Failure of Fixation of Tibial Plateau Fractures

Abstract

It is logical to define failure of fixation using the same measures considered as indications for reduction and fixation. Using these strict criteria, the incidence of radiologic failure was much higher than previous published series. In the elderly this was unacceptably high, and treatment goals should be limited to restoring stability and alignment.

Outcome of complex fractures of the tibial plateau treated with a beam-loading ring fixation system

“…52 Furthermore, restricted weight-bearing may be impractical, and many of these patients will walk fully weight-bearing regardless of the instructions given. 45 Therefore, we elected to allow our patients to start weight-bearing at three weeks and alignment was maintained in most of them. If, however, loss of reduction does occur, an important advantage of using the ring external fixation is the ability to carry out an early corrective osteotomy with the frame still in place.…”

“…45 Long-film radiographs for assessment of the mechanical axis of the limb were taken and compared with those of the contralateral normal limb in order to measure malalignment. Post-traumatic osteoarthritis (OA) was assessed on the most recent radiograph, on the basis of narrowing of the joint space, subchondral sclerosis, cysts and osteophytes.…”

Tibial Plateau Fractures

“…Both external fi xation and dual plating were sensitive to the bone quality with all failures due to cut-out within the bone [ 37 ] . Age and poor bone quality are associated with higher failures of fi xation in the treatment of tibial plateau fractures [ 38 ] . Some authors are advocating ORIF with dual plates and supplemental external fi xation post-operatively to avoid fi xation failures in this geriatric patient population [ 39 ] .…”

Circular external fixation in the management of tibial plateau fractures in patients over the age of 55 years

“…10 This reduction in BMD results in an increased risk of re-displacement of fractures, which may be as high as 79% in patients over the age of 60. 11 While several studies have reported promising results with the use of circular external fixation, little data is available on its use in the elderly. 1,2,8 In the elderly hybrid external fixation has been reported to deliver inferior results in comparison to internal fixation.…”