Is pin-plate overlap in tibial plateau fractures associated with increased infection rates?

Haase, Lucas; Haase, Douglas; Moon, Tyler J.; Clary, Steven J.; Nelson, Grant; Ochenjele, George; Wise, Brent; Napora, Joshua K.

doi:10.1016/j.injury.2022.01.017

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…A hybrid external fixator and staged treatment with a temporary external fixator and subsequent definitive surgery are used for fracture fixation associated with severe soft-tissue insult. External fixation devices generally are associated with pin site infection and poor patient compliance [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Using a single lateral locking plate to fix CTPFs provides stability, avoiding soft tissue stripping and reducing operating time. However, maintaining the axial alignment is difficult when the articular component of the posterior plateau has a coronal fracture line [ 10 , 11 ]. The stabilization of CTPFs associated with PTPF has improved as contemporary concepts and techniques have evolved in recent years, allowing better knowledge of precise radiological fracture geometry and fixation of the posteromedial and posterolateral fragments through two-incision dual plating using locking or buttress plate, leading to better clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The stabilization of CTPFs associated with PTPF has improved as contemporary concepts and techniques have evolved in recent years, allowing better knowledge of precise radiological fracture geometry and fixation of the posteromedial and posterolateral fragments through two-incision dual plating using locking or buttress plate, leading to better clinical outcomes. Different studies have favored this in terms of biomechanics, easy access to the articular surface for anatomic joint reduction, adequate fixation, maintenance of alignment, and early rehabilitation to achieve a better functional outcome in addition to preventing postoperative tibial subluxation, medial collapse, and subsequent varus collapse [7][8][9][10][11]. Galla M and Lobenhoffer P used a direct posteromedial approach, but the PTPFs may not be assessed properly via this approach [12].…”

Section: Introductionmentioning

confidence: 99%

“…Out of 28 patients, 14 (50%) patients had an excellent result with an average score of 28, 10 (35.71%) patients had good results with an average score of 26.50, and four (14.29%) patients had fair results with an average score of 21.50.The functional outcome measured with the help of the OKS showed excellent results in 24 (85.71%) cases and good results in the rest of the four (14.29%) cases. At the final follow-up, the mean OKS was 44.75 ± 2.5 (range 37-48).The RRS showed excellent or good radiographic results with a mean score of 14.1 ± 1.7 (range[8][9][10][11][12][13][14][15][16]. The radiographs at the final follow-up showed a mean MPTA of 83.98° ± 6.89 (75.44-89.21) and a mean PTPA of 12.31 ± 4.69(5.12-16.49).…”

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confidence: 97%

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Supplementary Posteromedial Plating for the Fixation of Complex Tibial Plateau Fractures: A Prospective Study

Arya¹,

Bhartiya²,

Singh³

et al. 2023

Cureus

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Introduction The management of complex tibial plateau fractures (CTPF) involving the posterior tibial plateau remains challenging and achieving maintenance of an axially stable construct with a single lateral locked plate is uncertain. Dual plating for such fractures via separate incisions can provide better fixation with superior clinical and radiological outcomes. This prospective study aimed to evaluate the results of the management of Schatzker type V and VI complex tibial plateau fractures using a conventional anterolateral plate along with a posteromedial buttress plate via two separate approaches and the potential complications associated with it. Methods Fifty-six patients presenting with tibial plateau fractures to the Department of Orthopaedics at a tertiary care center in the northern part of the state of Uttar Pradesh, India, between January 2018 and July 2022 were screened. Subsequently, 28 patients with CTPFs (AO/OTA types 41C1, 41C2, AND 41C3) were included in the study, managed with dual plating, and followed up for a duration of 12 months. The clinico-radiological outcome was assessed using Rasmussen's Functional Grading System (RFS), Oxford Knee Score (OKS), knee range of motion achieved, and Rasmussen's Radiological Scoring System (RRS), and statistical analysis of the data was performed. Results A total of 24 (85.71%) patients had excellent OKS and good to excellent RFS at the final follow-up. The average knee range of motion was 3.21° to 122°, with only two patients reporting an extensor lag of more than 10°. The final follow-up radiographs showed a mean medial proximal tibial angle (MPTA) of 83.98° ± 6.89 (75.44-89.21) and a mean posterior tibial plateau angle (PTPA) of 12.31 ± 4.69 (5.12 to 16.49) with the RRS showing excellent or good radiographic results with a mean score of 14.1 ± 1.7 (range 8-16). None of the patients showed signs of deep infection, whereas superficial infection was reported in two patients. A single case of secondary loss of particular reduction was seen. Conclusion Supplementary posterior buttress plating, along with the conventional anterolateral plate for the management of CTPF, achieves rigid fixation with superior articular reduction, a high knee score, a good range of motion, lower complication rates, and limited deformities with a good radiological outcome, with a few demerits of prolonged operative time, technically demanding procedure, increased blood loss, and a protracted hospital stay which can be minimized in most instances using minimally open reduction techniques and careful soft-tissue handling.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%