A New Surgical Approach in the Treatment of Depressed Lateral Condylar Fractures of the Tibia

Gossling, Harry R.; Peterson, Charles A.

doi:10.1097/00003086-197905000-00020

Cited by 14 publications

(13 citation statements)

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“…In contrast to the technique described by Grossling and Peterson, 14 the approach presented in this article differs in several important aspects. Although the approach presented in this article could be made as extensive as that described by Grossling and Peterson, 14 this is not intended.…”

Section: Discussionmentioning

confidence: 93%

“…Although the approach presented in this article could be made as extensive as that described by Grossling and Peterson, 14 this is not intended. On the contrary, our approach was developed to allow a circumferential approach to the tibial plateau when combined with an anteromedial and or a posteromedial approach while respecting the soft tissue capsule and its blood supply around the tibial plateau.…”

Section: Discussionmentioning

confidence: 99%

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Posterolateral Transfibular Approach to Tibial Plateau Fractures: Technique, Results, and Rationale

Solomon

Stevenson²,

Baird³

et al. 2010

Journal of Orthopaedic Trauma

110

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We describe a posterolateral transfibular neck approach to the proximal tibia. This approach was developed as an alternative to the anterolateral approach to the tibial plateau for the treatment of two fracture subtypes: depressed and split depressed fractures in which the comminution and depression are located in the posterior half of the lateral tibial condyle. These fractures have proved particularly difficult to reduce and adequately internally fix through an anterior or anterolateral approach. The approach described in this article exposes the posterolateral aspect of the tibial plateau between the posterior margin of the iliotibial band and the posterior cruciate ligament. The approach allows lateral buttressing of the lateral tibial plateau and may be combined with a simultaneous posteromedial and/or anteromedial approach to the tibial plateau. Critically, the proximal tibial soft tissue envelope and its blood supply are preserved. To date, we have used this approach either alone or in combination with a posteromedial approach for the successful reduction of tibial plateau fractures in eight patients. No complications related to this approach were documented, including no symptoms related to the common peroneal nerve, and all fractures and fibular neck osteotomies healed uneventfully.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Posterolateral Transfibular Approach to Tibial Plateau Fractures: Technique, Results, and Rationale

Solomon

Stevenson²,

Baird³

et al. 2010

Journal of Orthopaedic Trauma

110

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“…Krupp et al found that locked plating was associated with a decreased time to union, decreased incidence of articular malunion, decreased knee stiffness, and decreased overall complications. Moreover, Gossling et al [12] discovered that internal fixation with locking plates, following the principles of minimally invasive percutaneous osteosynthesis, could provide satisfactory fracture reduction with good results regarding the midterm clinical outcome. Usually a locking plate is inserted providing a raft of proximal locking screws to support the articular surface, buttressing the lateral wall of the proximal tibia and extending distally to adequately support the construct [13] .…”

Section: Surgical Proceduresmentioning

confidence: 99%

Surgical outcome of tibial plateau fracture using minimally invasive technique with locking compression plate

Vishwanath¹,

Mummigatti²

2017

Int. J. Orthop. Sci.

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Introduction:The following study was conducted to examine the short term clinical and radiological results particularly early complications and healing rate of tibial plateau fractures treated with LCP by minimally invasive technique. Methodology: The study was conducted in patients treated for tibial plateau fractures (type 1 to 4 Schatzker classification) at Adhichunchangiri Institute of Medical Science, BG Nagar from the month of May 2011 to May 2016. Fifty tibial plateau fracture patients were taken into the study, all were fixed with LCP using minimally invasive technique. Patients' age ranged from 20 to 70 years with a mean of 45. Results: The sample consisted of twenty patients with 38 males and 12 were females. The patients' ages ranged from 20-70 years with a mean age of 45 years. The causes of fractures were motorvehicle accident in 36 patients and fall in 14 patients. There were no sports or industrial accidents. 31 fractures involved the right side and 19 involved the left. The average length of hospitalisation was 12 days with a range of 7 to 20 days. The average number of days from injury to surgery was 5 days with a range of 2 to 10 days. The operative time ranged from 45 minutes to 100 minutes. Patients were followed up from 01 to 24 months. Functional outcome was rated as per NEER'S RATING SCORE, we got excellent results in 24 cases, good in 15, fair in 08 and poor in 03 patients. Conclusion: Treatment of tibial plateau fractures using LCP provides good results. Since we have used minimally invasive technique soft tissue damage is minimal thus promoting good healing of fracture and less infection rates. Our early results were encouraging but long term studies are needed to prove definitively acceptable outcomes so that the technique can become part of the in the armamentarium of the orthopaedic trauma surgeon. Keywords: Tibial plateau fracture, Schatzker classification, Minimally invasive technique, Locking Compression Plate, NEER'S Rating Score IntroductionTibial plateau fractures are on a raise due to increased incidence of road traffic accidents and also at the same time the surgical management for the same are also being modified continuously [1] . The luxuries of our life in the present time is at the cost of rapidly increasing industrialization, urbanization and mechanisation -so also the traumatic cases are on increase. Crowded cities, irregular traffic arrangement, fast moving vehicles are the most important contributory factors causing bony injuries, particularly polytrauma, comminuted fractures and also the soft tissue injury [2] . Tibial plateau fracture is one of them. Tibial plateau fractures have been studied and reported extensively and exhaustively but still controversy exists over its management, whether surgical or conservative. Even undisplaced tibial plateau fractures should be operated, so that early mobilization of knee is possible [1] .

