No abstract

Patients with the abovementioned medical conditions are at risk of surgical site infection after open reduction and internal fixation of tibial plateau fracture. Surgeons should be cognizant of these risks and give relevant preoperative advice.

Both SP fixation and DP fixation are acceptable strategies for managing this type of fracture. However, more high quality RCTs with large number of patients and long-term clinical evaluations are required to determine the optimal strategy for bicondylar tibial plateau fractures.

The aim of the present study was to clarify the biomechanical properties of oblique lumbar interbody fusion (OLIF) using different fixation methods in normal and osteoporosis spines. Methods: Normal and osteoporosis intact finite element models of L 1-S 1 were established based on CT images of a healthy male volunteer. Group A was the normal models and group B was the osteoporosis model. Each group included four subgroups: (i) intact; (ii) stand-alone cage (Cage); (iii) cage with lateral plate and two lateral screws (LP); and (iv) cage with bilateral pedicle screws and rods (BPSR). The L 3-L 4 level was defined as the surgical segment. After validating the normal intact model, compressive load of 400 N and torsional moment of 10 Nm were applied to the superior surface of L 2 to simulate flexion, extension, left bending, right bending, left rotation, and right rotation motions. Surgical segmental range of motion (ROM), cage stress, endplate stress, supplemental fixation stress, and stress distribution were analyzed in each group. Results: Cage provided the minimal reduction of ROM among all motions (normal, 82.30%-98.81%; osteoporosis, 92.04%-97.29% of intact model). BPSR demonstrated the maximum reduction of ROM (normal, 43.94%-61.13%; osteoporosis, 45.61%-62.27% of intact model). The ROM of LP was between that of Cage and BPSR (normal, 63.25%-79.72%; osteoporosis, 70%-87.15% of intact model). Cage had the minimal cage stress and endplate stress. With the help of LP and BPSR fixation, cage stress and endplate stress were significantly reduced in all motions, both in normal and osteoporosis finite element models. However, BPSR had more advantages. For cage stress, BPSR was at least 75.73% less than that of Cage in the normal model, and it was at least 80.10% less than that of Cage in the osteoporosis model. For endplate stress, BPSR was at least 75.98% less than that of Cage in the normal model, and it was at least 78.06% less than that of Cage in the osteoporosis model. For supplemental fixation stress, BPSR and LP were much less than the yield strength in all motions in the two groups. In addition, the comparison between the two groups showed that the ROM, cage stress, endplate stress, and supplemental fixation stress in the normal model were less than in the osteoporosis model when using the same fixation option of OLIF. Conclusion: Oblique lumbar interbody fusion with BPSR provided the best biomechanical stability both in normal and osteoporosis spines. The biomechanical properties of the normal spine were better than those of the osteoporosis spine when using the same fixation option of OLIF.

Background:The application of tubular microscopes discectomy (TMD) was supposed to have similar or better results than conventional microdiscectomy (CMD). However, this conclusion had not been verified by sufficient evidence. Therefore, the focus of this meta-analysis was to assess the efficiency, safety, and clinical outcome of these 2 surgical procedures for treating lumbar disk herniation (LDH).Methods:PubMed, Embase, and Cochrane Collaboration Central databases were searched for studies which compared the results of TMD and CMD for the treatment of LDH up to July 2017. Data analysis was conducted using RevMan 5.3. A standardized electronic form of 17 predefined criteria from the Consort statement was used for the quality assessment.Results:Eight randomized controlled trials (RCT) and 2 retrospective studies were included in this review, including 804 patients. The pooled analysis showed that there was no significant difference in operative time (P = .38), blood loss (P = .14), the length of hospital stay (P = .47), the rate of intraoperative complications (P = .79), postoperative complications (P = .16), dural tear (P = .87), the reoperation (P = .20), the short-term back visual analog scale (VAS) scores (P = .76), the long-term back VAS scores (P = .64), the short-term leg VAS scores (P = .09), the long-term leg VAS scores (P = .35), and the Oswestry disability index (ODI) scores (P = .41).Conclusion:The results of this meta-analysis demonstrate that TMD and CMD are both safe and effective surgical procedures which can be recommended for treating LDH. Additionally, the conclusion should be cautiously treated, because it was reached in the context of limited amount of studies and relatively small sample size. Therefore, future studies with good design and more large samples are required to validate this conclusion.

BackgroundMinimally invasive treatment of complex tibial plateau fracture represents one of the most challenging problems in orthopedic surgery. We intended to describe the percutaneous surgery involving an originally designed traction device which might facilitate the closed reduction for bicondylar tibial plateau fractures. Further, to assess the clinical outcomes of this minimally invasive technique.MethodsBetween December 2015 and July 2016, Twenty-one patients, mean age 43.71 ± 13.80 years, suffering from a bicondylar tibial plateau fracture (AO/OTA 41-type C) were included. All fractures were firstly reduced by skeletal traction with the aid of bidirectional rapid reductor, and residual depressed fragments were treated with minimally invasive bone tamp reduction. We then evaluated at a minimum follow-up of one year: (1) the rate of complications, (2) the radiographic outcomes (the amount of depression, tibial plateau widening, tibial plateau angle and posterior slope angle) and (3) the clinical outcome (Rasmussen scoring system).ResultsAll patients had their fractures healed without secondary displacement. No instrument-related complications occurred during operation. Post-operatively, superficial infection was found in two patients and donor-site morbidity was found in one patient. We observed a < 5 mm step-off in 100% of patients and a < 5 mm plateau widening in 95.5% of patients. Three patients were considered indicative of malalignment with TPA > 90° or PSA > 15°. At last evaluation, the Rasmussen clinical score was excellent in 11 patients (52.3%), good in 9 (42.9%) and fair in 1 (4.8%), and the radiological score was excellent in seven patients (33.3%), good in 14 (66.7%).ConclusionsThe bidirectional rapid reductor facilitates the minimally invasive treatment of bicondylar tibial plateau fracture. The patients exhibited excellent functional recovery. These results should be validated with a larger group of patients and longer period results.Trial registrationChiCTR-OPC-16008011.

The aim of this prospective study was to determine the incidence of meniscal and cruciate ligament injuries in operative tibial plateau fractures detected using knee arthroscopy, and to identify the radiological predictors observed on CT images. From January 2016 to February 2017, a total of 102 closed tibial plateau fractures were enrolled in this prospective protocol. Each patient underwent arthroscopic examination following the tibial plateau internal fixation. Univariate analysis and multivariable logistic regression were used to assess the association between imaging parameters and soft-tissue injuries. The menisci were traumatically injured in 52.9% of subjects (54 of 102) and the cruciate ligaments injured in 22.5% (23 of 102). Significantly higher injury rates for bucket-handle meniscal tears were observed in Schatzker type VI fractures (P = 0.04). Greater risk of lateral meniscus injury was observed in patients with >6.3 mm of lateral joint depression. Greater risk of ACL injury when the volumetric lateral joint depression was ≤209.5 mm2 and/or with >5.7 mm lateral joint widening. Associated meniscal and ligament injuries were commonly seen among operative tibial plateau fractures. Preoperative CT measurements might help predict a higher risk of meniscus and ACL injury, providing guidance to the surgeon to look for and to be prepared to treat such injuries.

No abstract