1998, there were 95 patients with closed tibial plateau fractures (Schatzker type I to VI) treated in the authors’ hospital. Among these 95 patients, the 18 patients with closed complex tibial plateau fractures were enrolled in this prospective study. All the patients underwent the same treatment protocol of arthroscopic-assisted surgery with bilateral buttress plate fixation for closed complex tibial plateau fractures. Data were gathered prospectively on these

Clinical assessment

The mean postoperative Rasmussen score was 26.6 (range, 18–29). Walking, motion, and stability were good or excellent in all cases, and pain and extension were good or excellent in 89% (Table 4). At final follow-up, range of motion averaged 2.5° to 130° (range, 0°–11° to 113°–140°). Two patients had fair results secondary to postoperative extension lags greater than 10°. Two patients (11%) complained of intense, constant pain around the knee after activity. Fifteen patients (83%) reported that

Discussion

The objective of treatment of tibial plateau fracture is precise reconstruction of the articular surface, stable fragment fixation allowing early motion, and repair of all concomitant lesions. Traditionally, the methods of treatment for bicondylar fractures, including skeletal traction with cast bracing,2, 3, 4, 5 open reduction and internal fixation with bilateral buttress plates,4, 6, 7, 8 indirect reduction with percutaneous techniques, limited internal fixation, and hybrid external fixation.