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“…O menisco lateral é inspecionado e deve ser mobilizado de forma a permitir a visualização da fratura. Classicamente, uma incisão transversa na porção menisco-tibial permite a liberação do menisco, que é afastado cranialmente (13) . Outra abordagem envolve a desinserção do corno anterior do menisco lateral, que é então rebatido lateralmente juntamente com o fragmento em cunha do planalto lateral (14) .…”

Section: Tratamento De Fraturas Específicas Fratura Schatzker I -Clasunclassified

Fraturas do planalto tibial

et al. 2009

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rESUMOAs fraturas do planalto tibial são lesões articulares cujos princí-pios de tratamento envolvem a redução anatômica da superfície articular e a restauração funcional do eixo mecânico do membro inferior. Contribuem para a tomada de decisões no tratamento dessas fraturas o perfil do paciente, as condições do envelope de tecidos moles, a existência de outros traumatismos associados e a infraestrutura disponível para abordagens cirúrgicas. Para as fraturas de alta energia, o tratamento estagiado, seguindo o princípio do controle de danos, tem como prioridade a manutenção do alinhamento do membro enquanto se aguarda a resolução das más condições de tecidos moles. Já nos traumas de baixa energia, desde que os tecidos moles não sejam um fator adverso, o tratamento deve ser realizado em tempo único, com osteossíntese definitiva. Fixação estável e movimento precoce são variáveis diretamente relacionadas com os melhores prognósticos. Desenvolvimentos recentes, como os implantes com estabilidade angular, substitutos ósseos e imagens tridimensionais para controle intraoperatório, deverão contribuir para cirurgias menos invasivas e melhores resultados. descritores - INTrOdUçãOAs fraturas do planalto tibial constituem um risco à integridade funcional do joelho. Resultam da aplicação de forças compressivas axiais combinadas ou não com estresses em varo ou em valgo da articulação do joelho. A geometria e o desvio da fratura dependem de vários fatores, como a magnitude e a direção da aplicação da força, do grau de flexão do joelho no momento do trauma e, por fim, da qualidade óssea. Em pacientes mais jovens, os fragmentos tendem a ser maiores e em "cunha", devido às forças de cisalhamento envolvidas. Nos pacientes idosos, por outro lado, é mais frequente encontrarmos fraturas por depressão pura, sendo geralmente causadas por traumas de menor energia (1) . A incongruência e instabilidade articulares residuais podem resultar em osteoartrose pós-traumática (2) . O diagnóstico das fraturas do planalto tibial nem sempre é óbvio. Não é infrequente que pacientes com fraturas incompletas ou fraturas por estresse tenham o Rev Bras Ortop. 2009;44(6):468-74

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A New Surgical Approach in the Treatment of Depressed Lateral Condylar Fractures of the Tibia

Cited by 14 publications

References 0 publications

Posterolateral Transfibular Approach to Tibial Plateau Fractures: Technique, Results, and Rationale

Posterolateral Transfibular Approach to Tibial Plateau Fractures: Technique, Results, and Rationale

Surgical outcome of tibial plateau fracture using minimally invasive technique with locking compression plate

Fraturas do planalto tibial

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