Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment

Berber, Reshid; Lewis, Charles P.; Copas, David; Forward, D. P.

doi:10.1016/j.injury.2013.11.028

Cited by 33 publications

(25 citation statements)

References 16 publications

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“…Meanwhile, none of the classifications aforementioned has taken into account the morphological characteristics of depression. Fracture line location is of great importance for the planning of an appropriate surgical approach [19–21]. Depression is the other factor that will influence the choice of surgical approach, anatomical reduction or functional restoration, and even the development of periarticular plates [22].…”

Section: Discussionmentioning

confidence: 99%

The morphological features of different Schatzker types of tibial plateau fractures: a three-dimensional computed tomography study

et al. 2016

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BackgroundTibial plateau fractures are of great challenge to treat with open reduction and internal fixation, because fractures vary from simple to complex, with little or extensive articular involvement. Hence, recognition and comprehension of the fracture features will help orthopedic surgeons understand the injury mechanism better and manage these fractures by planning optimal surgical procedures. This study aimed to evaluate the morphological characteristics of tibial plateau fractures based on the Schatzker classification.MethodsA total of 186 patients with 188 tibial plateau fractures from 2010 to 2014 in our hospital were reviewed using a computed tomography scan and three-dimensional (3D) reconstruction. The main fracture line angles (FLA) of Schatzker types I, II, and IV were measured. For each fracture, depression depth was measured, and the depression zone was also located. Depression zones were overlapped to obtain a frequency diagram.ResultsSchatzker type I and II fractures had three subtypes: single anterolateral fracture, single posterolateral fracture, and complex fracture (the anterolateral and posterolateral parts). Schatzker type IV fractures were also divided into three subtypes: single posteromedial fracture, single anteromedial fracture, and the whole medial fracture. For various Schatzker types and subtypes of fracture, fracture depression clustered and occurred at different locations of the tibial plateau. A significant difference was observed in the depression depth among the different Schatzker types (P < 0.01, Kruskal-Wallis test), especially between Schatzker type III and other types (Nemenyi test). There was no difference in the depression depth among the subtypes of Schatzker type II, whereas the difference was significant between the two subtypes of Schatzker type IV.ConclusionsSchatzker type I, II, and IV fractures could be divided into three corresponding subtypes by FLA. Various Schatzker types of fractures differed in location and depth of depression. A proper operative approach should be made based on the morphological characteristics of individual types of tibial plateau fractures.

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Section: Discussionmentioning

confidence: 99%

The morphological features of different Schatzker types of tibial plateau fractures: a three-dimensional computed tomography study

et al. 2016

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“…A debilitating outcome of ACL injury is severe knee instability, which can lead to osteoarthritis [15][16][17][18][19][20]. The ACL is usually surgically reconstructed to restore knee stability [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

The distinct prediction standards for radiological assessments associated with soft tissue injuries in the acute tibial plateau fracture

Wang

Wei

Wang

2015

Eur J Orthop Surg Traumatol

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The goal of this study was to assess the incidence of soft tissue injury in the tibial plateau fracture by magnetic resonance image (MRI) and reveal the relationship between the articular widening/depression and the risk of meniscus and ligament disorder. A total of 54 patients with tibial plateau fracture were indicated for operative intervention. Soft tissue injuries were assessed by MRI. Meniscus, anterior/posterior cruciate ligaments and medial/lateral collateral ligaments injuries on MRI were evaluated. The articular widening/depression was measured in picture archiving and communication systems. Schatzker classification of fracture types was not significantly associated with soft tissue injuries. The rates of soft tissue injury in types IV and II (respectively, 85.7 and 74.1 %) were higher than those in other types. The meniscus injury was the most common soft tissue damage, and the incidence of meniscus injury was 55.6 %. When LPDCT and LPWCT were, respectively, about 7.6 mm and 10.1 mm and LPDX-ray and LPWX-ray, respectively, 5.6 and 7.4 mm, more attention should be paid on the collateral and cruciate ligament injuries in types I, II and III. Furthermore, when LPWCT and LPWX-ray were, respectively, about 10.3 and 8.6 mm, the collateral and cruciate ligaments were susceptible to injury in types IV and V. In conclusion, tibial plateau fracture can occur high morbidity of soft tissue injury, including meniscus and ligament disorder. X-ray and CT scan had different predicting standards for soft tissue injury, and the articular widening/depression in the tibial plateau was associated with meniscus and ligament injuries.

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“…We observed an increasing number of papers discussing how to management complex tibial plateau fractures in the past 10 years. In the literature, several descriptions of double and single approaches to the proximal tibia are published in supine position [7][8][9][10][11]. We found these papers had great disadvantages to treat complex TPFs with PL corner injury.…”

Section: Discussionmentioning

confidence: 99%

A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury

Tarng

Lin

2019

Injury

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a b s t r a c tIntroduction: Updated three column fixation of tibial plateau fractures (TPFs) arouse the importance of posterior column articular reduction. Complex TPFs with posterolateral (PL) articular injury is difficult to manage. We presented a strategy of combined positions and approaches to treat these injuries. Surgical technique was described and outcome of these were reported. Materials and Methods: From 2014 Jan to 2016 Dec, there were 132 patients of TPFs treated in our institute. Preoperative evaluation included plain films and 2D/3D CT scan to evaluate the involvement of articular surface and associated columns. Inclusion criteria were three column TPFs with PL corner injury. We put patients in prone position first with reverse L incision to manage PL articular impaction and posteromedial (PM) fractures. Then we repositioned the patients in supine to treat anterolateral fixation. Postoperative radiographic analysis, physical examination findings, and patient reported outcome scores from the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire were recorded. Results: Patient demographic information was retrospectively reviewed with a mean follow-up time of 34.4 months (range 24-48 months). The average time to union was 5.2 months (range 4-8months). 13/16 (81%) of patients had satisfactory articular reduction by plain films (less than 2 mm articular step off). All patients demonstrated healed without secondary displacement or infection. All patients demonstrated satisfactory coronal (medial proximal tibia angle 84.68 degrees) and sagittal alignment (posterior proximal tibia angle 84.75 degrees). Condylar width averaged 3.93 mm. 3/16 (19%) of cases required posterolateral columnar plating in addition to posteromedial columnar plating. The knee range of motion averaged 115 degrees (ranged from 0 degrees of extension to140 degrees flexion). The average KOOS score was 83/100 (range 76-90). 3 patients in the series developed a surgical site superficial infection and resolved after debridement and oral antibiotics use. No patient eventually received total knee arthroplasty at the last follow up. Conclusions: Our strategy provides an effective method to treat three column tibial plateau fractures with PL articular injury.

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Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment

Cited by 33 publications

References 16 publications

The morphological features of different Schatzker types of tibial plateau fractures: a three-dimensional computed tomography study

The morphological features of different Schatzker types of tibial plateau fractures: a three-dimensional computed tomography study

The distinct prediction standards for radiological assessments associated with soft tissue injuries in the acute tibial plateau fracture

A combined prone and supine approaches for complex three column tibial plateau fracture with posterolateral articular injury

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