Frequency and Fracture Morphology of the Posteromedial Fragment in Bicondylar Tibial Plateau Fracture Patterns

Barei, David P.; O'Mara, Timothy J; Taitsman, Lisa A.; Dunbar, Robert P; Nork, Sean E.

doi:10.1097/bot.0b013e318169ef08

Cited by 191 publications

(180 citation statements)

References 30 publications

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“…We note that the morphological characteristics of the complex bicondylar four-quadrant tibial plateau fractures follow a regular pattern, which was also described by others [8][9][10][11][12]. The concave medial plateau is usually split into two large fragments (posteromedial and anteromedial) without articular depression, while the convex lateral plateau is split-depressed into various degrees of multi-fragments with broadening of the lateral compartment (anterolateral and posterolateral).…”

Section: Discussionmentioning

confidence: 66%

“…Chang et al [6,7] classified the tibial articular plateau into four-quadrants, and the fractures are categorized with an isolated single quadrant (anteromedial, anterolateral, posteromedial, and posterolateral) and different combinations of 2, 3 and 4 quadrants. The fracture on each quadrant may have unique characteristics [8][9][10][11][12] as well as require related incision or treatment protocols [13,14].…”

Section: Introductionmentioning

confidence: 99%

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A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Chang

Zhang

et al. 2014

International Orthopaedics (SICOT)

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Purpose Bicondylar tibial plateau fractures involving four articular quadrants are severe and complex injuries, and they remain a challenging problem in orthopaedic trauma. The aim of this study was to introduce a new treatment protocol with dual-incision and multi-plate fixation in the floating supine patient position as well as to report the preliminary clinical results. Methods From January 2006 to December 2011, 16 consecutive patients with closed bicondylar four-quadrant tibial plateau fractures (Schatzker type VI, OTA/AO 41C2/3) were treated with posteromedial inverted L-shaped and anterolateral incisions. With the posteromedial approach, three quadrants (posteromedial, anteromedial and posterolateral) can be exposed, reduced and fixed with multiple small antiglide plates and short screws in an enclosure pattern. With the anterolateral approach, after articular elevation and bone substitute grafting, a strong locking plate with long screws to the medial cortex is used to raft-buttress the reduced lateral plateau fracture, hold the entire reconstructed tibial condyles together, and contact the condyles with the tibial shaft. All patients were encouraged to exercise knee motion at an early stage. The outcome was evaluated clinically and radiologically after a minimum two-year follow-up. Results The average operation time was 98±26 minutes (range 70-128) and the average duration of hospitalization was 29±8.6 days (range 20-41). Three cases used five plates, nine cases used four plates, and four cases used three plates. All patients were followed for a mean of 28.7±6.1 months (range 26-38). Fifteen incisions healed initially, while one patient developed a medial wound dehiscence and was successfully managed by debridement. All patients achieved radiological fracture union after an average of 20.2 weeks. At the two-year follow up, the average knee range of motion (ROM) was 98°±13.7 (range 88-125°), with a Hospital for Special Surgery (HSS) knee score of 87.7±10.3 (range 75-95), and SMFA score of 21.3±8.6 (range 12-33). Conclusion For bicondylar four-quadrant tibial plateau fractures, the treatment protocol of multiple medial-posterior small plates combined with a lateral strong locking plate through dual incisions can provide stable fracture fixation to allow for early stage rehabilitation. Good clinical outcomes can be anticipated.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Chang

Zhang

et al. 2014

International Orthopaedics (SICOT)

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“…Barie et al have shown the presence of these fragments in 33% of tibial plateau fractures. 5 Hackl et al found that 40% of the fractures classified with plain AP radiographs using Schatzker classification have to be changed after doing Computed Tomography (CT). 10 Historically these fractures have been treated with single midline incision which was associated with high wound complication rate and secondary loss of alignment.…”

Section: Discussionmentioning

confidence: 99%

“…Barie et al have shown the presence of these fragments in 33% of tibial plateau fractures. 5 Several biomechanical studies have proved that fixation of these fragment is necessary to prevent secondary loss of alignment like varus collapse. 4 We have tried to assess the outcome of these fractures using ORIF with locking or buttress plate through Lobenhoffer approach.…”

