High-energy tibial plateau fractures: external fixation versus plate fixation

Liang, Yufeng; Zhong, Fenglin

doi:10.1007/s00590-014-1528-7

Cited by 20 publications

(21 citation statements)

References 30 publications

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“…In agreement with our data regarding earlier healing following internal stabilization, Krupp et al described a decreased time to union after plate fixation of bicondylar tibia fractures reporting an average of 5.9 months compared to 7.4 months for external fixation [ 13 ]. Although a recent meta-analysis comparing both treatment methods for tibial plateau fractures found no significant difference regarding the time to union [ 7 ], the recorded data document a similar tendency (17.73 ± 4.87 after external fixation vs 15.64 ± 4.36 weeks following plate fixation). This study included 22 case series and a retrospective cohort study, indicating the lack of direct comparing trials and a low summary evidence level.…”

Section: Discussionmentioning

confidence: 86%

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Comparing case-control study for treatment of proximal tibia fractures with a complete metaphyseal component in two centers with different distinct strategies: fixation with Ilizarov frame or locking plates

et al. 2018

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BackgroundThe purpose of this study was to compare two methods of stabilization for proximal tibia fractures (AO 41) with a complete metaphyseal component, external fixation with the Ilizarov wire frame, and internal fixation with locking plates.MethodsPatients from two level 1 trauma centers treated between 2009 and 2015 were included in a retrospective comparing cohort study. The first center stabilized the non-pathological, proximal tibia fractures exclusively with external fixation and the second with internal plating. Combined clinically and radiologically evaluated, bone healing was the primary outcome. The secondary outcomes included complications, range of motion (ROM) and axial alignment of the knee, the reoperation rate within 6 months, heterotopic ossifications (HTO), and signs of posttraumatic osteoarthritis (PTOA). A logistic regression analysis corrected for uneven distributed parameters.ResultsThe 62 patients treated with Ilizarov frame and the 68 patients treated with plate fixation were comparable regarding epidemiological parameters, injury characteristics, and comorbidity except for injury severity score (ISS) and smoking behavior. The time of healing was shorter in the group undergoing plate fixation (p = 0.041); however, the incidence of non-unions was equal. Furthermore, there was no difference regarding the rate of deep infections, thrombosis, alignment, reoperations, PTOA, and ROM. Heterotopic ossifications were more prevalent following plate fixation (13.2 vs 1.6%, p = .013). External fixation was associated with a higher rate of superficial infections (40.4 vs 2.9%, p = .000). The initial displacement, the incidence of deep infections, and the classification significantly influenced the incidence of non-unions in both groups (p < 0.02).ConclusionsFixation of proximal tibia fractures with plates resulted in a slightly shorter healing time compared to Ilizarov frame stabilization. Furthermore, the complication profiles differ with more heterotopic ossifications and less superficial infections following internal plating.Trial registrationDRKS, DRKS00013275, Registered 11/2/2017, Retrospectively registered.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0792-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 86%

“…Clinical results were reported for both treatment standards [ 5 , 6 ]; however, comparison of studies are lacking. Recently, a systematic review evaluated both principals based on the published cohort studies [ 7 ]. Although the article makes a differentiated analysis available, there are obvious difficulties.…”

Section: Introductionmentioning

confidence: 99%

Comparing case-control study for treatment of proximal tibia fractures with a complete metaphyseal component in two centers with different distinct strategies: fixation with Ilizarov frame or locking plates

et al. 2018

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“…In this study, with the intention to imitate the anatomical reduction of the medial tibial plateau fracture, no displacement between the fractured segments was created, which made the model the same as a simple non-displaced fracture. However, it should be noted that multiple pinning under the guidance of an image intensifier was clinically preferred to buttress plate fixation for the treatment of non-displaced tibial plateau fractures [ 22 , 23 ]. In contrast, displaced fractures of the medial plateau (Schatzker type IV) often are quite unstable and are generally best treated with open reduction and internal fixation with a medial buttress plate [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture: a comparative finite element study