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The use of arthroscopy does not increase the incidence of complications in the management of Schatzker IV-VI tibial plateau fractures
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El uso de asistencia artroscopica en fracturas de mesetas tibiales tipos I-III según la clasificación de Schatzker se ha popularizado; sin embargo aún existe controversia con respecto a su uso en fracturas Schatzker IV-VI por el potencial riesgo de complicaciones. El objetivo de este trabajo es comparar la tasa de complicaciones intra o postoperatorias entre pacientes con fracturas de mesetas tibiales de este tipo tratados con y sin artroscopia al momento de la reducción y osteosíntesis definitiva.
Estudio de cohortes retrospectivo. Se incluyeron pacientes con diagnóstico de fractura de mesetas tibiales Schatzker IV-VI, sometidos a reducción y osteosíntesis definitiva, y al manejo de lesiones asociadas con o sin el uso de artroscopia evaluando la aparición de síndrome compartimental, trombosis venosa profunda e infección relacionada a fractura con seguimiento mínimo de 12 meses posterior a la cirugía definitiva.
Se incluyeron 288 pacientes: 86 operados con asistencia artroscópica y 202 sin asistencia artroscópica. La tasa de complicaciones total en el grupo con y sin asistencia artroscópica fue del 18,60 y 26,73%, respectivamente (p = 0,141). No hubo asociación estadísticamente significativa entre el uso de asistencia artroscópica y el desarrollo de las complicaciones analizadas.
El uso de artroscopia de rodilla como apoyo de la reducción o como adyuvancia para el tratamiento simultáneo de lesiones intraarticulares concomitantes no aumentó el riesgo de complicaciones en el postoperatorio inmediato ni tras 12 meses de seguimiento.
The use of arthroscopy for tibial plateau fractures type I, II and III according to Schatzker classification has increased, yet its employment for tibial plateau fractures Schatzker IV, V and VI is controversial due to the potential risk of compartment syndrome, deep vein thrombosis and infection. We aimed to compare the rate of operative and postoperative complications among patients with these types of tibial plateau fractures treated with and without arthroscopy at the time of definitive reduction and osteosynthesis.
Retrospective cohort study. Patients with diagnosis of tibial plateau fracture Schatzker IV, V or VI who underwent reduction and definitive osteosynthesis with or without the use of arthroscopy were included. The development of compartment syndrome, deep vein thrombosis, and fracture-related infection was evaluated up to 12 months after the definitive surgery.
Two hundred eighty-eight patients were included: 86 with arthroscopic assistance and 202 without it. The overall complication rate in the group with and without arthroscopic assistance was 18.60% and 26.73%, respectively (P=.141). No statistical association was found between the use of arthroscopic assistance and the development of the analyzed complications.
The use of arthroscopy to support reduction or addressing concomitant intra-articular injuries did not increase the risk of complications in patients with high-energy tibial plateau fractures at 12 months of follow up.
Trends and Complications of Arthroscopic-Assisted Tibial Plateau Fracture Fixation: A Matched Cohort Analysis
2020, Arthroscopy, Sports Medicine, and Rehabilitation
To determine trends in arthroscopic-assisted tibial plateau fracture fixation (AATPFF), to evaluate trends in the overall rate of tibial plateau fracture fixation, and to compare postoperative complications between AATPFF and traditional tibial plateau fixation.
A retrospective review of patients undergoing AATPFF and traditional tibial plateau fixation was conducted using the Humana Inc. administrative database from 2007 to 2016. A 1:1 propensity match was utilized to match patients in the 2 study groups based on age, sex, obesity, diabetes, hypertension, chronic obstructive pulmonary disease, depression or anxiety, and smoking history. Postoperative complications were grouped as minor medical complications, major medical complications, surgical complications, emergency department visits, and reoperation. Linear regression analysis was used to assess trends and Pearson’s χ² test was used to compare postoperative complications with statistical significance defined as P < .05.
In total, 522 patients underwent AATPFF and 3920 patients underwent traditional tibial plateau fracture fixation. There was a 4-fold increase in the use of AATPFF over the study period (P = .0173). Similarly, there was an increase in the utilization of traditional tibial plateau fracture fixation, although to a lesser extent (1.33-fold). After propensity matching, the traditional fixation group demonstrated significantly higher rates of minor medical complications (8.2% vs 2.7%, P = .0002), major medical complications (9.9% vs 4.6%, P = .0018), surgical complications (13.2% vs 2.7%, P < .0001), and emergency department visits (21.4% vs 13.5%, P < .0001) within 90 days of surgery compared with the AATPFF group. There was no difference in reoperation rates within 90 days between the 2 groups (2.9% vs 3.6%, P = .85).
The incidence of tibial plateau fracture fixation is increasing, however, use of AATPFF is increasing at a faster rate compared to traditional techniques. Furthermore, the addition of knee arthroscopy to fracture fixation does not increase the risk of complication, reoperation, or emergency department visit within 90 days.
III, retrospective matched cohort.
Medial anatomical buttress plate in treating displaced femoral neck fracture a finite element analysis
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Displaced femoral neck fractures in young adults are most likely to result from high energy trauma that causes a vertically-oriented shearing injury through the femoral neck. The optimal strategy for treatment of displaced femoral neck fractures remains an unsolved challenge in orthopedic surgery.
our group has previously designed a medial anatomical buttress plate (MABP) based on the analysis of the computed tomography (CT) data of anatomical structures derived from a large sample population. In this study, finite element analyses (FEA) were carried out to compare the outcomes of the combination of our MABP with cannulated screws to those of the combination of tubular plate with cannulated screws, and to those of using cannulated screws alone.
MABP resulted in a more stable fixation as compared to the other two approaches, with respect to the femur and the stress distributions, stress peaks, and Z axis displacements.