Section: Introductionmentioning

confidence: 99%

Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

et al. 2017

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Background: Management of tibial plateau fractures with coronal fractures especially posteromedial fragment is frequent and challenging. This study was conducted to evaluate the functional outcome of patients with tibial plateau fractures having posteromedial fragment treated with open reduction and internal fixation (ORIF) using Lobenhoffer approach.Methods: Thirty two patients with tibial plateau fractures having posteromedial fracture alone or part of bicondylar fracture was operated with ORIF using Lobenhoffer approach. Time to union, maintenance of alignment, rate of complications and functional outcome was assessed using Oxford knee score.Results: The mean time to healing was 16.4 weeks, without any complication in the form of non-union and infection. Malunion with secondary loss of alignment was seen in only one case due to fracture comminution and early weight bearing. Oxford knee score was good to excellent in all the cases. Conclusions: With recent development in understanding these fractures, ORIF gives excellent to good outcome in all patients operated through Lobenhoffer approach. Long term disability can be prevented by maintenance of adequate alignment and reduction through direct visualization of fracture.

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“…Bicondylar tibial plateau fractures are complex injuries and treatment these fractures is challenging. Ideal method is still controversial with risk of unsatisfactory results ifnottreated properly [2]. Several strategies have been advocated for management of bicondylar tibial plateau fractures.…”

Section: Introductionmentioning

confidence: 99%

Does single locked plating provide a standard treatment Modality for bicondylar tibial plateau fractures? A prospective study

Youssef¹,

Nagi²,

Senna³

et al. 2017

J Rheumatol Orthop

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Background: Bicondylar tibial plateau fractures present a therapeutic challenge to the orthopaedic trauma surgeon, both in terms of the osseous injury as well as the concomitant soft-tissue insult. Double Plating with single incision or dual incisions provide more insult to the compromised soft tissue. However, single locking plate combines the technical advantages of an angular stable plate with those of the modern biological plating technique. Methods: The Study was held at Razi Orthopedic hospital in Kuwait. Between May 2012 and November 2013, 20 patients with a mean age of 37.65 years (Range from 24-57 years) with bicondylar tibial plateau fractures with or without metaphyseal extension. Patients were diagnosed clinically, checked with standard X-rays, CT was done for all cases. Patients were treated by single lateral anatomically contoured locked plate through LISS or Polyaxial locking plate systems with or without additional screws from medial side. Radiological evaluation and functional assessment was done according to the Rasmussen Knee score. Patients were followed-up for an average of 12 months. Results: Union was achieved in all patients with a mean knee range of motion of 1.5°-130° (range: 0°-10° for extension lag, range: 100°-135° for flexion). The mean Functional Rasmussen Knee score at 6 month follow up (25.32±1.53 SD) ranged from (23.0-28.0). The mean Functional Rasmussen Knee score at last follow-up was (28.33±1.57 SD) ranged between (25.0-30.0) with significant P value (P value<0.001). The mean Anatomical Rasmussen Knee score at 6 month follow up (16.11±1.56 SD) ranged from (14.0-18.0). The mean Anatomical Rasmussen Knee score at last follow-up was (16.67±1.37 SD) ranged from (14.0-18.0) with insignificant P value (P value 0.096 ). Of the 20 patients, one patient had wound related problems, one patient had preoperative compartment syndrome, one patient suffered from hardware irritation and one patient had fixation failure upon which revision with double plating done for him. Conclusions: Surgical treatment of bicondylar tibial plateau fractures with the single lateral locked plate that was evaluated in our study can lead to a good functional and anatomical outcome and considered an effective system for providing fracture stabilization provided that the correct surgical technique is used. Awareness of potential hardware complications is essential. Level of Evidence: Level IV, Prospective Therapeutic Study

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Frequency and Fracture Morphology of the Posteromedial Fragment in Bicondylar Tibial Plateau Fracture Patterns

Cited by 191 publications

References 30 publications

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

A surgical protocol for bicondylar four-quadrant tibial plateau fractures

Posteromedial fragment fixation through Lobenhoffer approach in tibial plateau fractures

Does single locked plating provide a standard treatment Modality for bicondylar tibial plateau fractures? A prospective study

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