Biomechanical aspects of the posteromedial split in bicondylar tibial plateau fractures—a finite-element investigation

Dehoust, Julius; Münch, M.; Seide, K.; Barth, Tobias; Frosch, Karl‐Heinz

doi:10.1007/s00068-020-01538-3

Cited by 20 publications

(12 citation statements)

References 25 publications

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“…In addition, this study focused the lateral compartment and simultaneous treatment of the medial plateau was not scientifically evaluated. To the authors’ experience, complex lateral plateau fractures often present with a coronal medial split fracture that can be addressed via a separate posteromedial approach [ 26 , 27 ]. However, complex medial plateau fractures will complicate the surgical strategy and need individual concepts, possibly with the necessity to reposition patients during surgery.…”

Section: Discussionmentioning

confidence: 99%

Anterolateral versus modified posterolateral approach for tibial plateau fractures with involvement of the posterior column: a cadaveric study

Behrendt

Berninger

Thürig

et al. 2022

Eur J Trauma Emerg Surg

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Introduction The aim of this study was to compare the reduction quality of the anterolateral (AL) and modified posterolateral approach (PL) in lateral tibial plateau fractures involving the posterior column and central segments. Methods Matched pairs of pre-fractured cadaveric tibial plateau fractures were treated by either AL approach (supine position) or PL approach (prone position). Reduction was controlled by fluoroscopy and evaluated as satisfying or unacceptable. Afterwards, the reduction was examined by 3D scan. Results 10 specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were evaluated. PL approach achieved significantly (p 0.00472) better fracture reduction results (0.4 ± 0.7 mm) of the posterior column compared to the AL group (2.1 ± 1.4 mm). Fracture steps involving the central area of the lateral plateau were insufficiently reduced after fluoroscopy using both approaches. Conclusion Optimal reduction of displaced tibial plateau fractures involving the posterolateral column necessitates a posterior approach, which can be conducted in prone or lateral positioning. The anterolateral approach is indicated in fractures with minor displacement of the posterolateral rim but fracture extension in the latero-central segments. In these cases, an additional video-assisted reduction or extended approaches are helpful.

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Section: Discussionmentioning

confidence: 99%

Anterolateral versus modified posterolateral approach for tibial plateau fractures with involvement of the posterior column: a cadaveric study

Behrendt

Berninger

Thürig

et al. 2022

Eur J Trauma Emerg Surg

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“…[55] ▪ Posteromedial support through angular or non-angular stable plate osteosynthesis is superior to sagittal and retrograde screw osteosynthesis [58] In the case of bicondylar tibial plateau fractures in multiple fragments, it may be necessary to reposition the patient from the prone position to a lateral or dorsal position in order to address the individual course of the fracture in a 3-dimensional way. Alternatively, primary lateral positioning (e.g., in "floppy" 45°) and tilting the OP table can make it possible to successfully address the posterior and anterior fragments, usually without the patient being repositioned (consensus: 100 %).…”

Section: Medial/anteromedial Accessmentioning

confidence: 99%

“…▪ indiziert bei posteromedialen Frakturen, knöchernen hinteren Kreuzbandausrissen, Impressionen des posterolaterozentralen Segmentes [2,55,57,59, 60] ▪ ermöglicht den Gelenkflächeneinblick der posteromedialen 15 % [55] ▪ posteromediale Abstützung durch winkel-oder nicht winkelstabile Plattenosteosynthese der sagittalen und retrograden Schraubenosteosynthese überlegen [58] Bei bikondylären, multifragmentären Tibiakopffrakturen kann die Umlagerung des Patienten aus der Bauchlage in eine Seit-oder Rückenlage notwendig werden, um den individuellen Frakturverlauf 3-dimensional zu adressieren. Alternativ können mit einer primären Seitenlagerung (z.…”

