Failure analysis of primary surgery and therapeutic strategy of revision surgery for complex tibial plateau fractures

Abstract

Purpose To analyze the cause of failure of the primary surgery for complex tibial plateau fractures and to define the therapeutic strategy of the revision surgery for the same. Methods Twenty-one cases with failure of primary surgery for complex tibial plateau fractures were treated in our hospital from January 2012 to September 2016. There were 13 males and 8 females with an average age of 39.4 years (ranged between 27 and 58 years). Patients presented with different types of complex tibial plateau fractures like Schatzker type V ( n =9), VI ( n =12), type 41.C1 ( n =9), type 41.C2 ( n =6), and type 41.C3 ( n =6). The therapeutic strategy for revision surgery in individual patients was decided following careful analysis and accurate assessment of the causes of failure of the primary surgery. All the patients were followed-up with Rasmussen radiographic scores and Hospital for Special Surgery (HSS) knee scores. Results All 21 patients underwent clinical and radiological examination after a mean follow-up time of 32.6 months. The average time of fracture healing was 4.5 months (ranged between 3 and 6 months). During the last follow-up, the mean range of motion of knee extension was 2.3° and knee flexion was 123.8°. The mean radiological Rasmussen score was 15.6 points, with an overall success rate of 85.7%. The average HSS knee score was 84.3 points, with an overall success rate of 80.9%. Conclusion The common reasons for the failure of primary surgery of complex tibial plateau fractures were inadequate experience of the surgeon, inaccurate diagnosis and management, improper selection of implants, and poor surgical techniques. The key factors to succeed revision surgery were adequate preoperative evaluation, accurate intraoperative procedures, and proper postoperative rehabilitation. Level of evidence Level IV, case series, treatment study

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

“…Schatzker type Ⅴ and Ⅵ tibial plateau fractures are usually caused by severe crushing and collapse of the medial and lateral condyles owing to high-energy trauma; however, the internal and external double incision approach, combined with bone grafting and double steel plate fixation, can achieve ideal results 14 . As there are an abundance of blood vessels around the knee joint, an increase in the incision exposure range and the use of tourniquets can lead to a large amount of blood loss and fibrinolytic response during the perioperative period 22 .…”

“…The pressure of the balloon-type tourniquet on the affected limb was set to 450 mmHg, and the mean arterial blood pressure (MAP) was maintained at 60-70 mmHg. This surgical technique has been described previously 13,14 . Briefly, a medial and lateral double incision approach, combined with double locking steel plates, was used to fix the fracture block.…”

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

“…Schatzker type and tibial plateau fractures are usually caused by severe crushing and collapse of the medial and lateral condyles owing to high-energy trauma; however, the internal and external double incision approach, combined with bone grafting and double steel plate xation, can achieve ideal results 14 . As there are an abundance of blood vessels around the knee joint, an increase in the incision exposure range and the use of tourniquets can lead to a large amount of blood loss and brinolytic response during the perioperative period 22 .…”

“…The pressure of the balloon-type tourniquet on the affected limb was set to 450 mmHg, and the mean arterial blood pressure (MAP) was maintained at 60-70 mmHg. This surgical technique has been described previously 13,14 . Brie y, a medial and lateral double incision approach, combined with double locking steel plates, was used to x the fracture block.…”

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

“…All other drugs, except for TXA and physiological saline solution during general anesthesia, were the same in all three groups. The pressure of the balloon-type tourniquet on the affected limb was set to 450 mmHg, and the mean arterial blood pressure (MAP) was maintained at 60-70 mmHg, as described previously 5,21 . Brie y, a medial and lateral double incision approach combined with double locking steel plates was used to x the fracture block.…”