The FEA encouraged us that addition of a medial buttress plate not only achieved superior medial buttress stability but also achieves superior performance because it perfectly fits with the existing anatomic structure of medial femoral neck. The results from our study may provide references for clinical decision making in dealing with such patients.
Tibial plateau fracture management: ARIF versus ORIF – clinical and radiological comparison
2019, Revue de Chirurgie Orthopedique et Traumatologique
L’arthroscopie a permis le développement de la chirurgie mini-invasive pour les fractures du plateau tibial. L’objectif de cette étude était d’évaluer et de comparer les résultats cliniques et radiologiques de patients traités par ARIF et ORIF. Notre hypothèse était que l’ARIF, dans le traitement de fractures du plateau tibial sélectionnées, permet (1) l’obtention de résultats cliniques similaires à l’ORIF (2) et d’une réduction satisfaisante avec une fixation stable.
Ont été inclus rétrospectivement dans une étude multicentrique les patients adultes présentant une fracture du plateau tibial (Schatzker I à III) entre janvier 2010 et décembre 2014 permettant un recul minimum de 2 ans. Les données cliniques et radiologiques ont été colligées à 3, 6, 12 mois et au dernier recul (amplitude articulaire, IKDC, HSS, Lysholm). Trois cent dix-sept patients (317 fractures) âgés de 48 ± 14 ans (18–82) ont été suivis pendant 38 ± 23 mois (24–90), avec 77 fractures (24 %) dans le groupe ARIF et 240 fractures (76 %) dans le groupe ORIF.
Les résultats cliniques n’ont pas montré de différence significative entre les deux groupes pour la flexion active, l’extension passive, active, les scores Lysholm, IKDC, et une différence pour le score HSS (ARIF : 74 ± 29 points et ORIF : 70 ± 31 points, p < 0,01) et la flexion passive (ARIF : 130 ± 19 [80–160] et ORIF : 130 ± 15,965 [60–140], p < 0,05). Les résultats radiologiques n’ont pas montré de différence concernant la qualité de la réduction, l’axe mécanique du membre inférieur ou la présence de signes d’arthrose. Aucun déplacement secondaire n’a été observé. Sept complications (7/77, 9 %) ont été observées dans le groupe ARIF et 18 dans le groupe ORIF (18/240, 8 %), et 6 reprises chirurgicales pour infection précoce (2 patients ARIF et 4 patients ORIF), sans différence entre les deux groupes.
L’hypothèse a été confirmée. L’ARIF, dans les fractures Schatzker I à III donne des résultats cliniques et radiologiques similaires à l’ORIF avec une réduction satisfaisante et une fixation stable. Elle a sa place dans la prise en charge des fractures enfoncement et/ou séparation du plateau tibial.
III, étude rétrospective comparative.
Tibial plateau fracture management: ARIF versus ORIF – clinical and radiological comparison
2019, Orthopaedics and Traumatology: Surgery and Research
Arthroscopy has enabled minimally invasive procedures to be developed to treat tibial plateau fracture. The aim of the present study was to assess and compare clinical and radiological results between arthroscopically assisted reduction and internal fixation (ARIF) and open reduction and internal fixation (ORIF) procedures. The study hypothesis was that, in selected tibial plateau fractures, ARIF provides (1) clinical results comparable to those of ORIF, and (2) satisfactory reduction and stable fixation.
A retrospective multicenter study included adult patients with tibial plateau fracture (Schatzker I to III), over the period January 2010 to December 2014, enabling a minimum 2 years’ follow-up. Clinical and radiological data (RoM, IKDC, HSS, Lysholm) were collected at 3, 6 and 12 months and at last follow-up. A total of 317 patients (317 fractures), aged 48 ± 14 years (range, 18–82 years) were followed up for 38 ± 23 months (range, 24–90 months), with 77 fractures (24%) in the ARIF group and 240 (76%) in the ORIF group.
Clinically, there were no significant inter-group differences for active flexion, passive or active extension or Lysholm and IKDC scores, with significant differences for HSS (ARIF: 74 ± 29; ORIF: 70 ± 31; p < 0.01) and passive flexion (ARIF: 130 ± 19° (range, 80–160°); ORIF: 130 ± 15.965° (range, 60–140°); p < 0.05). Radiologically, there were no significant inter-group differences for reduction quality, lower-limb mechanical axis or signs of osteoarthritis. There were no secondary displacements. There were 7 complications (7/77, 9%) in the ARIF group and 18 (18/240, 8%) in the ORIF group, and 6 surgical revisions for early infection (2 ARIF, 4 ORIF), with no significant inter-group differences.
The study hypothesis was confirmed: in Schatzker I–III fractures, ARIF provided clinical results comparable to those of ORIF, with satisfactory reduction and stable fixation. ARIF has its place in the treatment of tibial plateau subsidence and/or separation fracture.
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Contribution of minimally invasive bone augmentation to primary stabilization of the osteosynthesis of Schatzker type II tibial plateau fractures: Balloon vs bone tamp
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Schatzker type II tibial plateau fractures necessitate the least invasive treatment possible. Arthroscopic reduction by bone tamp followed by osteosynthesis is the current gold standard for this type of tibial plateau fracture. The objective of this study was to compare this technique to anterior approach tuberoplasty with balloon reduction. The comparison criteria were residual articular step off, metaphyseal cavity volume formed during reduction, and mechanical strength to separation and to depression displacement.
Fractures were created on 12 human cadaveric tibiae and reduced by a minimally invasive approach in six specimens by a balloon, and by bone tamp in the six others. Articular step off and metaphyseal-epiphyseal cavity volume were measured by TDM. Mechanical tests were performed up to assembly failure to characterize structural strength. Secondary displacements, fracture depression displacement and separation were measured by optical methods.
There was no significant difference in step off measurement after balloon reduction or bone tamp (0.29 cm vs 0.37 cm; p = 0.06). The cavity volume formed by balloon reduction was significantly smaller than the volume created by bone tamp reduction (0.45 cm³ vs 5.12 cm; p = 0.002). The compressive load required for assembly failure was significantly greater in the balloon group than in the bone tamp group (1210.17 N vs 624.50 N; p = 0.015).
There exists a correlation between load to failure of the assembly frame and the metaphyseal volume required for bone fracture reduction. The minimally invasive balloon technique has fewer negative effects on the osseous stock, thereby enabling better primary structural strength of the fracture.