Section: Posteromedialer Zugangunclassified

S2k-Leitlinie Tibiakopffraktur – Klassifikation, Diagnostik und Therapie

Berninger,

Schüttrumpf,

Barzen

et al. 2023

Z Orthop Unfall

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ZusammenfassungTibiakopffrakturen stellen mehrheitlich komplexe und chirurgisch anspruchsvolle Gelenkfrakturen dar, die für ein zufriedenstellendes Ergebnis ein umfassendes Verständnis der Frakturmorphologie, der ligamentären und neurovaskulären Begleitverletzungen sowie der diagnostischen und therapeutischen Optionen erfordern. Hierzu ist ein standardisiertes und strukturiertes Vorgehen erforderlich. Der Erfolg einer Behandlung von Tibiakopffrakturen liegt zu großen Teilen auch an der interdisziplinären Zusammenarbeit von operativ und konservativ tätigen Behandlern im ambulanten und stationären Bereich, Physiotherapeuten, Patienten und Leistungserbringern (Krankenkassen, gesetzliche Unfallversicherung, Rentenversicherungsträger). Im Auftrag der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie e. V. (DGOU), der Deutschen Gesellschaft für Unfallchirurgie (DGU) und der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA) wurde unter Federführung des Frakturen-Komitees der Deutschen Kniegesellschaft (DKG) ein leitliniengerechter Behandlungspfad zur Tibiakopffraktur erstellt, der im Rahmen eines Delphi-Prozesses in mehreren Abstimmungsrunden erarbeitet wurde. Dieser Behandlungspfad soll unter Berücksichtigung der aktuellen Literatur Empfehlungen aussprechen und die wichtigsten Behandlungsschritte der Diagnostik, Therapie und Nachbehandlung darlegen. Mit dem Ziel einer Konsensbildung wurden zudem 25 Aussagen unter Anwendung der Likert-Skala durch die Autoren in mehreren Befragungsrunden revidiert.

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“…Tibial plateau fractures (TPFs) are a common intra-articular fracture in clinical practice. Because of the complex injury mechanisms and diverse fracture patterns of TPFs, it presented a great challenge to clinical practice [1][2][3][4]. Therefore, a better understanding of the distribution of the fracture line and the morphological characteristics of the fracture mass is essential for making treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

Tibial plateau fractures: three dimensional fracture mapping and morphologic measurements

Yao

Gong

Shan

et al. 2022

International Orthopaedics (SICOT)

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Purpose The injury mechanisms and classifications of tibial plateau fractures (TPFs) are still controversial. The aim of this study is to show 3D fracture mapping of different types of tibial plateau fractures. Moreover, combined with Schatzker and ten-segment classification, we aimed to analyze the injury frequency and characteristics of different segments. Methods In total, 346 patients with TPFs treated at level I trauma centres from 2017 to 2021 were reviewed. The CT files of the included cases were typed and categorized. 3D reconstruction of TPFs patients’ CT files were performed using software. All fracture lines were superimposed on the standard model by the software to create TPFs 3D fracture mapping. Results This study included 204 male and 142 female patients (average age, 47 years [range, 18 to 83 years]) with a tibial plateau fracture. Using the Schatzker classification, we found 39 type I (11.27%), 103 type II (29.77%), nine type III (2.60%), 71 type IV (20.52%), 52 type V (15.03%), 59 type VI (17.05%) fractures, and 13 others (3.76%). The density areas of fracture lines are mainly located in the ALC and PLC segments (74.3%, 69.1%). In different views, fracture lines of different Schatzker types showed distinct distribution characteristics. Conclusions Schatzker classification combined with 3D fracture mapping provides a new presentation of tibial plateau fracture morphology. According to the 3D fracture mapping, different types of TPFs have distinctly different distribution characteristics of fracture lines. There are significant differences between different types of fracture injury segments.

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Biomechanical aspects of the posteromedial split in bicondylar tibial plateau fractures—a finite-element investigation

Cited by 20 publications

References 25 publications

Anterolateral versus modified posterolateral approach for tibial plateau fractures with involvement of the posterior column: a cadaveric study

Anterolateral versus modified posterolateral approach for tibial plateau fractures with involvement of the posterior column: a cadaveric study

S2k-Leitlinie Tibiakopffraktur – Klassifikation, Diagnostik und Therapie

Tibial plateau fractures: three dimensional fracture mapping and morphologic measurements

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