Functional outcome after tibial plateau fracture osteosynthesis: A mean follow-up of 6years

Timmers, Tim K.; Ven, Denise J.C. van der; Vries, L.S. de; Olden, G.D.J. van

doi:10.1016/j.knee.2014.09.011

Cited by 45 publications

(44 citation statements)

References 28 publications

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“…When treating tibial plateau fractures, the optimal surgical outcome is a stable and painless knee joint with full range of motion [1] [7] [16]. However, the severity of soft tissue injury directly correlates with the energy absorbed during the injury [17].…”

Section: Discussionmentioning

confidence: 99%

“…Many authors reported the advantage of early knee joint ROM after surgical treatment of tibial plateau fracture [1]- [3] [7]- [9] [11]- [25]. At postoperative first day, passive motion to 30˚ flexion is suggested and than it can be increased as tolerated.…”

Section: Discussionmentioning

confidence: 99%

“…These fractures constitute approximately 1.2% of all fractures and typically occur in young persons exposed to high-energy trauma, although they are also very common among elderly persons exposed to low-energy trauma [1] [2]. The mechanism of fracture is typically indirect and accompanied by axial loading, resulting in compression and angular forces that cause split or metaphyseal fractures [3].…”

Section: Introductionmentioning

confidence: 99%

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Immediate Knee Joint Range of Motion after Stable Fixation of Tibial Plateau Fractures

Arslan¹,

Polat²,

Ciliz³

et al. 2015

OJO

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The purpose of this study was to evaluate factors that affect initiation of early postoperative range of motion (ROM) rehabilitation and to investigate whether the postoperative ROM and clinical outcomes were affected by initiation of early ROM, immobilization and other factors. We conducted a retrospective analysis of tibial plateau fractures treated using stable internal fixation between December 2003 and June 2007. The resulting degree of flexion and Rasmussen Clinical and Radiographic Scores were evaluated. Thirty-nine patients were included, and 23 patients underwent a lateral submeniscal arthrotomy for evaluation of joint surface reduction, with 6 lateral meniscus lesions identified via arthrotomy. Three lateral collateral ligament lesions, 3 medial collateral ligament lesions and 1 anterior cruciate ligament lesion were found. Meniscus and ligament lesions significantly and negatively affected the initiation of knee joint ROM. Early ROM was achieved in 26 cases and 13 patients underwent immobilization for 4 weeks. At the final evaluation, the early ROM group had 130.42˚ ± 5.50˚ of flexion, compared with 122.92˚ ± 5.28˚ in the immobilization group. Moreover, the final Rasmussen score was 25.69 ± 2.92 in the early motion group, compared with 22.61 ± 3.5 in the immobilization group. There was no difference between radiographic scores of the groups. Although the initiation of early ROM improved the clinical results, soft tissue lesions influenced initiation of early knee joint motion. Therefore, meniscus and ligament injuries should be considered as prognostic factors in similar cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Immediate Knee Joint Range of Motion after Stable Fixation of Tibial Plateau Fractures

Arslan¹,

Polat²,

Ciliz³

et al. 2015

OJO

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“…Considering the results obtained in this study, it can be concluded that external fixation by the "Mitković" external fixator with the minimal internal fixation is a satisfactory method for the tratment of fractures of the tibial plafond causing less complications than internal fixation [18]. Despite the best current efforts at treatment, OA develops in as many as 25% of patients after fractures of the acetabulum, between 23% and 44% after intra-articular fractures of the knee, and in more than 50% of patients with fractures of the tibial plafond [19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Emergent hybrid external fixation for tibial pilon fractures in adults

Falzarano

Medici

Grubor

et al. 2015

Journal of Acute Disease

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Objective: To investigate that if the hybrid external fixation is the definitive treatment and management of tibial extra articular and intrarticulat pilon fractures of the adult in emergency. Methods: We treated 237 cases of pilon fractures using hybrid external fixation with or without minimal osteosynthesis from February 1999 to December 2014. All fractures were classified according to the Association for the Study of Internal Fixation. The three groups were represented by 108 patients (45.5%) for the Type A; 75 patients (31.8%) for Type B and 54 patients (22.7%) for Type C. Road accidents [118 patients (50.0%)] were the most common cause of tibial pilon fractures.Results: According to a mean follow-up of 7.3 years we had bone healing after 4.8 months from surgery in the 61.18% of the patients. The results were subjectively excellent, while the 54.00% were objectively excellent according to Ovadia and Beals score, and the results showed 29 complications.

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“…By contrast, TKA was required in up to 22% of patients in a series of 82 TPF at a mean follow-up of 6.8 years. 47 In this group, persistent pain is related to high-energy trauma injuries. Another study 48 comparing OA signs at 3 and at 22 years in a group of 31 patients with surgically treated TPF, showed that there is a deterioration of radiological OA signs between 3 and 22 years of follow-up and that there are differences in the evolution of the OA signs between the operated and the healthy knee in the same patient.…”

Section: What Outcomes Can Be Expected?mentioning

confidence: 99%

Treatment strategy for tibial plateau fractures: an update

2016

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Tibial plateau fractures are complex injuries produced by high- or low-energy trauma. They principally affect young adults or the ‘third age’ population.These fractures usually have associated soft-tissue lesions that will affect their treatment. Sequential (staged) treatment (external fixation followed by definitive osteosynthesis) is recommended in more complex fracture patterns. But one should remember that any type of tibial plateau fracture can present with soft-tissue complications.Typically the Schatzker or AO/OTA classification is used, but the concept of the proximal tibia as a three-column structure and the detailed study of the posteromedial and posterolateral fragment morphology has changed its treatment strategy.Limb alignment and articular surface restoration, allowing early knee motion, are the main goals of surgical treatment. Partially articular factures can be treated by minimally-invasive methods and arthroscopy is useful to assist and control the fracture reduction and to treat intra-articular soft-tissue injuries.Open reduction and internal fixation (ORIF) is the gold standard treatment for these fractures. Complex articular fractures can be treated by ring external fixators and minimally-invasive osteosynthesis (EFMO) or by ORIF. EFMO can be related to suboptimal articular reduction; however, outcome analysis shows results that are equal to, or even superior to, ORIF. The ORIF strategy should also include the optimal reduction of the articular surface.Anterolateral and anteromedial surgical approaches do not permit adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is necessary to reduce and fix them through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement.Some authors have also suggested that primary total knee arthroplasty could be an option in specific patients and with specific fracture patterns.Cite this article: Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev 2016;1:225-232. DOI: 10.1302/2058-5241.1.000031.

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Functional outcome after tibial plateau fracture osteosynthesis: A mean follow-up of 6years

Cited by 45 publications

References 28 publications

Immediate Knee Joint Range of Motion after Stable Fixation of Tibial Plateau Fractures

Immediate Knee Joint Range of Motion after Stable Fixation of Tibial Plateau Fractures

Emergent hybrid external fixation for tibial pilon fractures in adults

Treatment strategy for tibial plateau fractures: an update

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