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Original articleArthroscopic-assisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures

Abstract

Purpose:

Type of Study:

Methods:

Results:

Conclusions:

Section snippets

Patients and methods

Clinical assessment

Discussion

Orthop Clin North Am

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Fractures of the tibial plateau

Tibial plateau fracturesAn analysis of the results of treatment in 60 patients

Clin Orthop

Cast brace treatment of proximal tibia fracturesA ten-year follow-up study

Clin Orthop

The tibial plateau fractureThe Toronto experience 1968–1975

Clin Orthop

Fractures of the tibial plateauA review of ninety-five patients and comparison of treatment methods

J Trauma

Tibial plateau fracturesstandardized evaluation of operative results

Orthopedics

Hybrid external fixation for bicondylar tibial plateau fracture

Complications of internal fixation of tibial plateau fractures

Orthop Rev

The small pin circular fixation for proximal tibial fractures with soft tissue compromise

Orthopedics

Percutaneous methods of tibial plateau fixation

Clin Orthop

Bicondylar tibial plateau fractures treated with a hybrid ring external fixatora preliminary study

J Orthop Trauma

Tibial plateau fracturesManagement and expected results

Clin Orthop

External fixation and limited internal fixation for complex fractures of the tibial plateau

J Bone Joint Surg Am

Arthroscopy assisted operative management of tibial plateau fractures

Clin Orthop

Arthroscopic assessment and treatment of tibial plateau fractures

Arthroscopy

Arthroscopic-assisted treatment of lateral tibial plateau fractures in skiersuse of a cannulated reduction system

J Orthop Trauma

Medium-term results of percutaneous, arthroscopic-assisted osteosynthesis of fractures of the tibial plateau

J Bone Joint Surg Br

Indications and limits of arthroscopic management of intra-articular fractures of the knee joint

Aktuelle Traumatol

Tibial condylar fracturesA twenty-year follow-up

J Bone Joint Surg Am

Original article
Arthroscopic-assisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures