Tibial plateau fractures are complex injuries produced by high- or low-energy trauma. They principally affect young adults or the ‘third age’ population.These fractures usually have associated soft-tissue lesions that will affect their treatment. Sequential (staged) treatment (external fixation followed by definitive osteosynthesis) is recommended in more complex fracture patterns. But one should remember that any type of tibial plateau fracture can present with soft-tissue complications.Typically the Schatzker or AO/OTA classification is used, but the concept of the proximal tibia as a three-column structure and the detailed study of the posteromedial and posterolateral fragment morphology has changed its treatment strategy.Limb alignment and articular surface restoration, allowing early knee motion, are the main goals of surgical treatment. Partially articular factures can be treated by minimally-invasive methods and arthroscopy is useful to assist and control the fracture reduction and to treat intra-articular soft-tissue injuries.Open reduction and internal fixation (ORIF) is the gold standard treatment for these fractures. Complex articular fractures can be treated by ring external fixators and minimally-invasive osteosynthesis (EFMO) or by ORIF. EFMO can be related to suboptimal articular reduction; however, outcome analysis shows results that are equal to, or even superior to, ORIF. The ORIF strategy should also include the optimal reduction of the articular surface.Anterolateral and anteromedial surgical approaches do not permit adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is necessary to reduce and fix them through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement.Some authors have also suggested that primary total knee arthroplasty could be an option in specific patients and with specific fracture patterns.Cite this article: Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev 2016;1:225-232. DOI: 10.1302/2058-5241.1.000031.
Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with advanced osteoarthritis. This study aimed to assess the effects of using versus not using a fast-track protocol, including a new mobilization device called Flexet. Methods: This is a retrospective comparative study. Two groups were formed with a total of 507 TKA patients. 283 were treated in 2010 with a standard program (S group) and 224 with a fast-track protocol (FT group) in 2016. The variables studied were active knee flexion and extension, length of stay, and time to autonomous gait. Results: Study groups were comparable. The mean time from surgery to autonomous gait was shorter for the FT group (4.43 hours, SD = 2.11) than for the S group (59.95 hours, SD = 16.59) (p < 0.001). Mean stay for the FT group was 2.36 nights (SD = 1.81) and 6.20 nights (SD = 1.52) for the S group (p < 0.001). Mean active flexion at hospital discharge was 89.33º (SD = 7.45) in the FT group versus 84.10º (SD = 9.01) in the S group. The mean active extension was: -5.37º (SD = 2.49) in the FT group versus -8.60º (SD = 3.98) in the S group, (p<0.001). Conclusion: Patients in the FT group showed more significant improvements (i.e., shorter length of stay, shorter time to autonomous gait, and larger active ROM in flexion and extension). However, the exact role of the Flexet device is still to be determined.
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