Huang

Zhi

et al. 2015

J Orthop Surg Res

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PurposeThe purpose of this study is to compare the stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture.MethodsA three-dimensional (3D) finite element model of the medial tibial plateau fracture (Schatzker type IV fracture) was created. An axial force of 2500 N with a distribution of 60 % to the medial compartment was applied to simulate the axial compressive load on an adult knee during single-limb stance. The equivalent von Mises stress, displacement of the model relative to the distal tibia, and displacement of the implants were used as the output measures.ResultsThe mean stress value of the plate-screw fixation system was 18.78 MPa, which was significantly (P < 0.001) smaller than that of the screw fixation system. The maximal value of displacement (sum) in the plate-screw fixation system was 2.46 mm, which was lower than that in the screw fixation system (3.91 mm). The peak stress value of the triangular fragment in the plate-screw fixation system model was 42.04 MPa, which was higher than that in the screw fixation model (24.18 MPa). But the mean stress of the triangular fractured fragment in the screw fixation model was significantly higher in terms of equivalent von Mises stress (EVMS), x-axis, and z-axis (P < 0.001).ConclusionsThis study demonstrated that the load transmission mechanism between plate-screw fixation system and screw fixation system was different and the stability provided by the plate-screw fixation system was superior to the screw fixation system.

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“…10 ). Comparing this with double-plate internal fixation, some studies have reported a lower rate of deep infections [ 60 , 61 ], but a slight increase in superficial infections [ 60 , 62 ], partly due to the poor initial condition of the tissues, together with an increased incidence of malunion and of traumatic arthritis [ 63 ].…”

Section: Treatmentmentioning

confidence: 99%

“…found that fractures treated with a hybrid external fixator more commonly present traumatic arthritis, while those treated with internal fixation plates more often have valgus deformity. Nevertheless, these authors stress the need to conduct larger-scale studies to confirm their results [ 63 ]. The minimally-invasive use of a single plate reduces the incidence of infection and nonunion, because the periosteum is retained intact.…”

Section: Treatmentmentioning

confidence: 99%

Periarticular Fractures of the Knee in Polytrauma Patients

Bertrand¹,

Cano²,

Pascual-López³

2015

TOORTHJ

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Periarticular fractures around the knee are a challenge for the orthopaedic surgeon. When these fractures are presented in the context of a multiple trauma patient, they are even more difficult to manage because the treatment approach depends not only on the fracture itself, but also on the patient’s general condition. These fractures, caused by high-energy trauma, present complex fracture patterns with severe comminution and major loss of articular congruity, and are often associated with vascular and nerve complications, particularly in the proximal tibia, due to its anatomical features with poor myocutaneous coverage. They are almost always accompanied by soft tissue injury.The management of polytrauma patients requires a multidisciplinary team and accurate systemic stabilization of the patient before undertaking orthopaedic treatment. These fractures are usually addressed sequentially, either according to the general condition of the patient or to the local characteristics of the lesions. In recent decades, various fixation methods have been proposed, but there is still no consensus as to the ideal method for stabilizing these fractures. In this paper, we describe the general characteristics of these fractures, the stabilization methods traditionally used and those that have been developed in recent years, and discuss the treatment sequences proposed as most suitable for the management of these injuries.

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High-energy tibial plateau fractures: external fixation versus plate fixation

Abstract: Although lack of good quality randomized control trials, there are rather enough samples supporting the current available results. Meanwhile, future multicentered, randomized, controlled studies should be implemented to test these outcomes.

Cited by 20 publications

References 30 publications

Comparing case-control study for treatment of proximal tibia fractures with a complete metaphyseal component in two centers with different distinct strategies: fixation with Ilizarov frame or locking plates

Comparing case-control study for treatment of proximal tibia fractures with a complete metaphyseal component in two centers with different distinct strategies: fixation with Ilizarov frame or locking plates

Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture: a comparative finite element study

Periarticular Fractures of the Knee in Polytrauma Patients

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